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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

Most Medicare Advantage Markets are Dominated by One or Two Insurers

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

New & Noteworthy
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

Prescription Drugs

The Effect of Delaying the Selection of Small Molecule Drugs for Medicare Drug Price Negotiation

Part of a recent executive order from President Trump directs the Secretary of HHS to work with Congress to implement a change in the Medicare Drug Price Negotiation Program to delay negotiation of so-called “small molecule” drugs beyond 7 years after FDA approval under current law. If that timeframe had already been in place, more than half of the Part D drugs that were selected for price negotiation in the first or second rounds – 13 out of 25 – would not have been eligible at the time drugs were selected.

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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  • Explaining Health Care Reform: What is Comparative Effectiveness Research?

    Issue Brief

    The brief examines current funding for comparative effectiveness research, the provisions included in the current health reform legislation, and issues related to which treatments that might be studied, whether and how to weigh costs of care, and how such findings will be used and shared with health-care practitioners and the public.

  • Medicare Part D Update: Lessons Learned and Unfinished Business

    Report

    Enacted in 2003, Medicare’s Part D prescription drug benefit reflected an unprecedented and controversial new approach for Medicare, relying exclusively on private plans to provide health coverage and including an unusual gap in coverage. This analysis by Kaiser researchers examines in detail how the new model has worked since its launch almost four years ago.

  • Dual Eligibles: Medicaid’s Role for Low-Income Medicare Beneficiaries

    Fact Sheet

    This updated fact sheet describes the nearly 8.9 million "dual eligibles," the low-income elderly and persons with disabilities who are enrolled in both Medicare and Medicaid, why this population needs Medicaid, what services they receive from Medicaid, and what the new health reform law may mean for them. Fact Sheet (.

  • Views of the New Medicare Drug Law – Summary & Chartpack

    Report

    This comprehensive survey of people on Medicare assesses their attitudes toward the new Medicare drug law. The survey provides detailed insight in their perceptions and opinions about the law, the Medicare-approved drug-discount card program and the new Medicare drug benefit set to begin in January 2006.

  • The “Clawback:” State Financing of Medicare Drug Coverage

    Issue Brief

    This issue paper describes the origins of the clawback, the formula by which each state’s clawback amount is calculated, and the clawback’s implications for states and for low-income Medicare beneficiaries. Issue Paper (.

  • Trends in Medicare Supplemental Insurance and Prescription Drug Benefits, 1996-2001Data Update

    Report

    Trends in Medicare Supplemental Insurance and Prescription Drug Benefits, 1996-2001 Data Update This data update provides estimates of supplemental insurance and prescription drug coverage rates and trends between 1996 and 2001, which will help to provide important context for assessing future changes in supplemental insurance and drug coverage rates after provisions of the Medicare drug…

  • The Role of Health Coverage for People with Disabilities

    Event Date:
    Event

    People with disabilities are at risk in the health-care system because of their wide-ranging health-care needs, their relatively heavy use of prescription drugs, health-care and support services, and typically low incomes. A new survey of people with permanent mental and/or physical disabilities explores their health-care experiences and challenges in accessing and paying for care.

  • Note

    Other Post

    Get a printable copy of this report   This guide, designed to help you and your parents sort through basic issues about Medicare and health coverage, was written by the Medicare Rights Center in collaboration with the Henry J. Kaiser Family Foundation and was updated in 2003. The Henry J.