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CMS’s Decision to End Temporary Subsidies to Medicare’s Stand-Alone Drug Plans Could Mean Larger Premium Increases for Some Beneficiaries Next Year

The Centers for Medicare & Medicaid Services (CMS) plans to end the temporary Part D Premium Stabilization Demonstration after 2026. The goal of the demonstration, established in 2024, was to stabilize stand-alone prescription drug plan (PDP) premiums and enrollment amid the rollout of changes to the Part D benefit under the Inflation Reduction Act, including a new cap on annual out -of-pocket drug costs.

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

Nearly Four Million Medicare Beneficiaries Met the Eligibility Criteria in 2023 for the Medicare GLP-1 Bridge

NEW AND NOTEWORTHY

Decoding Medicare Advantage Coding Intensity

Federal payments to Medicare Advantage plans, and adjustments for health status, have come under increased scrutiny. This brief answers key questions about coding intensity, recent steps taken by CMS, the effects on beneficiaries, and other proposals to improve payment accuracy.

Medicare Advantage

Medicare Will Spend More Than $13 Billion on the Medicare Advantage Quality Bonus Program in 2026

A new KFF analysis finds that federal spending on the Medicare Advantage quality bonus program rose slightly to $13.4 billion in 2026, up from $12.7 billion the year before.

At the same time, the share of enrollees in plans that qualify for the higher payments declined to 68%, down from 75% in 2025 and the lowest share since 2018.

See Also: Medicare Advantage in 2026: Enrollment Update and Key Trends

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

Medicare Advantage Enrollees Have Access to Half of the Physicians Available to Traditional Medicare Beneficiaries

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

Medicare Advantage Insurers Deny Prior Authorization Requests for Post Acute Care at Higher Rates

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

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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  • Medicare Restructuring: The FEHBP Model

    Report

    This report provides a comprehensive description of the Federal Employees Health Benefits Program (FEHBP) and compares the FEHBP and Medicare programs as they are currently structured. It reviews evidence on the performance of FEHBP and examines the implications of restructuring Medicare to conform to a FEHBP-based plan. Overall, the report suggests that FEHBP offers some promise as an approach for reforming Medicare, but important issues would have to be addressed to adapt the model to…

  • Medicare Restructuring: The FEHBP Model A Summary

    Other Post

    Medicare Restructuring: The FEHBP Model Executive Summary Part 2 How Well Does FEHBP work? FEHBP has been somewhat more successful than Medicare in controlling costs. However, recent trends indicate that FEHBP's competitive structure alone cannot guarantee cost control over the long term. Until recently, FEHBP experienced slightly lower growth in spending per enrollee than Medicare. Over the period 1987 to 1997, Medicare spending per beneficiary grew at an annual rate of 8.1 percent. FEHBP spending…

  • Medicare’s Role for Latinos

    Fact Sheet

    Medicare's Role for Latinos Fact Sheet: The Medicare Program: Medicare's Role For Latinos

  • Medicare Part D Spotlight: Part D Plan Availability in 2011 and Key Changes Since 2006

    Report

    This initial analysis examines the private stand-alone Part D drug plans will be available to Medicare beneficiaries in 2011 and provides an early look at key trends in the options, premiums, and other plan characteristics. It finds that the average Medicare beneficiary will have a choice of 33 Part D stand-alone prescription drug plans in 2011, despite a 30 percent reduction in the total number of stand-alone plans available nationwide. Monthly premiums for stand-alone prescription…

  • Medicare Part D 2012 Data Spotlights

    Report

    The Kaiser Family Foundation has issued this collection of analyses related to the Medicare Part D stand-alone drug plan options available to seniors in 2012. These spotlights focuses on key aspects of the drug plan choices available and relevant trends since the Medicare drug benefit took effect in 2006. They were prepared by a team of researchers at Georgetown University, NORC at the University of Chicago and the Kaiser Family Foundation. Analysis Of Medicare Prescription…

  • 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…

  • Washington’s Managed FFS Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

    Issue Brief

    Washington is the first state to sign a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test a managed fee-for-service (FFS) financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid, beginning on April 1, 2013. Washington’s managed FFS demonstration uses Medicaid health home services to coordinate care for high risk/high cost dual eligible beneficiaries with chronic conditions. This policy brief summarizes key aspects of the…

  • Beneficiary Challenges in Using the Medicare Part D Appeals Process To Obtain Medically Necessary Drugs

    Issue Brief

    This paper describes the various steps of the Medicare Part D appeals process for obtaining necessary drugs not on a plan’s formulary. Using case reports collected from a network of beneficiary advocates, it illustrates the challenges and problems some beneficiaries encountered when navigating this aspect of the drug benefit. The paper concludes with a discussion of potential policy options including the implications of establishing an exceptions and appeals process that is uniform in paperwork and…

  • Oversight and Enforcement of Medicare Part D Plan Requirements:  Federal Role and Responsibilities

    Issue Brief

    Oversight and Enforcement of Medicare Part D Plan Requirements: Federal Role and Responsibilities This Issue Brief was commissioned by the Kaiser Family Foundation to gain insights into legal advocates’ views of how federal authorities enforce compliance with requirements of the new Medicare Part D prescription drug benefit. The report was prepared by Toby Edelman of the Center for Medicare Advocacy, Inc. The views expressed in this report are those of the author and not necessarily…

  • Implications of the New Medicare Law for Dual Eligibles:  10 Key Questions and Answers

    Issue Brief

    Implications of the New Medicare Law for Dual Eligibles: 10 Key Questions and Answers This publication is designed to provide a more detailed explanation of the change in drug coverage policy for dual eligibles under the new Medicare law, as well as explore its implications for the individuals affected by it. Issue Paper (.pdf)