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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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  • Private Plans In Medicare: A 2007 Update

    Issue Brief

    This March 2007 issue brief, commissioned by the Kaiser Family Foundation, examines changes between 2006 and 2007 in the availability of and enrollment in Medicare Advantage and Medicare prescription drug plans overall and in urban and rural areas. It also focuses on the firms that are offering various types of Medicare plans. Marsha Gold of Mathematica Policy Research, Inc., prepared the brief. Issue Brief (.pdf)

  • Medicare Part D 2008 Data Spotlights

    Issue Brief

    To better understand changes in the private plans providing drug coverage to Medicare beneficiaries under the program's Part D benefit, the Kaiser Family Foundation is issuing a series of data spotlights analyzing key elements of Medicare's private drug plans. Each spotlight will focus on a key aspect of the drug plans that will be available to Medicare beneficiaries in 2008 and examine relevant trends since the Medicare drug benefit took effect in 2006. >>More Recent…

  • Methodology Appendix to the Medicare Part D 2008 Data Spotlights

    Issue Brief

    The Kaiser Family Foundation has also posted an appendix detailing the methodology used in the Medicare Part D 2008 Data Spotlight series. The series analyzes key aspects of the 2008 Medicare Part D prescription drug plan choices. All of the spotlights in this series were prepared by a team of researchers at Georgetown University, NORC and the Kaiser Family Foundation. Data Spotlight Appendix (.pdf)

  • Analysis of Medicare Prescription Drug Plans In 2012 And Key Trends Since 2006

    Report

    This report presents findings from an analysis of the Medicare Part D marketplace in 2012 and changes in drug coverage and costs since 2006. It presents key findings related to Medicare drug plan plan availability, premiums, cost-sharing, the coverage gap and availability for low-income beneficiaries, the coverage gap, benefit design and cost sharing, formularies, and utilization management, based on data from CMS for all plans participating in Part D. The analysis was conducted jointly by…

  • Public Strongly Favors End-of-Life Conversations Between Doctors and Patients, With About Eight in 10 Saying Medicare and Other Insurers Should Cover These Visits

    News Release

    Six in 10 Oppose 'Cadillac Plan Tax' on High-Cost Health Plans Set to Take Effect in 2018, But Cost Savings Argument Can Change Some Opinions Views on the Affordable Care Act Remain Divided: 45% Unfavorable, 41% Favorable As the Centers for Medicare & Medicaid Services prepares to finalize a plan to pay physicians for discussing end-of-life treatment options with Medicare patients, the latest Kaiser Health Tracking Poll finds an overwhelming majority supports such coverage. The…

  • Medicare’s Drug Benefit Is Firmly-Established After Its First Decade, With Flat Premiums in Recent Years but Higher Cost-Sharing Over Time 

    News Release

    With Medicare Part D nearing the end of its tenth year, the program -- which now provides drug coverage to 72 percent of all Medicare beneficiaries -- has experienced no growth in average premiums in recent years but some notable increases in cost-sharing, according to a new report from the Kaiser Family Foundation. At a time of heightened public concern about the cost of prescription drugs, the report, Medicare Part D at Ten Years: The…

  • What’s In and What’s Out? Medicare Advantage Market Entries and Exits for 2016

    Issue Brief

    This Issue Brief examines the availability of Medicare Advantage plans nationwide and by state in 2016, and tracks changes in plan availability since 2012. It documents the number and share of Medicare Advantage enrollees affected by plan withdrawals each year, the characteristics of plans that will be entering or exiting the market in 2016, and the potential implications of these changes for Medicare Advantage enrollees.

  • With Medicare and Medicaid Getting High Marks from the Public and Beneficiaries, Majorities Favor Status Quo over Major Structural Changes Such As Premium Supports or Block Grants

    News Release

    Among Medicare Changes, Strongest and Broadest Support Is for Negotiating Drug Prices People With Medicare, Medicaid and Employer Plans Give Their Coverage Similar Ratings, But Some Report Affordability and Physician Access Problems Fifty years after President Lyndon Johnson signed the law creating the Medicare and Medicaid programs, a new Kaiser Family Foundation poll finds a majority of the public and the vast majority of program beneficiaries view the two programs positively. Likely as a result,…