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Medicare Part D

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

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.

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. 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-Medicaid Policy Interactions

    Issue Brief

    Because over seven million elderly and disabled individuals are entitled to benefits under both Medicare and Medicaid, policy changes in one program not only affect both coverage and spending in the other but also impact access to services by individuals eligible for both programs. This primer summarizes two key policy interactions and includes a quick reference table of the most significant linkages between the two programs. Issue Brief (.pdf)

  • The Transition of Dual Eligibles to Medicare Part D Prescription Drug Coverage: State Actions During Implementation

    Report

    This 50-state survey of Medicaid officials assesses states’ early experience relating to the transition of low-income seniors and people with disabilities enrolled in both Medicaid and Medicare (dual eligibles) to the Medicare Part D drug benefit. Conducted by Health Management Associates, the survey covers the types of problems observed by states during the transition of dual eligibles to the Medicare drug benefit, state actions to correct problems and ensure temporary coverage, and specific data on…

  • Tracking Prescription Drug Coverage Under Medicare:  Five Ways to Look at the New Enrollment Numbers

    Issue Brief

    Tracking Prescription Drug Coverage Under Medicare: Five Ways to Look at the New Enrollment Numbers This new analysis, which assesses Medicare drug benefit enrollment statistics released Feb. 22 by the U.S. Department of Health and Human Services, examines five different approaches to understanding the Medicare drug coverage numbers: What share of the total Medicare population has creditable prescription drug coverage? What share of the total Medicare population is enrolled in a Medicare drug plan? How…

  • Toplines: December 2005 Kaiser Health Poll Report

    Poll Finding

    Toplines: December 2005 Kaiser Health Poll Report These toplines provide the complete survey questions and responses to the December 2005 Kaiser Health Poll Report Survey, a bimonthly survey designed to provide key tracking information on public opinion about health care topics. The survey includes a series of questions on seniors' views of the new Medicare prescription drug benefit. Survey Toplines (.pdf)

  • Kaiser Health Poll Report Survey – Selected Findings on Seniors’ Views of the Medicare Prescription Drug Benefit

    Poll Finding

    Kaiser Health Poll Report Survey – Selected Findings on Seniors' Views of the Medicare Prescription Drug Benefit This February 2006 Kaiser Family Foundation tracking poll finds that 45% of seniors say they have enrolled or plan to enroll in a drug plan, 29% say they do not intend to enroll in a drug plan and another 23% say they are uncertain. The majority of those who do not plan to enroll say they have another…

  • Resources on Dual Eligibles and Issues Related to Their Transition to the New Medicare Drug Benefit

    Event Date:
    Event

    With the new Medicare prescription drug benefit available as of January 1, 2006, over 6 million low-income seniors and people with disabilities who are enrolled in both Medicaid and Medicare—also known as dual eligibles—have been transitioned from Medicaid drug coverage to new Medicare drug plans. While there are many policy issues related to the overall establishment of the new drug benefit, the mandatory transition of dual eligibles has created a special set of challenges for…

  • An Implementation Perspective on Part D, the Medicare Prescription Drug Program

    Report

    This focus group of 12 state Medicaid officials conducted in November 2005 explores the current status and likely results of the Part D dual eligible transition efforts as well as other Part D-related issues of particular importance to states. It includes discussion of the transition of dual eligibles from Medicaid to Medicare drug coverage, evaluating Part D plan options, states’ role in the low-income subsidy program, the fiscal implications of Part D to states, and…

  • Insights on Transitioning From Medicaid to the New Medicare Prescription Drug Benefit

    Report

    The Kaiser Commission on Medicaid and the Uninsured convened a focus group of state Medicaid officials in November 2005 to discuss the impact of the new Medicare drug program on states and Medicaid enrollees. State insights on the transition of dual eligibles and some beneficiary experiences are discussed in new material and an audio briefing. Podcast: December 19, 2005 Conference Call Briefing (Downloadable Audio File) Presentations from the December 19, 2005 Conference Call Briefing (.pdf)…