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Quick Take: CMS Extends Medicare’s Short-Term Bridge Program for GLP-1 Obesity Drug Coverage

CMS's temporary program to cover GLP-1 drugs for obesity in Medicare, called the BALANCE model, will not launch as scheduled on January 1, 2027. Instead, CMS is extending the Medicare GLP-1 Bridge, a separate short-term program that was to run from July to December 2026. It will now run through the end of 2027.
Also: What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid

Key Facts About Medicare Drug Price Negotiation

Recent Trends in GLP-1 Use and Spending in Medicare

What to Know About Pharmacy Benefit Managers (PBMs) and Federal Efforts at Regulation

The IRA Has Improved Coverage of Drugs Selected for Medicare Price Negotiation

NEW AND NOTEWORTHY

What to Know About Medicare Coverage of Telehealth

Congress has repeatedly extended pandemic-era flexibilities around Medicare coverage of telehealth, but most such flexibilities remain temporary. This brief answers key questions about the current scope of Medicare telehealth coverage, including both temporary and permanent changes adopted through legislation and regulation, and future policy considerations.

Changes to the Medicare Advantage Program Enhance Some Consumer Protections But Roll Back Others

CMS recently finalized policies as part of the 2027 Medicare Advantage final rule that both enhance consumer protections and roll back changes to the Medicare Advantage program that were intended to protect consumers. These changes have gotten less attention than payment issues and changes to the star ratings system, which also affect plan payments, but could have implications for Medicare beneficiaries.

Examining the Potential Impact of Medicare’s New WISeR Model

A federal initiative to establish new prior authorization requirements in traditional Medicare, called the Wasteful and Inappropriate Service Reduction (WISeR) model, is likely to have only modest impact in its first year.

State Profiles for Dual-Eligible Individuals

This data collection draws on Medicare and Medicaid administrative data to present national and state-level information on people who are covered by both Medicare and Medicaid, referred to as dual-eligible individuals (also known as dually-enrolled beneficiaries).

Medicare Advantage

Medicare Advantage Enrollment Grew by About 1 Million People, Mainly Due to Special Needs Plans

Medicare Advantage enrollment rose to 35.1 million people as of Feb. 1, an increase of 1.1 million since February 2025. The 3% uptick belied Medicare Advantage insurers’ projections that overall enrollment would decline compared to 2025. It was the lowest annual percentage increase in two decades.
The latest increase was largely driven by rising enrollment in Medicare Advantage Special Needs Plans (SNPs), which accounted for 83% of enrollment gains in 2026. However, three of the five largest Medicare Advantage insurers, including market leader UnitedHealth Group, Inc., experienced overall Medicare Advantage enrollment declines.

How Medicare Pays Medicare Advantage Plans: Issues and Policy Options

Medicare Advantage Enrollees Have Access to About Half of the Physicians Available to Traditional Medicare Beneficiaries

Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024

Most Medicare Beneficiaries Affected by Plan Terminations in 2025 Have Robust Medicare Advantage Options in 2026

Medicare Part D

Analyzing Changes in Medicare Part D Enrollment for 2026

Analysis of CMS data shows that 56.1 million people have Medicare Part D drug coverage as of Feb. 2026, with 56% of enrollees in Medicare Advantage plans with drug coverage (MA-PDs) and 44% in stand-alone prescription drug plans (PDPs.)PDP enrollment increased, mainly due to the rise in enrollment in group employer/union plans for retirees.

Between 2025 and 2026, enrollment in group Medicare Advantage drug plans dropped for the first time since 2010, while group PDP enrollment rose by the largest amount Since 2013.

Premiums Are Decreasing for Many Stand-Alone Part D Drug Plans in a Number of States in 2026

Stand-Alone Drug Plans Cover a Larger Share of Part D Enrollees Living in the Most Rural Areas Than Medicare Advantage Plans

A Current Snapshot of the Medicare Part D Prescription Drug Benefit

Changes to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act and How Enrollees Will Benefit

Data Visualization

The Facts About Medicare Spending

This interactive provides the facts on Medicare spending. Medicare, which serves 67 million people and accounts for 12 percent of the federal budget and 21 percent of national health spending, is often the focus of discussions about health expenditures, health care affordability and the sustainability of federal health programs. u003cbru003eu003cbru003eExplore data on enrollment growth, Medicare spending trends overall and per person, growth in Medicare spending relative to private insurance, spending on benefits and Medicare Advantage, Part A trust fund solvency challenges, and growth in out-of-pocket spending by beneficiaries.u003cbru003eu003cbru003eu003ca href=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022 data-type=u0022linku0022 data-id=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022u003eRelated:u003ca href=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022u003e FAQs on Medicare Financing and Trust Fund Solvencyu003c/au003eu003c/au003e

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Medicare Open Enrollment

Beneficiaries Have 32 Medicare Advantage Prescription Drug Plans Available, on Average, for 2026

The average Medicare beneficiary will be able to choose among 32 Medicare Advantage plans with prescription drug coverage for 2026, two fewer than in 2025. The number of MA-PD options has grown steadily since 2010, peaking in 2024 when the average Medicare beneficiary had 36 options. Open enrollment runs October 15 through December 7.

Also: Medicare Open Enrollment FAQs

Premiums Are Decreasing for Many Stand-Alone Drug Plans in a Number of States in 2026

A Current Snapshot of the Medicare Part D Prescription Drug Benefit

The Role of SHIPs in Helping People with Medicare Navigate Their Coverage

What to Know About the Medicare Open Enrollment Period and Medicare Coverage Options

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  • Private Fee-For-Service Plans In Medicare: Rapid Growth and Future Implications

    Event

    Kaiser Family Foundation Vice President Patricia Neuman, Ph.D., testified May 2007 before the House Ways and Means Subcommittee on Health on the rapid growth of private fee-for-service plans in the Medicare program and its implications for seniors and people with disabilities. Dr. Neuman is director of the Foundation's Medicare Policy Project. Testimony (.pdf)

  • Perspectives on Medicare Part D and Dual Eligibles: Key Informants’ Views From Three States

    Report

    In 2006, low-income individuals receiving health coverage through both the Medicaid and Medicare programs, “dual eligibles,” experienced a change in their prescription drug benefit when their Medicaid prescription coverage was replaced by the Medicare prescription drug program known as Medicare Part D. This study provides information on the ongoing successes and challenges that dual eligibles faced in the first eight months of Part D and how different state approaches may affect dual eligibles’ ability to…

  • The Impact of Part D on Dual Eligibles Who Spend-Down to Medicaid

    Issue Brief

    Individuals with incomes exceeding thresholds for regular Medicaid eligibility may qualify under state medically needy programs by spending down excess income on healthcare services. For the vulnerable population of Medicare beneficiaries who spend down to Medicaid, the Part D transition has added additional complexities that may result in disruptions in pharmacy coverage and add financial burdens. This paper explores the inter-relationship of Medicare prescription drug coverage and Medicaid spend-down for the medically needy. It describes…

  • Medicare Advantage Chartpack

    Report

    These charts highlight key data about the Medicare Advantage program, which has grown rapidly in terms of enrollment and number of plans since the enactment of the Medicare Modernization Act in 2003. The package includes a map showing Medicare Advantage penetration by state as well as key facts about private fee-for-service plans, which have contributed significantly to the recent growth of the Medicare Advantage program. Chartpack (.pdf)

  • Prescription Drug Sources Among Medicare Beneficiaries

    Report

    Note: Estimates are rounded to the nearest whole number, therefore do not sum to total. (1) Includes Veterans Administration, Indian Health Service, employer plans without retiree subsidies, employer plans for active workers, and state pharmaceutical assistance programs. (2) Includes employer/union, FEHB, and TRICARE coverage. (3) Approximately 0.5 million dual eligibles are enrolled in Medicare Advantage drug plans and are reported in this category. Source: HHS, January 30, 2007. Data as of January 16, 2007.

  • Medicare Payments and Beneficiary Costs for Prescription Drug Coverage

    Issue Brief

    This March 2007 issue brief, commissioned by the Kaiser Family Foundation, provides a basic introduction to the reimbursement system for private Medicare drug plans. It explains the system of plan bidding and payment, including the special provisions for low-income enrollees, and considers how aspects of the payment system may affect the total cost of the drug benefit over time, the cost of coverage for beneficiaries and the variety and quality of available plans. Mark Merlis…

  • Medicare Consumer-Directed Health Plan: Medicare MSAs and HSA-like Plans in 2007

    Issue Brief

    Medicare Consumer-Directed Health Plan: Medicare MSAs and HSA-like Plans in 2007 This March 2007 issue brief, commissioned by the Kaiser Family Foundation, examines the development of consumer-directed health plans in the Medicare program. Medicare Medical Savings Account plans have high deductibles accompanied by a personal savings account that can be used to pay for medical expenses. The paper examines how such plans operate in Medicare, how they differ from other types of Medicare Advantage plans…

  • An Examination of Medicare Private Fee-for-Service Plans

    Issue Brief

    This March 2007 issue brief, commissioned by the Kaiser Family Foundation, provides insight Medicare private fee-for-service plans, the most rapidly growing type of Medicare Advantage plan. As of February 2007, these plans enrolled 1.3 million beneficiaries, up from just 209,000 in December 2005. The paper examines the history of these plans, their key features, trends related to their availability and enrollment and their implications for Medicare beneficiaries. Jonathan Blum, Ruth Brown and Miryam Frieder of…

  • The Basics of Medicare and Medicaid

    Issue Brief

    Together, Medicare and Medicaid provide health coverage to about 90 million Americans. To help explain the two programs, the Kaiser Family Foundation issued a new primer on the Medicare program and an updated version of its primer on the Medicaid program. Prepared by Kaiser staff, the primers provide an overview of the programs, who they serve, how the programs work and how they are financed. Medicare: A Primer Medicaid: A Primer

  • Private Plans In Medicare: A 2007 Update

    Issue Brief

    This March 2007 issue brief, commissioned by the Kaiser Family Foundation, examines changes between 2006 and 2007 in the availability of and enrollment in Medicare Advantage and Medicare prescription drug plans overall and in urban and rural areas. It also focuses on the firms that are offering various types of Medicare plans. Marsha Gold of Mathematica Policy Research, Inc., prepared the brief. Issue Brief (.pdf)