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Prescription Drugs

People with Medicare Will Face Higher Costs for Some Orphan Drugs Due to Changes in the Tax and Budget Law

A provision in the 2025 tax and budget law that will expand the exclusion of orphan drugs from Medicare’s drug price negotiation program could lead to at least $5 billion in additional Medicare spending over time, as well as higher out-of-pocket costs for beneficiaries who use these medications.

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

New & Noteworthy

Health Provisions in the 2025 Federal Budget Reconciliation Law

On July 4, President Trump signed the budget reconciliation bill, previously known as the “One Big Beautiful Bill Act,” into law. This summary provides background, description, budgetary impact and related information on the health care provisions of the law in four categories: Medicaid, the Affordable Care Act, Medicare and Health Savings Accounts (HSAs).

Income and Assets of Medicare Beneficiaries in 2024

This brief examines the income, assets, and home equity of Medicare beneficiaries, overall and by age, race and ethnicity, and gender. Most Medicare beneficiaries live on relatively low incomes and have modest financial resources to draw upon if they need costly care or long-term services and supports.

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 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

A Closer Look at the Growing Role of Special Needs Plans in Medicare Advantage

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

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

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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  • Pieces of the Puzzle

    Report

    A new report describes the Report to Congress by the Department of Health and Human Services on consumer protection and quality assurance requirements for Medicaid managed care and discusses the differences between the original Federal rule and the revised one.

  • Prescription Drug Coverage for Medicare Beneficiaries: A Side-by-Side Comparison

    Other Post

    This document, prepared by Health Policy Alternatives, Inc., provides a side-by-side comparison of five major federal proposals under consideration to provide outpatient prescription drug coverage to Medicare beneficiaries. It includes both a summary and a detailed comparison of the following major proposals: S. 357, The Medicare Preservation and Improvement Act of 2001 (Breaux/Frist I), S.

  • Medicare and Prescription Drug Focus Groups

    Report

    Summary Report This report, : Summary Report, produced jointly by the bipartisan team of Bill McInturff of Public Opinion Strategies and Geoff Garin of Peter D. Hart Research Associates, presents key findings from a series of eight focus groups on the Medicare program and the current debate over prescription drug coverage and Medicare reform.

  • Key Facts: Women and Medicare

    Report

    Medicare is a critical source of health insurance coverage for virtually all older women in the U.S. and for many younger women who have permanent disabilities. Today, 22 million women one in five adult women rely on Medicare for basic health insurance protection. In fact, women comprise 57% of the Medicare population.

  • Women and Medicare:  Making the Connection

    Other Post

    Women and Medicare: Making the Connection This briefing examines Medicare s role in meeting older women's health needs, the gaps in Medicare's benefits package for women, and the emerging debate over prescription drug coverage and Medicare reform.

  • Women and Medicare

    Fact Sheet

    Medicare is a critical source of health insurance coverage for virtually all older women in the U.S. and for many younger women who have permanent disabilities. Because women have longer life expectancies than men, more than half (57%) of the people covered by the program are women.

  • Federal Budget Chartbook 2001

    Report

    A new chart book examines Fiscal Year 2002 budget proposals by President Bush and Congress, focusing on their impact on health programs. It provides both an examination of how health care programs fit into the overall U.S. budget and a review of past budget trends and future projections for government health care programs.

  • Targeting Medicare Drug Benefits: Costs and Issues

    Report

    This report, written by Marilyn Moon and Matthew Storeygard of the Urban Institute, estimates the potential cost of targeting drug benefits to low-income Medicare beneficiaries and those with catastrophic drug expenses and discusses some of the key programmatic issues that could arise under this approach.

  • Medicaid’s Disabled Population and Managed Care

    Fact Sheet

    Medicaid's Disabled Population and Managed Care This fact sheet highlights the key facts about the Medicaid managed care programs that serve persons with disabilities. It describes the Medicaid disabled population and the role managed care plays in serving them.