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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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  • Profile and Analysis of the 26 Medicare Advantage Regions

    Issue Brief

    This issue brief examines the 26 new Medicare Advantage PPO regions and their implications for beneficiaries. The paper describes the characteristics of the new Medicare Advantage regions and the extent to which Medicare Advantage plans are already available in each region. It highlights the substantial gap between the current availability of Medicare Advantage health plans, including Medicare HMOs, PPOs and private fee-for-service plans, throughout the country and that intended for 2006. Issue Brief (.pdf)

  • The Effects of Formularies and Other Cost Management Tools on Access to Medications:  An Analysis of the MMA and the Final Rule

    Issue Brief

    This report examines the formulary and cost management provisions of the final Medicare regulations implementing the new Medicare Part D drug benefit that was passed as part of the Medicare Modernization Act of 2003, and their implications for people with Medicare who enroll in new drug plans and their access to medications. It was prepared for the Foundation by Jack Hoadley, Ph.D., of the Health Policy Institute at Georgetown University. Issue Brief (.pdf)

  • Cost Containment Strategies For Prescription Drugs: Assessing The Evidence In The Literature

    Report

    This report describes and reviews various options to address prescription drug spending growth, including a description of each cost-containment strategy, its use by private or public payers, and a discussion of known evidence about its effectiveness or cost-saving potential. It was prepared for the Kaiser Family Foundation by Jack Hoadley, Ph.D., of the Health Policy Institute at Georgetown University. Report (.pdf)

  • Policy Workshop on Formularies and Medicare

    Event Date:
    Event

    The Kaiser Family Foundation hosted a March 14, 2005 policy workshop on the use of drug formularies in the private sector and their potential implications for beneficiaries under the new Medicare drug benefit, set to go into effect January 1, 2006. The workshop involved an expert panel, including perspectives from a health plan, a pharmacy benefits manager, a physician, the Centers for Medicare & Medicaid Services and policy experts. Agenda (.pdf) Presentation (.pdf) Speaker Biographies…

  • The President’s FY 2006 Budget Proposal:

    Report

    Overview and Briefing Charts This chartpack reviews the President’s FY 2006 budget request to Congress and highlights overall budget assumptions and funding for major health programs. It begins with a description of the federal budget process, followed by an overview of federal surplus/deficit spending patterns dating back to 1969. It then turns to summary information on the overall composition of the Administration’s budget, followed by the President’s proposed funding for some of the major programs…

  • Summary of Final Regulations Implementing the New Medicare Prescription Drug Benefit

    Issue Brief

    This document summarizes the final regulations to implement the new Medicare prescription drug benefit. The regulations were published by the Centers for Medicare and Medicaid Services (CMS) as a final rule in the Jan. 28 Federal Register. It provides an overview that allows interested parties to obtain information about specific provisions of the law. The summary was prepared by Health Policy Alternatives Inc. on behalf of the Kaiser Family Foundation. Issue Brief (.pdf)

  • Navigating Medicare and Medicaid, 2005: A Resource Guide for People with Disabilities, Their Families, and Their Advocates

    Report

    This guide explains the critical role Medicare and Medicaid have come to play in the lives and the futures of roughly 20 million children, adults, and seniors with disabilities - and gives people with disabilities new information to help them get the most from these programs. Full PDF Report (.pdf) Section 1: Introduction HTML PDF Section 2: Medicare HTML PDF Section 3: Medicaid HTML PDF Section 4: Interaction Between Medicare and Medicaid HTML PDF

  • Navigating Medicare and Medicaid: A Resource Guide for People with Disabilities, Their Families, and Their Advocates

    Report

    Navigating Medicare and Medicaid: Resource Guides for People with Disabilities, Their Families, and Their Advocates These guides explain the critical role Medicare and Medicaid have come to play in the lives and the futures of roughly 20 million children, adults, and seniors with disabilities - and give people with disabilities new information to help them get the most from these programs. Navigating Medicare and Medicaid, 2005 Keeping Medicare and Medicaid When You Work, 2005

  • Keeping Medicare and Medicaid When You Work, 2005: A Resource Guide for People with Disabilities, Their Families, and Their Advocates

    Report

    This guide helps to explain the program rules for Medicare and Medicaid with regard to work. Medicare and Medicaid have come to play important roles in the lives and the futures of roughly 20 million children, adults, and seniors with disabilities - and this guide gives people with disabilities new information to help them get the most from these programs. Full PDF Report Section 1: Protecting Health Coverage For People With Disabilities Who Work HTML…