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How Medicare Advantage Rebates Disadvantage Medicare’s Stand-Alone Drug Plan Market

Rebates that reduce Part D premiums for Medicare Advantage plans with drug coverage make it harder for stand-alone prescription drug plans (PDPs) to compete. That may contribute to instability in the PDP market relied on by people in traditional Medicare. The number of Part D stand-alone Rx drug plan options for the avg Medicare beneficiary has fallen by half in recent years, while Medicare Advantage drug plan options have risen.

Also: Medicare Part D Enrollment, Premiums, and Cost Sharing in 2026

Analyzing Changes in Medicare Part D Enrollment for 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

NEW AND NOTEWORTHY

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 in 2026: Enrollment Update and Key Trends

More than half (55%) of eligible Medicare beneficiaries are enrolled in Medicare Advantage in 2026, continuing a decades-long shift toward private plans. Special Needs Plans have driven recent growth, with nearly 1 in 4 enrollees now in such plans.
To better understand trends in the growth of the Medicare Advantage program, this brief provides current information about enrollment, including by plan type and firm.

See Also: Medicare Advantage in 2026: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization

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

Medicare Advantage Out-of-Pocket Limits: Variation & Trends

Prescription Drugs

What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid and the Medicare GLP-1 Bridge

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.

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

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. Explore 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.

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  • Many Medicare Beneficiaries Face High Out-of-Pocket Costs for Dental and Hearing Care, Whether in Traditional Medicare or Medicare Advantage

    News Release

    Many Medicare beneficiaries face high annual out-of-pocket costs for dental and hearing care -- services that generally aren’t covered in traditional Medicare, but typically are covered by Medicare Advantage plans though the scope and value of these benefits vary, finds a new KFF analysis. The analysis shows that, among beneficiaries who used each type of service, average annual out-of-pocket spending was $914 for hearing care and $874 for dental care in 2018, but considerably less…

  • FDA’s Approval of Biogen’s New Alzheimer’s Drug Has Huge Cost Implications for Medicare and Beneficiaries

    Issue Brief

    The question of what would happen when a new, expensive prescription drug comes to market for a disease like Alzheimer’s that afflicts millions of people has loomed large in discussions over drug prices in the U.S. This brief analyzes the cost implications for Medicare and beneficiaries associated with Biogen's new FDA-approved Alzheimer's drug, which will cost $56,000 per year.

  • Although Their Share of the Market Varies By State, Enrollment in Medicare Advantage Plans Has More Than Doubled Over the Past Decade, with More than 4 in 10 Medicare Beneficiaries Now Enrolled in the Private Plans

    News Release

    The private plans known as Medicare Advantage now cover more than 4 in 10 Medicare beneficiaries, reflecting a more than doubling of enrollment over the past decade even as the plans remain a far larger presence in some states than others, according to a new KFF analysis. More than 26 million of the nation’s nearly 63 million Medicare beneficiaries are enrolled in Medicare Advantage plans in 2021. The share varies considerably by state, ranging from…

  • Cost-Related Problems Are Less Common Among Beneficiaries in Traditional Medicare Than in Medicare Advantage, Mainly Due to Supplemental Coverage

    Issue Brief

    This analysis examines health care cost-related problems among Medicare beneficiaries, comparing beneficiaries in traditional Medicare, including those with and without supplemental coverage, to those in Medicare Advantage, with a focus on racial equity. We compare rates of cost-related problems among White, Black, and Hispanic beneficiaries, those in fair or poor health, and those under age 65 with long-term disabilities. The measure of cost-related problems include problems getting care due to cost, delays seeking care due…

  • Millions of Medicare Part D Enrollees Have Had Out-of-Pocket Drug Costs High Enough to Exceed the Catastrophic Threshold Over Time

    News Release

    Nearly 3 million Medicare Part D enrollees had out-of-pocket drug spending above the catastrophic threshold in a recent five-year period, finds a new KFF analysis that takes a comprehensive look at how many people on Medicare have drug expenses high enough to push them above that limit. While the Part D drug benefit has helped make drugs more affordable for people with Medicare, the lack of a hard cap on annual out-of-pocket spending under Part…

  • Who Didn’t Get a Second Shingrix Shot? Implications for Multidose COVID-19 Vaccines

    Issue Brief

    As the U.S. prepares for nationwide distribution of vaccines to combat COVID-19, some are asking whether people who get the first of two doses will return to complete the series. This analysis draws on Medicare Part D prescription drug claims data for the herpes zoster vaccine Shingrix, which also requires two doses, to shed light on this potential challenge of the leading COVID-19 vaccine candidates.

  • Resources for Medicare & Medicaid’s 50th Anniversary

    News Release

    On July 30, 1965, President Lyndon Johnson signed the law creating the Medicare and Medicaid programs.  As the programs' 50th anniversary nears, the Kaiser Family Foundation offers several resources that look at the programs' past and future, including videos that are available to share at in-person events or with online communities: Six new articles authored by Foundation staff and published in the journal Generations reflecting on Medicare’s history, evolution and future, the Medicare and Medicaid…

  • Allowing Medicare to Negotiate Drug Prices Is A Popular Idea But May Not Produce Substantial Savings

    News Release

    In response to rising drug costs, some policymakers and presidential candidates, including Republican Donald Trump and Democrats Hillary Clinton and Bernie Sanders, have proposed allowing Medicare to negotiate directly with pharmaceutical companies over the price of prescription drugs, in contrast to the current approach under Medicare Part D drug where private plans do the negotiating.  A version of this proposal was also included in the Obama Administration’s FY 2016 and FY 2017 budgets. While the…

  • Medicare-for-All vs. Single Payer: The Impact of Labels

    From Drew Altman

    In this column for The Wall Street Journal’s Think Tank, "Medicare-for-All vs. Single Payer: The Impact of Labels", Drew Altman uses new polling on a Medicare-for-all or single payer health system to explain how what you call a health reform plan can substantially affect the public's response.

  • Medicare-for-All vs. Single Payer: The Impact of Labels

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, “Medicare-for-All vs. Single Payer: The Impact of Labels”, Drew Altman uses new polling on a Medicare-for-all or single payer health system to explain how what you call a health reform plan can substantially affect the public’s response. All previous Drew Altman columns are online.