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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 Advantage Networks Included 46 Percent of Physicians in a County, On Average  

    News Release

    Medicare Advantage plan networks included 46 percent of all physicians in a county, on average, according to a new analysis from the Kaiser Family Foundation. The study, using 2015 data, is the first to examine the size and composition of physician networks among increasingly popular Medicare Advantage private plans, which now cover 19 million people, or one-third of the Medicare population. The study, which analyzed data from 391 plans offered by 55 insurers in a…

  • Disparities in Women’s Health

    Other Post

    Disparities in Women's Health Disparities in health and health care continue to burden women, particularly affecting women of color or those who are poor. To shed more light on the factors contributing to inequalities in health and access to care for women, the Kaiser Family Foundation provided support for the newest issue of the Journal of the American Medical Women's Association (JAMWA) Disparities in Women's Health. This special issue features an editorial by Surgeon General…

  • What Could a Medicaid Per Capita Cap Mean for Low-Income People on Medicare?

    Issue Brief

    Policymakers are currently considering proposals that would fundamentally change the structure and financing of Medicaid, and potentially affect 11 million people on Medicare. This brief discusses the potential implications of Medicaid per capita cap or block grant proposals for the 11 million low-income seniors and people with disabilities on Medicare. It also describes how the per capita cap model proposed in the American Health Care Act could potentially affect low-income people on Medicare who receive…

  • Medicare Savings in Perspective: A Comparison of 2009 Health Reform Legislation and Other Laws in the Last 15 Years

    Issue Brief

    Although Medicare is not the main focus of current health reform legislation, the bill recently passed by the House—H.R. 3962, America’s Affordable Health Choices Act of 2009—and the bill before the Senate—H.R. 3590, Patient Protection and Affordable Care Act—include a number of provisions that would affect Medicare program expenditures. This policy brief considers the proposed 10-year Medicare savings and increased spending in the two proposals in the context of other laws enacted during the last…

  • A Primer on Medicare Financing

    Issue Brief

    As Congress and the Administration increasingly focus on the nation’s budget deficit, many policy experts and several bipartisan deficit reduction panels have proposed significant changes to Medicare to reduce federal spending and address rising health care costs. This primer provides an overview of Medicare spending trends, how the program is financed, and factors contributing to the growth in Medicare spending. Medicare now covers 47 million seniors and younger people with disabilities, with total expenditures of…

  • Medicare Advantage 2011 Data Spotlight: Plan Availability and Premiums

    Report

      This Medicare Advantage Data Spotlight provides an overview of recent changes made to the Medicare Advantage program and examines trends in plan participation, premiums and certain benefits. About 12 million people, or nearly a quarter of the Medicare population, are enrolled in Medicare Advantage, the privately administered plans that are an alternative to the traditional fee-for-service Medicare program. The analysis was conducted by a team researchers at Mathematica Policy Research, Inc. and the Kaiser…

  • Improving Prescription Drug Coverage: Opportunities and Challenges for Reform

    Event Date:
    Event

    Tricia Neuman, Vice President and Director of the Medicare Policy Project, testified before the Senate Finance Committee on prescription drug coverage under Medicare. The statement reviews existing sources of prescription drug coverage for Medicare beneficiaries and the importance of such coverage for this population. It reviews current approaches for improving prescription drug coverage, identifying significant areas of common ground, as well as the key decisions and challenges facing policymakers in designing a Medicare drug benefit.

  • What’s in There? The New Health Reform Law and Medicare

    Event Date:
    Event

    As part of an ongoing series to explore what is in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, this May 7 briefing sponsored by the Alliance for Health Reform and the Kaiser Family Foundation examines how the reform law affects Medicare. Changes to Medicare were among the most hotly debated issues as the legislation was developed, and this briefing includes a detailed look at the…

  • The Budget: What Would You Cut?

    Perspective

    As President Obama and Congress begin to hash out the 2012 budget, it is a good time to revisit results from our January 2011 survey showing that in spite of the fact that most Americans report being very concerned about the budget deficit, there is little public support for major reductions across a number of program areas. Majorities said they would not support any reductions in Social Security (64 percent), public education (63 percent), or…

  • Betting on Private Insurers

    Perspective

    Just-released estimates of national health spending in 2010 by the Centers for Medicare and Medicaid Services (CMS) show that 45% of our health care spending is financed by the federal and state governments, primarily through the Medicare and Medicaid programs. This share has grown temporarily in recent years because of the economic downturn, as private insurance has declined and Medicaid has grown. It has also increased due to our demographic destiny: the growing cohort of baby…