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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 Part D: A First Look at Prescription Drug Plans in 2018

    Issue Brief

    This issue brief provides an overview of the 2018 Medicare Part D stand-alone prescription drug plan landscape, the largest segment of the Part D marketplace, It includes national and state-level data on plan availability, premiums, benefit design, cost sharing, information about premium-free plans for low-income beneficiaries, and information about the top ten Part D plans in 2018.

  • Medicare Advantage 2018 Data Spotlight: First Look

    Issue Brief

    This data note analyzes the number and variety of Medicare Advantage plan choices available to beneficiaries, and also describes changes in the health care insurers offering private health plans in 2018. This spotlight is part of a series of spotlights tracking key changes in the Medicare Advantage program.

  • Medicare Advantage Networks Included 46 Percent of Physicians in a County, On Average  

    News Release

    Medicare Advantage plan networks included 46 percent of all physicians in a county, on average, according to a new analysis from the Kaiser Family Foundation. The study, using 2015 data, is the first to examine the size and composition of physician networks among increasingly popular Medicare Advantage private plans, which now cover 19 million people, or one-third of the Medicare population. The study, which analyzed data from 391 plans offered by 55 insurers in a…

  • Medicare Advantage: How Robust Are Plans’ Physician Networks?

    Report

    This report takes an in-depth look at Medicare Advantage plans’ physician networks. The analysis draws upon data from 391 Medicare Advantage plans serving beneficiaries in 20 diverse counties in 2015. The report examines the size and composition of plans’ physician networks, the variation across counties, the inclusion of physicians by specialty, and the relationship between network size and other plan features, such as premiums and quality star ratings.

  • Many More Counties Lack Medicare Advantage Plans Today than are at Risk for Lacking an ACA Marketplace Insurer in 2018

    News Release

    A new analysis from the Kaiser Family Foundation finds that 147 counties lack Medicare Advantage plans – many more than the 19 counties expected to lack an Affordable Care Act (ACA) marketplace insurer next year. Yet Medicare Advantage, the private plans that cover a third of all Medicare beneficiaries, is often described as an example of a robust insurance market, while some policymakers say the “bare” counties under the ACA are evidence that the law…

  • What Are the Implications for Medicare of the American Health Care Act and the Better Care Reconciliation Act?

    Issue Brief

    This issue brief highlights a major implication of the American Health Care Act and Better Care Reconciliation Act for Medicare. Both bills would repeal the Affordable Care Act provision to increase the payroll tax on high-income earners. Repealing this surtax would move up the insolvency date of the Medicare Part A trust fund by 2 years, from 2028 to 2026, and also worsens the program's long-term financial outlook.

  • Testimony: Promoting Integrated and Coordinated Care for Medicare Beneficiaries

    Issue Brief

    Gretchen Jacobson, Associate Director of the Foundation's Program on Medicare Policy, testified on June 7, 2017 before the U.S. House Committee on Ways and Means, Subcommittee on Health. Her testimony focused on three approaches for integrating and coordinating care for Medicare beneficiaries, and the opportunities and challenges presented by these approaches.

  • 1 in 3 People in Medicare is Now in Medicare Advantage, With Enrollment Still Concentrated Among a Handful of Insurers 

    News Release

    For the first time, 1 in every 3 people with Medicare is enrolled in Medicare Advantage, the private Medicare plans that have played an increasingly large role in the Medicare program over the past decade, according to a new analysis from the Kaiser Family Foundation. Medicare Advantage enrollment has more than tripled since 2004, reaching 19 million, or 33 percent of enrollees, in 2017, the analysis shows. That milestone is up from 17.6 million beneficiaries…