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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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  • Medicare Prescription Drug Benefit Progress Report: Findings From A 2006 National Survey of Seniors

    Event Date:
    Event

    The share of seniors without drug coverage dropped significantly under Medicare’s new drug benefit, according to this August 2007 Health Affairs Web Exclusive article based on a Kaiser Family Foundation, Commonwealth Fund and Tufts-New England Medical Center survey of more than 16,000 seniors. Seniors with drug coverage from any source were less likely to face high monthly drug costs or to skip prescribed medications due to cost than seniors who remained without drug coverage. However,…

  • Inside Deficit Reduction: What it Means for Health Care

    Event Date:
    Event

    After much heated debate on the U.S. debt limit, the Budget Control Act of 2011 was passed on August 2, 2011, containing more than $900 billion in federal spending reductions over 10 years. The law also established the 12-person “super committee” charged with finding more than $1 trillion in additional savings. What exactly is called for in the law? What are the implications for health care programs, including Medicare, Medicaid, CHIP and the Patient Protection…

  • Best Bets for Reducing Medicare Costs for Dual Eligible Beneficiaries: Assessing the Evidence

    Report

    With pressure mounting to slow the growth in federal health care spending, policymakers are exploring ways to reform the way care is delivered to the 9 million low-income Medicare beneficiaries who also receive Medicaid – a group that on average is sicker and frailer than other Medicare beneficiaries, and therefore receive significantly more care at greater cost. Major efforts are underway at the federal and state level to better coordinate care for this population and…

  • Webinar for Journalists: A Year-End Update on the ACA Rollout & Looking Ahead to 2014

    Event Date:
    Event

    Two and an half months into the open enrollment period for the Affordable Care Act, where does the rollout of the law stand with marketplace coverage set to begin on January 1, 2014? Featuring two Kaiser Family Foundation experts--Larry Levitt, Co-Director of the Foundation's Program for the Study of Health Reform and Private Insurance & Senior Vice President, and Jennifer Tolbert, State Health Policy Director--the webinar touched on some of the major questions as people…

  • A Study of Media Coverage of Health Policy 1997-2000

    Poll Finding

    The debate over President Clinton's national health care reform plan put health care policy at the forefront of the national agenda in 1993 and 1994. After the end of that debate, it remained to be seen whether or not health policy would hold the media's and the public s interest to the same degree. To help answer that and other questions, a comprehensive study of health policy media coverage from 1997 through 2000 - focusing…

  • Trends in Medicare Supplemental Insurance and Prescription Drug Coverage 1996-1999

    Other Post

    This paper, featured in the February 27, 2002, online issue of Health Affairs, examines trends in Medicare beneficiaries supplemental insurance and prescription drug coverage between 1996 and 1999, using the Medicare Current Beneficiary Survey (MCBS) Access to Care files. It also provides snapshot estimates of coverage among subgroups of Medicare beneficiaries in 1999. The findings from this study provide important context for the debate over current policy proposals to reform Medicare and extend prescription drug…

  • Post-Election Survey of Voters’ 1997 Health Care Agenda

    Poll Finding

    Post-Election Survey of Voters' 1997 Health Care Agenda A nationally representative sample of 1000 voters, conducted immediately after the 1996 election, examines voters' priorities for the new Congress. Balancing the budget, cutting taxes and spending on public education top the list of voters priorities. The survey also looks at public support for regulating managed care, expanding health insurance coverage, Medicare spending, and the welfare reform law passed last year. Topline Download

  • Medicare Beneficiaries: A Population At Risk – Findings from the Kaiser/Commonwealth 1997 Survey of Medicare Beneficiaries

    Report

    Medicare Beneficiaries: A Population At Risk - Findings from the Kaiser/Commonwealth 1997 Survey of Medicare Beneficiaries This report by the Henry J. Kaiser Family Foundation and the Commonwealth Fund, based on the Kaiser/Commonwealth 1997 Survey of Medicare Beneficiaries, highlights the challenges facing Medicare beneficiaries and the importance of addressing the needs of low-income and other high-risk segments of the Medicare population. Report