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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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  • Prescription Drug Procurement and the Federal Budget

    Issue Brief

    This brief commissioned by the Foundation considers areas where Medicare faces limited opportunity for market-based competition and price negotiation to drive down drug spending. These areas include drug purchasing for low-income people enrolled in Part D plans who face minimal cost-sharing requirements, and purchasing certain unique drugs, such as biologicals, that have no therapeutic alternatives or competitors. Authored by Richard G. Frank of Harvard University, the brief discusses policy options that could lower Medicare spending…

  • Toplines: July/August 2005 Health Poll Report Survey

    Poll Finding

    Health News Index July/August, 2005 These toplines provide the complete survey questions and responses to the July/August 2005 Kaiser Health Poll Report, a bimonthly report designed to provide key tracking information on public opinion about health care topics to journalists, policymakers and the general public. It includes a series of questions on seniors' views and knowledge about the Medicare prescription drug benefit. Topline/Survey

  • Medicare Advantage 2012 Data Spotlight: Enrollment Market Update

    Report

    This data spotlight examines the growth in private Medicare Advantage plan enrollment in 2012, with a record 13 million Medicare beneficiaries enrolled as of March, representing 27 percent of all Medicare beneficiaries. Enrollment jumped by more than 1 million enrollees from the previous year and increased in every state except Alaska and New Hampshire. Medicare Advantage plan enrollees generally must pay Medicare's standard Part B premium, but more than half do not pay any additional…

  • The Exceptions and Appeals Process: Issues and Concerns in Obtaining Coverage Under the Medicare Part D Prescription Drug Benefit

    Issue Brief

    This issue brief describes how Medicare beneficiaries navigate the Medicare Part D exceptions, appeals, and grievances processes to get access to medically necessary prescriptions not covered under their Medicare prescription drug plans. It identifies and describes policy issues that may make it difficult for beneficiaries to utilize the processes. Issue Brief (.pdf)

  • The Medicare Drug Benefit: Beneficiary Perspectives Just Before Implementation – Toplines

    Poll Finding

    These toplines provide the complete results from a comprehensive survey of seniors on their understanding of and views toward the Medicare drug benefit. The survey of 802 seniors was conducted in late October 2005, prior to the start of the benefit's open enrollment period, which runs from Nov. 15, 2005 to May 15, 2006. The survey was conducted and analyzed by researchers at the Kaiser Family Foundation and the Harvard School of Public Health. It…

  • Medicare and Medicaid for the Elderly and Disabled Poor

    Other Post

    This fact sheet provides an overview of the role of Medicare and Medicaid in serving these beneficiaries; describes the health status of dual Medicare/Medicaid beneficiaries, and discusses issues of managed care and access to care. Available in PDF format. Return to top Library Index

  • National Surveys of Pharmacists and Physicians, Findings on Medicare Part D

    Poll Finding

    Two national surveys conducted and analyzed by the Kaiser Family Foundation show that substantial majorities of pharmacists and physicians believe that the prescription drug law is helping people on Medicare save money on their medications. At the same time, a majority in both professions report that Medicare beneficiaries who they see are encountering problems in getting their medications, sometimes with serious consequences. The questions about Medicare drug plans were part of surveys designed and analyzed…