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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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  • Medicare Advantage Plan Star Ratings and Bonus Payments in 2012

    Report

    This report looks at the star ratings that have been used for many years to help consumers compare plans, and examines how Medicare Advantage quality scores will interact with plan payments, beginning in 2012. To encourage Medicare Advantage plans to provide quality care, the 2010 health reform law authorized Medicare to pay plans bonuses beginning in 2012 if they receive four or five stars on the program’s five-star quality rating system, or are unrated. Building…

  • New Resources and Briefing Explore Nursing Home Reform Twenty Years After Passage of Landmark Law

    Event Date:
    Event

    To mark the 20th anniversary of the passage of landmark federal legislation to improve the quality of nursing home care, the Omnibus Budget Reconciliation Act of 1987 (known as OBRA 87), the Kaiser Family Foundation released new resources and cosponsored a Washington, D.C. briefing. Among the resources released were new opinion poll results on the public’s views about the quality of long-term care services in the United States; the short film, “Nursing Home Reform: Then…

  • Prospects for Retiree Health Benefits as Medicare Drug Coverage Begins – Report

    Report

    Prospects for Retiree Health Benefits as Medicare Drug Coverage Begins:Findings from the Kaiser/Hewitt 2005 Survey on Retiree Health Benefits - Report This report assesses how large businesses that provide retiree health benefits to their workers are responding to the new Medicare drug benefit in 2006, their plans for the future, and the way these responses affect retirees. It also looks at the rising costs and changing benefits of retiree health coverage overall in 2005. Full…

  • Observations on the Initial Implementation of the Medicare Prescription Drug Program:  Perspectives of State Medicaid Directors Through a Focus Group Discussion

    Report

    Observations on the Initial Implementation of the Medicare Prescription Drug Program: Perspectives of State Medicaid Directors Through a Focus Group Discussion Medicaid directors express the need to continue to focus on the interaction between Medicaid and the Medicare prescription drug benefit and to address the key system and coordination issues that remain, particularly with the potential disruptions that could occur in January 2007 when new Medicare drug plan contracts and recalculated benchmarks for the low-income…

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

    Fact Sheet

    Dual Enrollees: Medicaid's Role for Low-Income Medicare Beneficiaries This fact sheet describes the low-income elderly population that is eligible for both Medicaid and Medicare, why they need Medicaid, what services they receive from Medicaid, and the current policy challenges related to this population. Fact Sheet (.pdf)

  • 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…

  • 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. Published as an article in today’s New England Journal of Medicine, the analysis by Kaiser vice president Patricia Neuman 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

  • A Side-by-Side Comparison of the Prescription Drug Coverage Provisions of S.1 and H.R. 1

    Report

    This document, prepared by Health Policy Alternatives, Inc., provides a detailed side-by-side comparison of the prescription drug provisions of the House and Senate Medicare proposals, as passed on June 27, 2003. Along with these provisions, the side-by-side compares the major provisions relating to the role of private health plans in Medicare. This document includes a more in-depth description of the bills, which were previously summarized in publication #6095, which is also available on the Foundation?s…