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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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  • e-Health and the Elderly: How Seniors Use the Internet for Health

    Poll Finding

    A national Kaiser Family Foundation survey of older Americans found that as the Internet becomes an increasingly important resource for informing decisions about health and health care options, less than a third (31%) of seniors (age 65 and older) have ever gone online, but that more than two-thirds (70%) of the next generation of seniors (50-64 year-olds) have done so. The differences among seniors and 50-64 year-olds are striking and indicate that online resources for…

  • The Distributional Consequences of  Medicare Premium Support Proposal

    Other Post

    The Distributional Consequences of a Medicare Premium Support Proposal This article analyzes the expected distributional impact of enacting a premium support proposal for Medicare based on legislation introduced by Sen. Breaux and Sen. Frist in 1999. This legislation suggested that the Federal Employees Health Benefits plan be used as a model for Medicare. The article simulates impacts in three areas: among beneficiaries who choose to retain fee-for-service coverage, between different geographic areas, and according to…

  • Current Trends and Future Outlook for Retiree Health Benefits:  Findings from the Kaiser/Hewitt 2004 Survey on Retiree Health Benefits

    Other Post

    Current Trends and Future Outlook for Retiree Health Benefits: Findings from the Kaiser/Hewitt 2004 Survey on Retiree Health Benefits A new survey of large employers finds businesses and retirees experienced double-digit increase in retiree health costs, with further increases expected in 2005. The survey also includes an early look at employers' responses to the new Medicare drug law. News Release Report - Interactive online version and downloadable chapters Chartpack Materials From the December 14, 2004…

  • Summary of the Proposed Rule to Implement the New Medicare Prescription Drug Benefit

    Issue Brief

    In August 2004, the Centers for Medicare and Medicaid Services published a proposed rule to implement the Medicare Prescription Drug Benefit (Title I of the Medicare Modernization Act). Given the high level of interest in the proposed rules for implementing the Medicare drug benefit, the Kaiser Family Foundation commissioned Health Policy Alternatives, Inc. to prepare this summary of the proposed regulations. Issue Brief (.pdf)

  • The Impact of Cost Sharing on Appropriate Utilization and Health Status: A Review of the Literature on Seniors

    Other Post

    The Impact of Cost-Sharing on Appropriate Utilization and Health Status: A Review of the Literature on Seniors This article provides a review of research that has addressed the impact of patient cost-sharing on the use of health care services and subsequent health status for those ages 65 and older. Twenty-two studies are reviewed -- 16 focusing on cost-sharing for prescription drugs and 6 on cost-sharing for medical services. The article concludes that most studies examined…

  • Prescription Drug Spending Under The MMA: Modeling The Impact On Out-of-Pocket Costs

    Event Date:
    Event

    This report projects the impact of the new Medicare drug benefit on out-of-pocket spending for people who enroll in 2006. The analysis is based on a model developed by the Actuarial Research Corporation for the Kaiser Family Foundation. The model generally conforms to the Congressional Budget Office’s assumptions and projections about Medicare drug benefit spending and participation rates for the new benefit and for the low-income subsidy. The report was released at a briefing in…

  • Estimates of Medicare Beneficiaries’ Out-of-Pocket Drug Spending in 2006

    Report

    This report projects the impact of the new Medicare drug benefit on out-of-pocket spending for people who enroll in 2006. This analysis from November 2004 estimates that 6.9 million beneficiaries are projected to be affected by the coverage gap (the so-called "doughnut hole") in the standard Part D drug benefit. This estimate is based on projected enrollment in Part D plans of 29 million (Congressional Budget Office, July 2004), prior to implementation of the drug…

  • Health Care and the 2004 Elections: Medical Liability Reform

    Issue Brief

    Medical Liability Reform   Download a printable .pdf of Health Care and the 2004 Elections: Medical Liability Reform. IssueBackgroundOptions for Assuring Access to Affordable Liability CoverageAssessing Candidate PositionsIssue Sharp increases in medical liability insurance premiums in recent years, and the withdrawal of some insurers from this market have focused the attention of health care providers, patients, and policymakers on reform of the medical liability system. Of additional concern is that the fear of liability causes…

  • Health Care and the 2004 Elections: Health Care for Americans with Disabilities

    Issue Brief

    Health Care for Americans with Disabilities Download a printable .pdf of Health Care and the 2004 Elections: Health Care for Americans with Disabilities. IssueBackgroundHealth CoveragePrescription Drugs Under Public ProgramsCoverage of Long-Term Services and SupportsFinancing Medicaid and MedicareAssessing Candidate Positions Issue More than 50 million individuals, or roughly one in five Americans, have a disability. Diverse in health-care needs, levels of functioning, goals, and life circumstances, many count on Medicaid and Medicare to provide coverage for…