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Medicare Advantage

1 in 6 Medicare Advantage Enrollees Had a Diagnosis Added on a Chart Review That Increased Federal Payments to their Insurer

A KFF analysis finds that 1 in 6 (17%) Medicare Advantage enrollees had a diagnosis added on a chart review that increased federal payments to the insurer who ran their plan. Chart reviews, which are not used in traditional Medicare and have drawn bipartisan scrutiny, are the largest contributor to higher payments to Medicare Advantage plans.

Also: How Medicare Pays Medicare Advantage Plans: Issues and Policy Options

Medicare Advantage in 2025: Enrollment Update and Key Trends

Medicare Advantage Enrollees Have Access to About Half of the Physicians Available to Traditional Medicare Beneficiaries

Medicare Advantage in 2025: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization

Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023

Medicare Open Enrollment

Beneficiaries Have 32 Medicare Advantage Prescription Drug Plans Available, on Average, for 2026

The average Medicare beneficiary will be able to choose among 32 Medicare Advantage plans with prescription drug coverage for 2026, two fewer than in 2025. The number of MA-PD options has grown steadily since 2010, peaking in 2024 when the average Medicare beneficiary had 36 options. Open enrollment runs October 15 through December 7.

Also: Medicare Open Enrollment FAQs

Premiums Are Decreasing for Many Stand-Alone Drug Plans in a Number of States in 2026

A Current Snapshot of the Medicare Part D Prescription Drug Benefit

The Role of SHIPs in Helping People with Medicare Navigate Their Coverage

What to Know About the Medicare Open Enrollment Period and Medicare Coverage Options

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 Part D

Premiums Are Decreasing for Many Stand-Alone Part D Drug Plans in a Number of States in 2026

This analysis finds that monthly premiums for many Part D stand-alone prescription drug plans (PDPs) in a number of states will be lower in 2026 than they were this year. At the same time, the total number of PDPs, which provide prescription drug coverage to people in traditional Medicare, will fall for the third year in a row, as insurers continue to scale back their offerings and adjust to higher costs under the redesigned Part D benefit, reflecting changes in the Inflation Reduction Act.

The Uncertain Future of Medicare's Stand-Alone PDP Market and Why It Matters

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

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

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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  • Medicare Part D in 2018: The Latest on Enrollment, Premiums, and Cost Sharing

    Issue Brief

    This brief about the 2018 Medicare Part D marketplace analyzes the latest data on Medicare drug coverage and trends over time, including both stand-alone prescription drug plans and Medicare Advantage drug plans. The analysis focuses on enrollment, premiums, cost sharing, and the low-income subsidy.

  • 10 FAQs: Medicare’s Role in End-of-Life Care

    Fact Sheet

    About eight of 10 of the 2.6 million people who died in the US in 2014 were people on Medicare, making Medicare the largest insurer of health care provided during the last year of life. These Frequently Asked Questions explain Medicare’s role in or coverage of end-of-life care, advance care planning, advance directives, and hospice care. They also provide information on Medicare spending on end-of-life care, changes to the physician fee schedule, and how related issues arose prior to the passage of the Affordable Care Act.

  • What Percent of New Medicare Beneficiaries Are Enrolling in Medicare Advantage?

    Issue Brief

    The analysis examines enrollment in Medicare Advantage plans during beneficiaries’ first year on Medicare and finds that less than one-third or 29% enrolled in these private health plans, including HMOs or PPOs. The majority of people new to Medicare are choosing traditional Medicare in the year they first go on Medicare. The study looks at how these findings vary across age, Medicaid status, states, and counties.

  • How Many Medicare Part D Enrollees Had High Out-of-Pocket Drug Costs in 2017?

    Issue Brief

    The Medicare Part D prescription drug benefit has helped improve the affordability of medications for people with Medicare. Yet Part D enrollees can face relatively high out-of-pocket costs because the Part D benefit does not have a hard cap on out-of-pocket spending. This analysis presents the latest data on out-of-pocket drug spending among Medicare Part D enrollees without low-income subsidies who have costs above the catastrophic coverage threshold.

  • Medicare Advantage 2020 Spotlight: First Look

    Issue Brief

    In 2020, more than 22 million Medicare beneficiaries (34%) are enrolled in Medicare Advantage plans, which are mainly HMOs and PPOs offered by private insurers as an alternative to the traditional Medicare program. This data note provides an overview of the Medicare Advantage plans that will be available in 2020, including the variation in the number of plans available by county and plan type. The brief also examines the insurers entering the Medicare Advantage market for the first time and also examines the insurers exiting the market.

  • Medicare Part B Drugs: Cost Implications for Beneficiaries in Traditional Medicare and Medicare Advantage

    Issue Brief

    In the face of rising prescription drug costs, a large majority of the public supports federal efforts to lower drug spending. Policymakers are considering several proposals that would lower prescription drug costs. To better understand the potential out-of-pocket cost exposure that Medicare beneficiaries may face for Part B drugs, which are typically administered by physicians and other health care providers, we analyzed cost-sharing liability for these drugs in traditional Medicare and cost-sharing requirements in Medicare Advantage plans.