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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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  • Toplines: The Public’s Health Care Agenda

    Poll Finding

    These toplines provide the complete survey questions and findings from The Public’s Health Care Agenda for the New Congress and Presidential Campaign, conducted jointly by the Kaiser Family Foundation and the Harvard School of Public Health between November 9 and 19, 2006. The survey looks at the public’s priorities and views on health issues as a new Democratic majority takes the leadership of Congress and as the 2008 presidential campaign begins to take shape. It…

  • Medicare Advantage 2012 Spotlight: Plan Availability and Premiums

    Report

    This brief highlights trends in the Medicare Advantage marketplace, including the choices available to Medicare beneficiaries in 2012, premium levels and other plan characteristics. The brief was authored by researchers at Mathematica Policy Research and the Kaiser Family Foundation. Data Spotlight (.pdf)

  • Medicare Restructuring: The FEHBP Model A Summary

    Other Post

    Medicare Restructuring: The FEHBP Model Executive Summary Part 2 How Well Does FEHBP work? FEHBP has been somewhat more successful than Medicare in controlling costs. However, recent trends indicate that FEHBP's competitive structure alone cannot guarantee cost control over the long term. Until recently, FEHBP experienced slightly lower growth in spending per enrollee than Medicare. Over the period 1987 to 1997, Medicare spending per beneficiary grew at an annual rate of 8.1 percent. FEHBP spending…

  • Designing a Medicare Drug Discount Card: Implications of Policy Choices for Medicare Beneficiaries and Plan Sponsors

    Report

    This report analyzes key issues surrounding the implementation of a Medicare-endorsed prescription drug discount card program. Medicare prescription drug discount cards have been proposed as a short-term strategy for lowering prescription drug costs for Medicare beneficiaries. The report considers the implications for both discount card sponsors and beneficiaries of alternative program designs, including such features as the annual lock-in for consumers, exclusive formularies, providing comparative information to consumers about drug prices and discounts, administration of…

  • Learning From History: Deinstitutionalization of People with Mental Illness As Precursor to Long-Term Care Reform

    Report

    This report examines what policy lessons can be learned from the deinstitutionalization of people with mental illnesses and applied to potential long-term care reform for the elderly or those with significant disabilities. The study assesses the reforms that took place under deinstitutionalization, their impact and what mistakes were made. It also discusses the take-away lessons for long-term care policy, with a focus on planning, financing, living situations and the role of families, workplace issues, and…

  • The Federal Employees Health Benefits Program: Program Design, Recent Performance and Implications for Medicare Reform

    Report

    This report provides a basic description of the Federal Employees Health Benefits Program's (FEHBP) structure, benefits, financing, and operations. The report also assesses FEHBP's recent performance in a variety of areas, including cost increases, benefit changes, access to providers, and risk selection. It concludes with a brief discussion of the implications of the FEHBP experience for Medicare reform proposals. Report Speaker Presentation (Merlis) Webcast of briefing

  • The Role of Medicare and the Indian Health Service for American Indians and Alaska Natives: Health, Access and Coverage

    Report

    This report examines the role of both Medicare and the Indian Health Service (IHS) in providing access to health care for about 650,000 American Indians and Alaska Natives who are age 65 and older or who have permanent disabilities. While Medicare provides important health care coverage for most in this group, its relatively high cost-sharing and gaps in benefits can be problematic for American Indians and Alaska Native Medicare beneficiaries who do not have additional…

  • How High Drug Prices Weigh on the Sickest Americans

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman explores the data behind public concern about prescription drug costs and highlights that the people most in need are the most burdened by the problem.