Medicare

NEW AND NOTEWORTHY

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).

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.

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  • New Trump Administration Proposals Would Further Limit Gender Affirming Care for Young People by Restricting Providers and Reducing Coverage

    Issue Brief

    This brief examines two proposed federal rules that would further restrict youth access to gender affirming care. One rule would change the hospital Conditions of Participation (CoPs) which would prohibit most Medicare and Medicaid enrolled hospitals from providing certain types of gender affirming medical care for young people and the other would prohibit federal Medicaid or CHIP funds from covering this care. The rules have a 60-day comment period, do no take immediate effect, and…

  • Examining the Potential Impact of Medicare’s New WISeR Model

    Issue Brief

    On January 1, 2026, the Center for Medicare & Medicaid Innovation (CMMI) launched the Wasteful and Inappropriate Service Reduction (WISeR) Model that establishes new prior authorization requirements in traditional Medicare. This analysis explores the potential impact of the WISeR model by examining recent spending and utilization trends in traditional Medicare for services selected for prior authorization requirements in the six model states (Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington).

  • The IRA Has Improved Coverage of Drugs Selected for Medicare Price Negotiation

    Issue Brief

    The Medicare drug price negotiation program could improve coverage of drugs selected for negotiation for Medicare beneficiaries because the law requires all Medicare Part D plans to cover each of the selected drugs, including all dosages and forms, when negotiated prices take effect. This analysis examines 2026 Medicare Part D formulary coverage of drugs selected for negotiation to measure the effect of the IRA's coverage requirement.

  • Analyzing Changes in Medicare Part D Enrollment for 2026

    Issue Brief

    The Medicare Part D prescription drug benefit is provided by private plans, either Medicare Advantage plans that offer drug coverage (MA-PDs) or, for those in traditional Medicare, stand-alone prescription drug plans (PDPs). New data from CMS shows that 56 million people are enrolled in Part D plans as of February 2026, with more in MA-PDs than PDPs, reflecting higher overall enrollment in Medicare Advantage than in traditional Medicare. Enrollment in group MA-PD plans decreased while…

  • New Weight Loss Drugs Raise Issues of Coverage, Cost, Access and Equity

    Event Date:
    Event

    New weight loss drugs, such as Novo Nordisk’s Ozempic and Wegovy (semaglutide) and Eli Lilly’s Mounjaro (tirzepatide), could be transformative for people who struggle with obesity and obesity-related medical conditions, but there are major questions to consider related to insurance coverage, the cost of the drugs, and who has access. On August 4, three experts joined Larry Levitt, executive vice president for health policy at KFF, for a 45-minute “Health Wonk Shop” discussion about the…

  • Health Insurer Financial Performance in 2024

    Issue Brief

    This analysis of trends in health insurers’ financial data shows that insurers’ gross margins per enrollee dipped slightly in 2024 across four markets, remaining highest in the Medicare Advantage market, followed by the individual (non-group) market, the fully insured group (employer) market, and Medicaid managed care. The analysis also examines insurers’ medical-loss ratios across the four markets.

  • As Debate Heats Up in Washington Over Possible Entitlement Cuts, A New KFF Analysis Details the 30% of Federal Spending That Goes to Health Care Programs

    News Release

    As some policymakers in Washington are pushing to reduce the federal deficit and debt, a new KFF resource provides a concise explanation of federal spending for domestic and global health programs and services, which could be part of any conversation about curbing federal spending. Federal spending on health programs and services accounted for 30 percent of net federal spending in fiscal year 2022 -- or $1.7 trillion out of a total of $5.9 trillion. Specifically,…

  • Unpacking the Controversy Over Medicare Advantage

    Event Date:
    Event

    Medicare Advantage is the rapidly growing private plan alternative to traditional Medicare that provides coverage to approximately half of Medicare beneficiaries. On Tuesday, March 21, three experts joined series moderator Larry Levitt in a 45-minute discussion on Medicare Advantage, addressing such questions as: What has driven the growth in Medicare Advantage enrollment? What are the implications of enrollment being concentrated in a few insurance firms? Is the federal government overpaying plans? What would the new…