Juliette Cubanski @jcubanski.bsky.social · 29/09/2026The bottom line is that it will pay to shop around during the 2027 Medicare open enrollment period and look past premiums to assess other benefit changes. Some enrollees will see only modest premium increases for their same PDP but others will see big jumps. Analysis of other changes is to come. 010
Juliette Cubanski @jcubanski.bsky.social · 29/09/2026The data released today don't tell us anything about Part D plan changes underneath the hood to control costs. Are plans dropping drugs from formularies, increasing copays, moving to coinsurance, etc. These features affect patient cost and access as much as (if not more than) premiums. 131
Juliette Cubanski @jcubanski.bsky.social · 29/09/2026Centene continues to offer the lowest premium PDPs. 2027 premiums will be as low as $5.30 (Wellcare Value Script) or $7.30 (Wellcare Classic) in many regions. Value Script has 6 million enrollees in 2026. Some will see modest premium increases, others modest reductions. www.kff.org/medicare/med...kff.orgMedicare Part D Enrollment, Premiums, and Cost Sharing in 2026 | KFFThe Medicare Part D program provides an outpatient prescription drug benefit to 56 million older adults and people with long-term disabilities in Medicare who enroll in private plans. This brief analy... 120
Juliette Cubanski @jcubanski.bsky.social · 29/09/2026In many states, enrollees in United’s AARP PDPs will face substantially higher premiums, with monthly premium increases of $50 or more in most states for AARP Medicare Rx Preferred and in many states for AARP Medicare Rx Saver. These plans enroll more than 2 million non-LIS enrollees in 2026. 132
Juliette Cubanski @jcubanski.bsky.social · 29/09/2026There will be no $0 premium PDPs for enrollees not receiving low-income subsidies in 2027. KFF analysis shows 28% of non-LIS PDP enrollees are in $0 premium plans this year. They will all face higher premiums in 2027. www.kff.org/medicare/med...kff.orgMedicare Part D Enrollment, Premiums, and Cost Sharing in 2026 | KFFThe Medicare Part D program provides an outpatient prescription drug benefit to 56 million older adults and people with long-term disabilities in Medicare who enroll in private plans. This brief analy... 121
Juliette Cubanski @jcubanski.bsky.social · 29/09/2026The overall number of stand-alone prescription drug plans will drop from 360 to 312, with two plans (HealthSpring Extra and SilverScript Choice) pulling out of multiple regions. Humana remains the only insurer offering three PDPs in all 34 PDP regions. 121
Juliette Cubanski @jcubanski.bsky.social · 29/09/2026CMS has just released information about Medicare drug plan offerings for 2027, emphasizing stability. Some quick top-level analysis about the stand-alone Part D drug plan market to follow. ⬇️ www.cms.gov/newsroom/pre...cms.govMedicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2027Medicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2027The Centers for Medicare & Medicaid Services (CMS) today announced significant premium savings for millions ... 263
Juliette Cubanski @jcubanski.bsky.social · 28/07/2026PDPs are already less competitive on premiums than Medicare Advantage drug plans, with average premiums 4x higher. Without the extra premium support, PDPs may soon seem even less affordable than MA-PDs overall, leading to further enrollment growth in Medicare Advantage. www.kff.org/medicare/med...kff.orgMedicare Part D Enrollment, Premiums, and Cost Sharing in 2026 | KFFThe Medicare Part D program provides an outpatient prescription drug benefit to 56 million older adults and people with long-term disabilities in Medicare who enroll in private plans. This brief analy... 010
Juliette Cubanski @jcubanski.bsky.social · 28/07/2026Without this enhanced financial support in place for 2027, some Medicare beneficiaries enrolled in PDPs could face steeper premium increases for drug coverage next year, though the plan-specific premium amounts are not yet known. That announcement will come in the fall. 100
Juliette Cubanski @jcubanski.bsky.social · 28/07/2026CMS originally stated the demo could last for at least 3 years, but after 2 years (2025 and 2026), CMS now states that, based on their evaluation of 2027 plan bids, PDP sponsors have gained "sufficient experience" to support bid development, therefore the extra subsidies are no longer needed. 100
Juliette Cubanski @jcubanski.bsky.social · 28/07/2026CMS has just announced the agency is ending the Part D premium stabilization demonstration after 2026. The demo provided extra subsidies to Part D stand-alone drug plan sponsors amid uncertainty about the impact on plan bids from the IRA's changes to the Part D benefit. www.cms.gov/files/docume...cms.gov 102
Juliette Cubanski @jcubanski.bsky.social · 21/04/2026Higher Medicare spending will result from CMS footing the bill for the expanded GLP-1 obesity drug coverage under the Bridge program; Part D plans will bear no costs for it. The longer duration of the GLP-1 Bridge is good news for beneficiaries but raises concerns re: higher Medicare spending. 000
Juliette Cubanski @jcubanski.bsky.social · 21/04/2026CMS said the BALANCE model wouldn't launch in 2027 without the participation of plans covering at least 80% of enrollees. Given the potential uptake in use of GLP-1s under the model, it seems many plans were reluctant to participate, even with the promise of access to discounted prices for GLP-1s. 100
Juliette Cubanski @jcubanski.bsky.social · 21/04/2026CMS has just announced that the BALANCE program for GLP-1 coverage will not launch in Medicare Part D in 2027 and the BRIDGE program will be extended through 2027 (it was set to run from July-Dec 2026). This could add billions to Medicare spending in 2027. www.kff.org/quick-take/w...kff.orgWhat Medicare's Temporary Program Covering GLP-1s for Obesity Means for BeneficiariesCMS’s efforts to expand Medicare coverage of GLP-1s for obesity could provide substantial benefits to millions of Medicare beneficiaries, given the potential demand for these highly effective medicati... 322
Juliette Cubanski @jcubanski.bsky.social · 20/04/2026Today, April 20, is the deadline for Medicare Part D plans to apply to participate in the BALANCE model for Medicare coverage of GLP-1 obesity drugs. Without robust plan participation, the model will not move forward in 2027. See our @kff.org brief for details. www.kff.org/medicare/wha...kff.orgWhat to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid | KFFThis brief describes current coverage of GLP-1s in Medicare and Medicaid, the Centers for Medicare & Medicaid Services’ (CMS) efforts to expand access and lower costs for GLP-1s through temporary demo... 101
Juliette Cubanski @jcubanski.bsky.social · 25/09/2025Medicare's State Health Insurance Assistance programs are still up and running! (For those who might not know about the role of SHIPs in helping people with Medicare navigate their coverage options, our new @KFF brief explains) www.kff.org/medicare/the...kff.orgThe Role of SHIPs in Helping People with Medicare Navigate Their Coverage | KFFThe State Health Insurance Assistance Program (SHIP) offers free counseling to help millions of Medicare beneficiaries make decisions about coverage. However, federal funding has been modest over the ... 020
Juliette Cubanski @jcubanski.bsky.social · 25/09/2025CMS is shutting down the National Training Program, whose mission is "to communicate Medicare and other CMS-program information that...can be used to effectively train the public." The site will be discontinued Oct 15, the first day of Medicare 2026 open enrollment cmsnationaltrainingprogram.cms.gov 22618
Juliette Cubanski @jcubanski.bsky.social · 04/04/2025Requiring Medicare to cover drugs to treat obesity would have increased Medicare spending by $25 billion over 10 years, but would also have helped millions of people with Medicare who might benefit from these drugs but can’t afford them due to their high price tags. www.kff.org/policy-watch...kff.orgProposed Coverage of Anti-Obesity Drugs in Medicare and Medicaid Would Expand Access to Millions of People with Obesity | KFFThis policy watch examines the implications of new proposed regulations that would allow Medicare and require Medicaid to cover drugs used to treat obesity, including a relatively new class of highly ... 042
Juliette Cubanski @jcubanski.bsky.social · 04/04/2025Spending on anti-obesity drugs has skyrocketed in recent years, even though they are now only covered under Medicare for uses other than obesity. One of these drugs, Ozempic (semaglutide), was recently selected for Medicare drug price negotiation, with total gross spending of $14 billion in 2024. 110
Juliette Cubanski @jcubanski.bsky.social · 04/04/2025🚨CMS just announced that Medicare will NOT move forward with a proposal to require coverage of drugs used to treat obesity. This proposal was issued at the end of the Biden administration but it was up to the Trump administration to finalize, or not. www.cms.gov/newsroom/fac... 143
Juliette Cubanski @jcubanski.bsky.social · 12/03/2025CMS makes it official: the Innovation Center will not move forward with the Medicare $2 drug list model, a Biden administration plan to test whether improved access to low-cost drugs would improve health outcomes, which Trump moved to cancel on day one of his second term. www.cms.gov/newsroom/fac...cms.govCMS Innovation Center Announces Model Portfolio Changes to Better Protect Taxpayers and Help Americans Live Healthier Lives | CMSWhat’s changing: Today, the CMS Innovation Center announced changes to its model portfolio to align with its statutory obligation and strategic goals. 094
Juliette Cubanski @jcubanski.bsky.social · 28/02/2025How workforce reductions at the Social Security Administration will affect people is unknown, but could make it harder for people to get connected to benefits they might qualify for through paperwork delays or other hurdles, which would in turn affect coverage through Medicare and/or Medicaid. 011
Juliette Cubanski @jcubanski.bsky.social · 28/02/2025Social Security is also a pathway to health coverage for people with disabilities, who can qualify for Medicare after receiving disability benefits for two years, or Medicaid for people receiving Supplemental Security Income, as our @kff.org brief explains. www.kff.org/medicare/iss...kff.orgThe Connection Between Social Security Disability Benefits and Health Coverage Through Medicaid and Medicare | KFFThis analysis examines who was eligible for Medicare and/or Medicaid between 2002 and 2022 because they received disability benefits from one of the country's Social Security disability programs, Soci... 111
Juliette Cubanski @jcubanski.bsky.social · 28/02/2025With news that Social Security is implementing major workforce reductions, it's worth noting that the agency plays a big role in helping people enroll in Medicare by processing applications for Part A and B, as well as for the Part D drug benefit's extra help program. www.kff.org/faqs/medicar...kff.orgI am turning 65 in a few months and want to go on Medicare. Will I be automatically enrolled in Parts A and B or do I need to sign up? | KFFIt depends. If you’re receiving benefits from Social Security or the Railroad Retirement Board (RRB) at least four months before you turn 65, you do NOT need to sign up; you’ll automatically get Part ... 144
Juliette Cubanski @jcubanski.bsky.social · 17/01/2025The outgoing Biden administration has proposed this change, but we don’t know yet whether the incoming Trump administration will decide to finalize this proposal. 010
Juliette Cubanski @jcubanski.bsky.social · 17/01/2025The outcome matters not just for the people on Medicare who are currently using these drugs for diabetes and cardiovascular disease risk reduction, but those who would take this drug in the future if Medicare coverage expands to cover anti-obesity drugs, which is currently prohibited. 110
Juliette Cubanski @jcubanski.bsky.social · 17/01/2025🚨 Round 2 of Medicare's drug price negotiation program just kicked off. The popular diabetes and obesity drugs Ozempic and Wegovy are at the top of the list. Medicare price negotiation could play a key role in increasing affordability and access to these drugs. www.kff.org/quick-take/w...kff.orgWhy Medicare Drug Price Negotiation Matters for Potential Medicare Coverage of Obesity DrugsIt’s quite likely that one of these popular anti-obesity medications will be selected for negotiation in the next round of Medicare’s relatively new drug price negotiation program. 142
Juliette Cubanski @jcubanski.bsky.social · 26/11/2024This proposal would also expand coverage under state Medicaid programs, which currently can but aren't *required* to cover drugs to treat obesity. Our new policy watch explains the implications of this proposed change for Medicare and Medicaid coverage and costs. www.kff.org/policy-watch...kff.orgProposed Coverage of Anti-Obesity Drugs in Medicare and Medicaid Would Expand Access to Millions of People with Obesity | KFFThis policy watch examines the implications of new proposed regulations that would allow Medicare and require Medicaid to cover drugs used to treat obesity, including a relatively new class of highly ... 056
Juliette Cubanski @jcubanski.bsky.social · 26/11/2024It's important to note that this is a proposed rule that will be finalized under the incoming Trump administration. Will the new administration finalize the change as proposed, try to modify it, or pull back altogether on this popular idea of allowing Medicare to cover these drugs? Time will tell. 110
Juliette Cubanski @jcubanski.bsky.social · 26/11/2024This would be a big deal for millions of people with obesity on Medicare who currently have to pay the full price of these drugs out of pocket, if they can even afford to - unless they also have another condition where Medicare is already authorized to cover these drugs, like for type 2 diabetes. 110
Juliette Cubanski @jcubanski.bsky.social · 26/11/2024The Biden administration has proposed to allow Medicare to cover anti-obesity drugs, which is currently prohibited by law. The proposals hinges on reinterpreting the statutory language to allow coverage when these drugs are used to treat obesity, which is now commonly regarded as a disease. 153
Juliette Cubanski @jcubanski.bsky.social · 22/11/2024With 2 weeks left in #Medicare open enrollment, people in stand-alone #PartD drug plans are facing a lot of changes in the market, with fewer choices overall and higher premiums for some plans but lower premiums for others. More details in our analysis of the 2025 market: www.kff.org/medicare/iss...kff.orgMedicare Part D in 2025: A First Look at Prescription Drug Plan Availability, Premiums, and Cost Sharing | KFFMedicare Part D is a voluntary outpatient prescription drug benefit for people with Medicare provided through private plans, including stand-alone prescription drug plans and Medicare Advantage plans ... 024
Juliette Cubanski @jcubanski.bsky.social · 21/11/2024For Medicare D, the law defines what drugs will and won't be covered >> drugs and vaccines that are approved by the Food & Drug Administration (with a few exceptions, like anti-obesity drugs). So Congress would need to change the law in order to change what drugs and vaccines Medicare covers. 151
Reposted by Juliette CubanskiCynthia Cox @cynthiaccox.bsky.social · 21/11/2024NEW @kff.org calculator tool shows how much more ACA enrollees will pay if enhanced subsidies to expire www.kff.org/interactive/...kff.orgHow Much More Would People Pay in Premiums if the ACA's Enhanced Subsidies Expired? | KFFEnhanced Affordable Care Act (ACA) subsidies lower premium payments for ACA Marketplace coverage by boosting existing ACA subsidies and making some people newly eligible. Enrollees across incomes bene... 32229
Juliette Cubanski @jcubanski.bsky.social · 19/11/2024It's also worth keeping an eye on the several lawsuits that have been filed against the negotiation program by drug companies and the pharma industry, and how vigorously HHS under President-elect Trump will continue to defend the program in court. 000
Juliette Cubanski @jcubanski.bsky.social · 19/11/2024It is unclear what direction the incoming Trump administration might choose to take with respect to the negotiation program, but it certainly seems possible that the approach to implementation in 2025 and beyond may differ from that which was laid out in CMS’s most recent guidance. 100
Juliette Cubanski @jcubanski.bsky.social · 19/11/2024A key deadline for Medicare's drug price negotiation program will come soon after President-elect Trump is inaugurated: releasing the list of up to 15 drugs selected for round 2 of negotiation by Feb 1, 2025. Our updated FAQs has a timeline of key activities to watch. www.kff.org/medicare/iss... 111