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Medicare Advantage

Medicare Advantage Out-of-Pocket Limits: Variation & Trends

While there are many distinguishing features between Medicare Advantage and traditional Medicare, one key benefit of Medicare Advantage is an annual cap on out-of-pocket costs for medical benefits, which traditional Medicare does not include.

An analysis finds that the average Medicare Advantage in-network limit is $5,421 in 2026, but nearly 1 in 5 enrollees face in-network limits higher than $7,000.

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 Enrollment Grew by About 1 Million People, Mainly Due to Special Needs Plans

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).

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

Medicare Part D

Analyzing Changes in Medicare Part D Enrollment for 2026

Analysis of CMS data shows that 56.1 million people have Medicare Part D drug coverage as of Feb. 2026, with 56% of enrollees in Medicare Advantage plans with drug coverage (MA-PDs) and 44% in stand-alone prescription drug plans (PDPs.)PDP enrollment increased, mainly due to the rise in enrollment in group employer/union plans for retirees.

Between 2025 and 2026, enrollment in group Medicare Advantage drug plans dropped for the first time since 2010, while group PDP enrollment rose by the largest amount Since 2013.

Premiums Are Decreasing for Many Stand-Alone Part D Drug Plans in a Number of States in 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. 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 Open Enrollment

Beneficiaries Have 32 Medicare Advantage Prescription Drug Plans Available, on Average, for 2026

The average Medicare beneficiary will be able to choose among 32 Medicare Advantage plans with prescription drug coverage for 2026, two fewer than in 2025. The number of MA-PD options has grown steadily since 2010, peaking in 2024 when the average Medicare beneficiary had 36 options. Open enrollment runs October 15 through December 7.

Also: Medicare Open Enrollment FAQs

Premiums Are Decreasing for Many Stand-Alone Drug Plans in a Number of States in 2026

A Current Snapshot of the Medicare Part D Prescription Drug Benefit

The Role of SHIPs in Helping People with Medicare Navigate Their Coverage

What to Know About the Medicare Open Enrollment Period and Medicare Coverage Options

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  • Visualizing Health Policy: Medicare’s Role and Future Challenges

    Other Post

    November 2012 infographic in the Visualizing Health Policy series takes a look at Medicare—who it covers; the services its beneficiaries use; and the balance policymakers must strike between setting fair payments, keeping care affordable, and sustaining the program for future generations. See the full-size infographic at The Journal of the American Medical Association View the related Slideshow Visualizing Health Policy is a monthly infographic series produced in partnership with the Journal of the American Medical Association (JAMA).…

  • Visualizing Health Policy: The Role of Medicaid and Medicare in Women’s Health Care

    Other Post

    This month’s Visualizing Health Policy infographic provides information about the role of Medicaid and Medicare in women’s health care: the proportion of US women who are covered by Medicaid and Medicare; how women comprise the majority of those covered by the Medicaid and Medicare programs and the majority of those receiving long-term services and supports (such as home health care); how women on Medicaid are poorer and sicker than women with private coverage; how Medicaid…

  • Making Ends Meet: The Medicare Generation

    Video

    This short Kaiser Family Foundation documentary profiles the experiences of three Medicare families trying to pay for their health care costs with other household spending. The families are among 16 featured in a companion report examining the role Medicare now plays in the lives of beneficiaries and the challenges many face in paying for their health care and other living expenses on a fixed budget.

  • Raising the Age of Medicare Eligibility: A Fresh Look Following Implementation of Health Reform

    Report

    Several major deficit-reduction and entitlement reform proposals include raising Medicare's age of eligibility from 65 to 67 as a way of improving Medicare's solvency. This Kaiser Family Foundation report estimates the expected effects of such a change on the federal budget, as well as on affected seniors' out-of-pocket costs, employers, Medicaid and others in light of the major changes in coverage enacted under the 2010 health reform law. The study estimates that raising Medicare’s eligibility…

  • The Medicare Prescription Drug Law – What Are Seniors Saying?

    Other Post

    As the first phase of the new Medicare prescription drug law takes effect, the Kaiser Family Foundation commissioned focus groups conducted by Bill McInturff of Public Opinion Strategies and Geoff Garin of Peter D. Hart Research Associates in consultation with Foundation staff. The focus groups were designed to explore what people on Medicare know and think about the discount drug card that went in effect June 1st, and the new benefit that takes effect in…

  • Reactions to the New Medicare Law, Findings Based on Focus Groups with People on Medicare

    Report

    This report, Reactions to the New Medicare Drug Law, produced jointly by a bipartisan team of pollsters from Public Opinion Strategies and Peter D. Hart Research Associates, presents key findings from ten focus groups of people on Medicare in three cities: Pittsburgh, PA; Kansas City, KS, and Washington, DC. The focus groups explored knowledge, perceptions, and early experiences with the new Medicare drug law – both the Medicare-approved drug discount card and the drug benefit…

  • National Survey of Public Knowledge of the Medicare Program and Public Support for Medicare Policy Proposals

    Other Post

    New Survey finds most Americans oppose slowing the growth of Medicare to balance the budget or cut taxes, but would support changes to avoid bankruptcy Embargoed for release until: 9:30 AM EST Thursday, June 29, 1995 Contacts: Matt James Tina Hoff (415) 854-9400 --Public Favors Incremental Rather than Sweeping Reforms-- --Significant Generational Differences on Medicare Reform-- Washington, D.C. -- A new survey has found that close to three out of four Americans (73%) support reducing…

  • The Implications of Medicare Prescription Drug Proposals for Employers and Retirees

    Report

    This report examines the potential savings for employers who currently represent the largest source of drug coverage for seniors. The study finds substantial savings for large employers under comprehensive Medicare prescription drug proposals ranging from $5-8.5 billion in 2003 to $10-$15 billion in 2009. It also finds that the majority of large employers are likely to retain retiree coverage, as a supplement to a Medicare drug benefit. Report