Medicare-related News

The Medicare Part D prescription drug benefit is provided by private plans, either Medicare Advantage plans that offer drug coverage (MA-PDs) or, for those in traditional Medicare, stand-alone prescription drug plans (PDPs). New data from CMS shows that 56 million people are enrolled in Part D plans as of February 2026, with more in MA-PDs than PDPs, reflecting higher overall enrollment in Medicare Advantage than in traditional Medicare. Enrollment in group MA-PD plans decreased while group PDP enrollment increased.

Just over 35 million people are enrolled in Medicare Advantage in February 2026, an increase of 1.1 million since a year ago. The increase was largely driven by increased enrollment in special needs plans.

This analysis of trends in health insurers’ financial data shows that insurers’ gross margins per enrollee dipped slightly in 2024 across four markets, remaining highest in the Medicare Advantage market, followed by the individual (non-group) market, the fully insured group (employer) market, and Medicaid managed care. The analysis also examines insurers’ medical-loss ratios across the four markets.

The Medicare drug price negotiation program could improve coverage of drugs selected for negotiation for Medicare beneficiaries because the law requires all Medicare Part D plans to cover each of the selected drugs, including all dosages and forms, when negotiated prices take effect. This analysis examines 2026 Medicare Part D formulary coverage of drugs selected for negotiation to measure the effect of the IRA's coverage requirement.

On January 1, 2026, the Center for Medicare & Medicaid Innovation (CMMI) launched the Wasteful and Inappropriate Service Reduction (WISeR) Model that establishes new prior authorization requirements in traditional Medicare. This analysis explores the potential impact of the WISeR model by examining recent spending and utilization trends in traditional Medicare for services selected for prior authorization requirements in the six model states (Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington).