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Medicare Advantage in 2025: Enrollment Update and Key Trends

In 2025, more than half (54%) of eligible Medicare beneficiaries - 34.1 million out of about 62.8 million with both Medicare Parts A and B - are enrolled in Medicare Advantage plans. The Congressional Budget Office projects that the share will rise to 64% by 2034.

One in five (21%) Medicare Advantage enrollees is in a special needs plan (SNP), reflecting a steady increase in recent years. Overall, Medicare Advantage enrollment is highly concentrated among plans owned by a few firms.

Also: Medicare Advantage in 2025: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization

Medicare Advantage Enrollees Account for 25% of Inpatient Hospital Days

Most Medicare Advantage Markets are Dominated by One or Two Insurers

Medicare Advantage Quality Bonus Payments Will Total at Least $12.7 Billion in 2025

Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023

New & Noteworthy
Medicare PArt D

The Uncertain Future of Medicare's Stand-Alone PDP Market and Why It Matters

This brief discusses the uncertain future of Medicare’s Part D stand-alone prescription drug plan (PDP) market, in light of declining PDP availability, rising premiums, and the unknown fate of a temporary demonstration program designed to stabilize the market more broadly. The uncertain future of the market is especially relevant for rural areas, where nearly 6 in 10 beneficiaries are enrolled in traditional Medicare and PDPs, and where there are fewer Medicare Advantage options.

A Current Snapshot of the Medicare Part D Prescription Drug Benefit

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

Key Facts About Medicare Part D Enrollment, Premiums, and Cost Sharing in 2025

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

Prescription Drugs

The Effect of Delaying the Selection of Small Molecule Drugs for Medicare Drug Price Negotiation

Part of a recent executive order from President Trump directs the Secretary of HHS to work with Congress to implement a change in the Medicare Drug Price Negotiation Program to delay negotiation of so-called “small molecule” drugs beyond 7 years after FDA approval under current law. If that timeframe had already been in place, more than half of the Part D drugs that were selected for price negotiation in the first or second rounds – 13 out of 25 – would not have been eligible at the time drugs were selected.

FAQs About the IRA's Medicare Drug Price Negotiation Program

Allowing Medicare to Negotiate Drug Prices Is Broadly Popular

The Facts About the $35 Insulin Copay Cap in Medicare

Enrollees in Most Rural Areas Rely More on Stand-alone Part D Plans

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.

Related: FAQs on Medicare Financing and Trust Fund Solvency

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  • What’s in Store for Medicare’s Part B Premiums and Deductible in 2016, and Why?

    Issue Brief

    As a result of the recently-enacted Bipartisan Budget Act of 2015, the Medicare Part B monthly premium will be $121.80 in 2016 according to the Centers for Medicare and Medicaid Services, an increase of 16 percent over the 2015 amount for 30 percent of beneficiaries —far lower than the 52 percent increase initially projected by the Medicare actuaries. This Issue Brief reviews how Medicare Part B premiums and deductibles are affected by the recent budget deal (including the premium surcharge that covers the costs) and explains the connection between the Social Security cost-of-living adjustment (COLA), Medicare premiums, and the “hold harmless” provision that will keep premiums flat for 70 percent of beneficiaries in 2016.

  • What Paul Ryan’s Stance on 2016 Means for Health Care

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman discusses the implications of Paul Ryan’s decision to rule out being drafted as a Republican presidential candidate for the 2017 health care agenda and how it could focus greater attention on proposals to change Medicare and Medicaid along with the Affordable Care Act.

  • Visualizing Health Policy: Medicare Spending: A Look at Present, Short-Term and Long-Term Trends

    Other

    This Visualizing Health Policy infographic with the Journal of the American Medical Association (JAMA) provides an overview of Medicare spending trends in the present, short term and long term. In the long term, Medicare spending as a share of the economy is projected to grow, and Medicare is projected to lack sufficient funds to pay all hospital bills beginning in 2030.

  • Health Affairs Article: At Least Half of New Medicare Advantage Enrollees Had Switched From Traditional Medicare During 2006-11

    Issue Brief

    In an article in Health Affairs, researchers from the Kaiser Family Foundation counter the popular misperception that the steady rise in Medicare Advantage enrollment has been driven by members of the Baby Boom generation overwhelmingly choosing the private plans as they become eligible for Medicare. Their study examines the 2006-2011 growth in Medicare Advantage enrollment and finds that a majority of new enrollees in Medicare Advantage in each year were, in fact, seniors switching from traditional Medicare.

  • As Medicare’s Open Enrollment Nears, New Analyses Highlight Key Changes in Medicare Advantage and Part D Plans for 2015

    News Release

    With Medicare's 2015 open enrollment set to begin Oct. 15, two new analyses from the Kaiser Family Foundation find modest change in the total number of private Medicare Advantage plans available for 2015, and the fewest Part D prescription drug plans nationwide since the start of the drug benefit in 2006. As in previous years, changes in Medicare Advantage and Part D plan availability, premiums, cost-sharing and benefits could require some beneficiaries to find alternative coverage and lead others to pay more if they continue with their existing coverage.

  • Public Strongly Favors End-of-Life Conversations Between Doctors and Patients, With About Eight in 10 Saying Medicare and Other Insurers Should Cover These Visits

    News Release

    Six in 10 Oppose 'Cadillac Plan Tax' on High-Cost Health Plans Set to Take Effect in 2018, But Cost Savings Argument Can Change Some Opinions Views on the Affordable Care Act Remain Divided: 45% Unfavorable, 41% Favorable As the Centers for Medicare & Medicaid Services prepares to finalize a plan to pay physicians for discussing…