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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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  • Access To Health Care:

    Report

    Promises and Prospects For Low-Income Americans This book explores critical issues affecting access to health care for low-income Americans by assessing the importance of expansions of health coverage for the poor, the emerging challenges providers who serve low-income and uninsured populations face in a rapidly evolving health care delivery system, and the effects of these changes on particularly vulnerable populations. Articles include: IntroductionMarsha Lillie-Blanton, Rose Marie Martinez, Barbara Lyons, Diane Rowland A Review Of The…

  • Medicaid and the Elderly

    Other Post

    Long-Term Care Spending In 1993, Medicaid spent $25.5 billion for long-term care services for elderly beneficiaries (Figure 5). This represents 58 percent of the $44 billion Medicaid spent on long-term care services for all population groups. The majority of spending was for care delivered in nursing facilities (84 percent) and ICFs-MR (2 percent). The remaining 14 percent of Medicaid long-term care spending went towards community-based care, including 3 percent for mental health services and 11…

  • Medicare and Women

    Fact Sheet

    As part of The Faces of Medicare, a collection of fact sheets profiling the characteristics and health needs of different groups of Medicare beneficiaries, provides descriptive information about women on Medicare, who constitute nearly seventy percent of Medicare's poor. Fact Sheet

  • Pulling it Together: Duals: The National Health Reform Experiment We Should Be talking More About

    From Drew Altman

    The Center for Medicare & Medicaid Services (CMS) and 26 states are moving to launch a large scale managed care demonstration project potentially involving millions of the poorest, sickest, most expensive Medicare and Medicaid beneficiaries, the so-called dual eligibles. The experiment is getting more and more attention from policy experts, but with controversial issues like the survival of the Affordable Care Act and converting Medicare to a premium support program grabbing the limelight, it has…

  • Medicare Advantage Chartpack

    Report

    These charts highlight key data about the Medicare Advantage program, which has grown rapidly in terms of enrollment and number of plans since the enactment of the Medicare Modernization Act in 2003. The package includes a map showing Medicare Advantage penetration by state as well as key facts about private fee-for-service plans, which have contributed significantly to the recent growth of the Medicare Advantage program. Chartpack (.pdf)

  • Toplines: Kaiser Health Tracking Poll — April 2009

    Poll Finding

    This document contains the toplines from the April Health Tracking Poll. The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and was conducted April 2 through April 8, 2009, among a nationally representative random sample of 1,203 adults ages 18 and older. Telephone interviews conducted by landline (902) and cell phone (301, including 98 who had no landline telephone) were carried out in English and Spanish. The margin of…

  • Medicare Part D: A First Look at Part D Plan Offerings in 2013

    Report

    This data spotlight examines the stand-alone Part D drug plan options available to Medicare beneficiaries in 2013 during the open enrollment period, which runs from October 15 to December 7, 2012. The analysis is the first in a series of planned reports examining the private plan choices available to Medicare beneficiaries for 2013. It is authored by Jack Hoadley and Laura Summer of Georgetown University, Juliette Cubanski and Jennifer Huang of the Kaiser Family Foundation,…