Medicare

Medicare Open Enrollment

More Than 4 Million Medicare Beneficiaries Will Have Their Medicare Advantage or Stand-Alone Rx Drug Plan Terminated at the End of 2026

Data from the Centers for Medicare & Medicaid Services (CMS) shows that 4.3 million Medicare beneficiaries, including 3.1 million Medicare Advantage drug plan enrollees and 1.2 million PDP enrollees, will have their plan terminated at the end of 2026. An additional 1.4 million Medicare Advantage enrollees are in a plan that is consolidating with another plan offered by the same insurer.

Medicare Open Enrollment and Coverage Options: Key Questions and Answers

Each year, Medicare beneficiaries have an opportunity to make changes to how they receive their Medicare coverage during the nearly 8-week annual open enrollment period, which runs from October 15 through December 7. This brief answers key questions about the Medicare open enrollment period and Medicare coverage options.

NEW AND NOTEWORTHY

How Much Do People With Medicare Pay For Coverage?

This brief provides an overview of the costs faced by Medicare beneficiaries in traditional Medicare, Medicare Advantage, and Medicare Part D, including premiums, deductibles, copays, and coinsurance, focusing on costs in 2026.

What’s in a Name? From Today’s Medicare to Medicare for All

KFF’s Larry Levitt explains how proposals to create Medicare-for-All promise more generous benefits than the existing Medicare program, with no premiums or cost-sharing, but could end up looking more like Medicare if it became the subject of a serious national debate about the tradeoffs involved to implement it.

Medigap

Medigap Guaranteed Issue Requirements: An Overview of Federal and State Rules

This issue brief analyzes federal and state rules related to guaranteed issue requirements for Medigap policies and how they impact beneficiaries’ access to Medigap, including the implications for Medicare beneficiaries with pre-existing medical conditions and those under age 65 with long-term disabilities.

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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  • Analyzing Changes in Medicare Part D Enrollment for 2026

    Issue Brief

    The Medicare Part D prescription drug benefit is provided by private plans, either Medicare Advantage plans that offer drug coverage (MA-PDs) or, for those in traditional Medicare, stand-alone prescription drug plans (PDPs). New data from CMS shows that 56 million people are enrolled in Part D plans as of February 2026, with more in MA-PDs than PDPs, reflecting higher overall enrollment in Medicare Advantage than in traditional Medicare. Enrollment in group MA-PD plans decreased while…

  • Health Insurer Financial Performance in 2024

    Issue Brief

    This analysis of trends in health insurers’ financial data shows that insurers’ gross margins per enrollee dipped slightly in 2024 across four markets, remaining highest in the Medicare Advantage market, followed by the individual (non-group) market, the fully insured group (employer) market, and Medicaid managed care. The analysis also examines insurers’ medical-loss ratios across the four markets.

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

    Issue Brief

    The Medicare drug price negotiation program could improve coverage of drugs selected for negotiation for Medicare beneficiaries because the law requires all Medicare Part D plans to cover each of the selected drugs, including all dosages and forms, when negotiated prices take effect. This analysis examines 2026 Medicare Part D formulary coverage of drugs selected for negotiation to measure the effect of the IRA's coverage requirement.

  • Examining the Potential Impact of Medicare’s New WISeR Model

    Issue Brief

    On January 1, 2026, the Center for Medicare & Medicaid Innovation (CMMI) launched the Wasteful and Inappropriate Service Reduction (WISeR) Model that establishes new prior authorization requirements in traditional Medicare. This analysis explores the potential impact of the WISeR model by examining recent spending and utilization trends in traditional Medicare for services selected for prior authorization requirements in the six model states (Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington).

  • Recent Trends in GLP-1 Use and Spending in Medicare

    Issue Brief

    Ahead of the Trump administration’s planned expansion of Medicare coverage for GLP-1s to treat obesity through temporary models and the availability of Medicare’s negotiated price for certain GLP-1 products beginning in 2027, this analysis examines CMS’s Medicare Part D claims data from 2019 to 2024 to document the increase in the number of beneficiaries being treated with GLP-1 drugs and the growth in Medicare spending and claims for these drugs.

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

    Issue Brief

    Nearly 53 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of Medicare Advantage enrollees in 2024, of which 4.1 million (7.7%) were denied. Just 11.5% of denied requests were appealed, though 80.7% of appeals overturned the initial denial in Medicare Advantage. Substantially fewer prior authorization requests were made in traditional Medicare, reflecting the small number of services subject to prior authorization requirements.