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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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  • 2006 Kaiser/Hewitt Retiree Health Benefits Survey

    Report

    The 2006 Kaiser/Hewitt survey of large businesses that provide retiree health benefits to their workers assesses their evolving responses to the new Medicare drug benefit in 2006. It also looks at the rising costs and changing benefits of retiree health coverage overall in 2006, as well as the outlook for 2007 and beyond. The Kaiser/Hewitt study, the fifth joint survey since 2002, analyzes responses from a non-probability sample of 302 businesses with 1,000 or more…

  • An Examination of Medicare Private Fee-for-Service Plans

    Issue Brief

    This March 2007 issue brief, commissioned by the Kaiser Family Foundation, provides insight Medicare private fee-for-service plans, the most rapidly growing type of Medicare Advantage plan. As of February 2007, these plans enrolled 1.3 million beneficiaries, up from just 209,000 in December 2005. The paper examines the history of these plans, their key features, trends related to their availability and enrollment and their implications for Medicare beneficiaries. Jonathan Blum, Ruth Brown and Miryam Frieder of…

  • Article and Policy Forum Examine Medicare, Health Reform and the Challenges Facing People With Disabilities

    Event Date:
    Event

    Wednesday, Sept. 8, the Foundation held a policy workshop examining Medicare, health reform and the challenges facing people with disabilities. Younger Medicare beneficiaries with disabilities are much more likely than seniors in the program to report problems accessing and paying for needed medical services, Kaiser Family Foundation researchers report in this Health Affairs article. Based on a national random-sample survey of people on Medicare, the study finds that half of nonelderly disabled beneficiaries report problems…

  • The Nuts and Bolts of Medicare Premium Support Proposals

    Issue Brief

    In April 2011, as part of its 2012 budget resolution, the U.S. House included a proposal to reduce Medicare spending by transforming the program into a system sometimes called "premium support" or vouchers. Such an approach also has been a central element of other proposals by national leaders seeking to reduce the federal deficit and national debt. This Kaiser Family Foundation brief reviews the evolution of the premium support concept, examines key policy decisions and…

  • Managing Costs and Improving Care: Team-based Care of the Chronically Ill

    Event Date:
    Event

    Treating those with multiple chronic conditions, including the elderly and disabled populations, accounts for 30 percent of total U.S. health care spending. Half of this amount is spent by Medicare and Medicaid on behalf of beneficiaries eligible for both programs. This briefing, cosponsored by the Alliance for Health Reform and The Commonwealth Fund, looked at ways to improve the quality of care for the chronically ill while reducing the growth in spending for their care.…

  • Medicare Advantage 2011 Data Spotlights

    Report

    Now Available: 2012 Medicare Advantage Spotlight: Plan Availability and Premiums The Kaiser Family Foundation has issued a series of data spotlights and issue briefs examining the Medicare Advantage plan options available in 2011 and trends affecting the Medicare Advantage marketplace. These analyses were prepared by researchers at Mathematica Policy Research, Inc. and the Kaiser Family Foundation. Medicare Advantage Enrollment Market Update Firm Perspectives on the Medicare Advantage Market Plan Availability and Premiums

  • Integrating Care for Dual Eligibles: What Do Consumers Want?

    Event Date:
    Event

    Many deficit reduction plans have recognized the need to improve care for the 9 million beneficiaries dually eligible for Medicare and Medicaid. How do Medicaid and Medicare coordinate payment and care for people covered by both programs? Are Health and Human Services initiatives encouraging innovations to integrate care for dual eligible beneficiaries? What kind of programs are currently available? What do consumers think about different ways of getting care? What lessons for program design can…

  • Medicare Advantage 2012 Data Spotlights

    Report

    The Kaiser Family Foundation has issued a series of data spotlights and examining the Medicare Advantage plan options available in 2012 and trends affecting the Medicare Advantage marketplace. These analyses were prepared by researchers at Mathematica Policy Research Inc. and the Kaiser Family Foundation. Plan Availability and Premiums Enrollment Market Update

  • The Olmstead Decision: Implications for Medicaid

    Issue Brief

    In June, 1999, the Supreme Court rule in Olmstead v L.C. that states were required to provide services to persons with disabilities in community settings rather than institutions, if certain conditions were met. This Policy Brief provides an overview of the Olmstead case, including the facts, the court ruling, and the disposition of the case. In addition, the brief describes the issues surrounding implementation and the implications this ruling could have for state Medicaid programs.…

  • Medicare Beneficiaries and HMOs: A Case Study of the Portland Market

    Report

    This case study of the evolution of Medicare managed care in Portland, Oregon, is part of a series of four case studies being prepared for the Kaiser Family Foundation to learn more about the factors influencing, and consequences of, the growth of Medicare managed care. Portland was one of the first markets to implement a Medicare managed care program, with the Kaiser Foundation Health Plan beginning its Medicare HMO in 1978 and all four of…