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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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  • An Implementation Perspective on Part D, the Medicare Prescription Drug Program

    Report

    This focus group of 12 state Medicaid officials conducted in November 2005 explores the current status and likely results of the Part D dual eligible transition efforts as well as other Part D-related issues of particular importance to states. It includes discussion of the transition of dual eligibles from Medicaid to Medicare drug coverage, evaluating Part D plan options, states’ role in the low-income subsidy program, the fiscal implications of Part D to states, and…

  • Explaining Health Care Reform: How Do Health Care Costs Vary By Region?

    Issue Brief

    Although regional variations in health spending have been studied for decades, there is renewed focus on this issue because of the role of health care costs in health care reform and the potential source of funds if addressing cost variations can yield savings. This explainer examines what is known about regional variations in health care costs and their relationship to quality of care, and addresses key questions about their role in health reform. Issue Brief…

  • Pulling it Together: The Sleeper in Health Reform

    Perspective

    The health reform legislation currently being crafted on Capitol Hill is undeniably complex.  To oversimplify slightly it can be boiled down into four parts: coverage (subsidies for private coverage and Medicaid expansions); delivery and payment reforms; insurance market reforms and regulations; and prevention, with each broad category containing a range of specific policy proposals and ideas. There’s been a lot of discussion so far about coverage expansions and how to pay for them, as well…

  • 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…

  • 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…

  • Medicare Part D Spending Trends: Understanding Key Drivers and the Role of Competition

    Issue Brief

    This brief commissioned by the Foundation examines factors that contributed to Medicare's lower-than-expected spending on prescription drugs under the Medicare Part D drug benefit that started in 2006. Since its launch, Medicare has spent about 30 percent less on Part D benefits than the Congressional Budget Office originally projected. Some cite the program's design, with private plans competing for enrollment, as the driving factor in lower spending; others point to factors in the overall market…

  • Women and Medicare

    Fact Sheet

    Medicare is a critical source of health insurance coverage for virtually all older women in the U.S. and for many younger women who have permanent disabilities. Because women have longer life expectancies than men, more than half (57%) of the people covered by the program are women. In 1999, there were 21 million women on Medicare 19 million ages 65 and over and another 2 million women under age 65 with disabilities who received Social…