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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).

Medicare Open Enrollment FAQs

This list of Frequently Asked Questions (FAQs) about the Medicare Open Enrollment period covers a range of topics related to enrollment, including Medicare Advantage, Part D, Medigap, and more.

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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  • How Do Dual-Eligible Individuals Get Their Medicare Coverage?

    Issue Brief

    People who are dually eligible for both Medicare and Medicaid coverage can get their Medicare coverage in a variety of ways. The brief breaks out the data for traditional Medicare, Medicare Advantage plans that are available to all Medicare beneficiaries, and plans that are designed specifically for dual-eligible beneficiaries.

  • New OIG Report Examines Prior Authorization Denials in Medicaid MCOs

    Policy Watch

    Congress asked the U.S Department of Health and Human Services (HHS) Office of the Inspector General (OIG) to investigate whether Medicaid MCOs are providing medically necessary health care services to their enrollees. OIG found that Medicaid MCOs had an overall prior authorization denial rate of 12.5%–more than 2 times higher than the Medicare Advantage rate. Prior authorization denial rates ranged widely across and within parent firms and states. After a prior authorization request is denied, Medicaid enrollees can appeal, but it’s not always straightforward and many appeals don’t change the initial decision. Unlike in Medicare Advantage, if a Medicaid MCO upholds its original denial, there is no automatic, independent external medical review. OIG found that state Medicaid agency oversight of prior authorization denials is limited. The OIG report underscores concerns about prior authorization and access in Medicaid managed care, keeping this issue at the forefront of ongoing policy discussions.

  • Key Facts About Medicare Part D Enrollment and Costs in 2023

    Issue Brief

    The Medicare Part D program provides an outpatient prescription drug benefit to older adults and people with long-term disabilities in Medicare who enroll in private plans. This brief analyzes Medicare Part D enrollment and costs in 2023 and trends over time. The analysis highlights the substantial growth of Medicare Advantage drug plans in the marketplace for Part D drug coverage, where enrollment overall is concentrated in a handful of large plan sponsors.

  • A Small Number of Drugs Account for a Large Share of Medicare Part D Spending

    Issue Brief

    The Inflation Reduction Act requires the federal government to negotiate the price of certain high-spending drugs covered by Medicare. This analysis provides context for understanding the potential impact of negotiating prices for a limited number of Medicare-covered drugs by identifying the 10 top-selling Part D drugs in 2021, measuring the share of total Part D drug spending accounted for by top-selling drugs that year, and examining changes in spending and use of these drugs since 2018.

  • New Alzheimer’s Drugs Spark Hope for Patients and Cost Concerns for Medicare

    Policy Watch

    The Food and Drug Administration granted full approval to Leqembi, a new Alzheimer's drug, on July 6, 2023. This updated policy watch focuses on the implications of Medicare coverage of the drug for program spending as well as equity and affordability issues for beneficiaries, and the potential for the Inflation Reduction Act to address the spending impacts. It also covers additional details from the Centers for Medicare and Medicaid Services about patient registries.

  • KFF Survey of Consumer Experiences with Health Insurance

    Poll Finding

    The survey finds nearly six in 10 people with health insurance experienced a problem using their insurance in the past year, with even larger shares reporting problems among people who are sick or who have mental health needs. It includes data for people with different types of coverage, including employer, Marketplace, Medicare and Medicaid, and also examines affordability issues and mental health access.

  • What Could New Anti-Obesity Drugs Mean for Medicare?

    Policy Watch

    In this piece, we discuss Medicare coverage of obesity treatments, the potential cost implications if Medicare covers anti-obesity drugs, and how the Inflation Reduction Act could potentially address these cost concerns.