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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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  • Retiree Health Trends and Implications of Possible Medicare Reforms – Fact Sheet

    Fact Sheet

    Retiree Health Trends And Implications Of Possible Medicare Reforms September 1997 Approximately 12 million of Medicare's 39 million beneficiaries receive employer-sponsored retiree health benefits as a supplement to their Medicare coverage. In addition, millions of retired workers under age 65 rely on retiree health benefits as their primary source of health insurance coverage. While employer-sponsored health insurance is an important source of coverage for current retirees, health benefits for future retirees are uncertain. Retiree Health…

  • An Update on the Clawback: Revised Health Spending Data Change State Financial Obligations for the New Medicare Drug Benefit

    Issue Brief

    An Update on the Clawback: Revised Health Spending Data ChangeState Financial Obligations for the New Medicare Drug Benefit States are obligated to finance part of the new Medicare prescription drug benefit via a monthly "clawback" payment to the federal government. This issue update analyzes the latest data and provides an overview of the state financing of the Medicare drug benefit. Revisions by the federal government due to updated data has resulted in an estimated net…

  • Medicare Payments and Beneficiary Costs for Prescription Drug Coverage

    Issue Brief

    This March 2007 issue brief, commissioned by the Kaiser Family Foundation, provides a basic introduction to the reimbursement system for private Medicare drug plans. It explains the system of plan bidding and payment, including the special provisions for low-income enrollees, and considers how aspects of the payment system may affect the total cost of the drug benefit over time, the cost of coverage for beneficiaries and the variety and quality of available plans. Mark Merlis…

  • Summary of the Proposed Rule to Implement the New Medicare Prescription Drug Benefit

    Issue Brief

    In August 2004, the Centers for Medicare and Medicaid Services published a proposed rule to implement the Medicare Prescription Drug Benefit (Title I of the Medicare Modernization Act). Given the high level of interest in the proposed rules for implementing the Medicare drug benefit, the Kaiser Family Foundation commissioned Health Policy Alternatives, Inc. to prepare this summary of the proposed regulations. Issue Brief (.pdf)

  • Health Care Agenda for the New Congress

    Poll Finding

    This survey captures the public's attitudes regarding the health care agenda for Bush's second term and the new Congress in 2005. It assesses the relative priority placed on health-care concerns by the American public and also provides insight into public opinion on key issues likely to face the new Congress, such as implementing the Medicare drug law, controlling health care costs, reducing the nation’s uninsured population and reforming the malpractice litigation system. This survey of…

  • The Impact of Cost Sharing on Appropriate Utilization and Health Status: A Review of the Literature on Seniors

    Other Post

    The Impact of Cost-Sharing on Appropriate Utilization and Health Status: A Review of the Literature on Seniors This article provides a review of research that has addressed the impact of patient cost-sharing on the use of health care services and subsequent health status for those ages 65 and older. Twenty-two studies are reviewed -- 16 focusing on cost-sharing for prescription drugs and 6 on cost-sharing for medical services. The article concludes that most studies examined…

  • The New Medicare Rx Benefit:  Challenges for Maintaining Access to Prescription Drugs

    Other Post

    The New Medicare Rx Benefit: Challenges for Maintaining Access to Prescription Drugs With the launch of the new Medicare Part D prescription drug benefit less than 18 months away, and growing interest in beneficiaries’ access to medications in the future, the Kaiser Family Foundation is pleased to release two new publications that examine issues concerning access to medications raised by the implementation of the new Part D Medicare prescription drug benefit. The New Medicare Drug…

  • Long-Term Care in the United States: A Timeline

    Other Post

    Long-term care (LTC) in the United States has evolved over the course of the last century to better serve the needs of seniors and person with disabilities. This long-term care timeline outlines the major milestones in LTC from the nursing home era, which created an institutional bias in LTC, to the era of home and community based services (HCBS) and integration, and into the era of health reform and beyond.

  • The Role of Medicare and Beneficiaries in the Deficit-Reduction Debate

    Event Date:
    Event

    This Kaiser Family Foundation briefing examined how Medicare reform options now under consideration might work and their implications for beneficiaries and taxpayers. As context for understanding the potential effects of reforms, the briefing looked at the current and projected income and assets of people on Medicare, out-of pocket health care spending and the ability of Medicare beneficiaries to absorb rising costs. The Foundation also released a new report and video profiling Medicare families and the…