Newsletter

KEY FACTS ABOUT MEDICARE DRUG COVERAGE ENROLLMENT IN 2025

As reported by the Kaiser Family Foundation.

In 2025, nearly 55 million beneficiaries are enrolled in either stand-alone drug plans or Medicare Advantage plans that include drug coverage. Here's a breakdown of key updates, trends, and market shifts as reported by the Kaiser Family Foundation.

Enrollment Snapshot

• Total Part D enrollment: 54.8 million
• Medicare Advantage drug plans (MA-PDs): 32 million (58%)
• Stand-alone Prescription Drug Plans (PDPs): 23 million (42%)

While MA-PD enrollment continues to grow, PDP enrollment remains stable despite fewer plan options.

Premiums And Cost Sharing

• Average monthly premiums:

o   PDPs: $39 (down from $43 in 2024)

o   MA-PDs: $7 (down from $9 in 2024

• Zero-premium coverage:

o  80% of MA-PD enrollees without subsidies pay $0

o Only 31% of PDP enrollees without subsidies pay $0

Note: MA-PDs benefit from rebate dollars (these don’t exist for stand-alone PDP plans) that help lower premiums.

Extra Help [Low-Income Subsidy (LIS)]

Enrollment

• Total Extra Help enrollees: 13.1 million (down from 13.7 million in 2024)

• 67% (8.8 million) are enrolled in MA-PDs

• 6 million are in Special Needs Plans (SNPs) for dual-eligible individuals

The decline in Extra Help enrollment is largely due to Medicaid disenrollments following the end of COVID-era continuous coverage protections.

Who Has The Largest Market Share?



These are the five largest carriers by combined enrollment in MA-PDs and stand-alone PDPs for 2025:

Together, these five carriers account for approximately 73% of all Medicare Part D enrollment in 2025. The remaining 27% is spread across regional plans, smaller insurers, and new entrants to the market.

Spotlight: Five Largest Stand-Alone Part D Carriers in 2025

These carriers dominate the stand-alone PDP market, accounting for nearly 90% of enrollment nationwide:

UnitedHealthcare offers PDPs, but its plans rank outside the top five by enrollment. compared to competitors.

Final Takeaway

With premiums trending downward and a new $2,000 out-of-pocket cap in place, 2025 brings meaningful changes to Medicare Part D. MA-PDs continue to dominate the market, while Extra Help enrollment shifts reflect broader changes in Medicaid eligibility. As always, understanding the landscape helps beneficiaries make informed plan choices.

Important Tip: When choosing a plan with drug coverage, beneficiaries should always check their medications to determine how--or if--they are covered by the plan they are choosing.

MEDICARE AT 60: A POPULAR PROGRAM FACING CHALLENGES

This is a summary of an article written by Tricia Neuman, Jeannie Fuglesten Biniek, and Juliette Cubanski for the Kaiser Family Foundation that was published on July 10, 2025.

Overview

Medicare covers 67 million older adults and people with disabilities and enjoys broad support across the political spectrum. Since its inception, it has extended life expectancy, helped narrow racial and socioeconomic disparities in care, and become a cornerstone of health and retirement security in the United States—so much so that policymakers treat it as a third rail of politics.

Key Challenges

• Privatization: Enrollment in private Medicare Advantage plans has surged, raising questions about the implications of private insurers playing a more dominant role in delivering Medicare benefits.

• Affordability: Gaps in covered benefits and rising out-of-pocket costs leave some beneficiaries struggling with medical and drug expenses.

• Sustainability: Demographic shifts, a declining worker-to-beneficiary ratio, and escalating health care costs place long-term financing at risk and threaten Medicare’s ability to serve future generations.

Policy Questions Ahead

As Medicare approaches its 60th anniversary, three fundamental questions guide the debate:

1. What does Medicare’s transformation toward private plans mean for costs, quality, and access?

2.  Which benefit enhancements and affordability measures could close existing coverage gaps?

3. How can financing be structured to preserve Medicare for today’s beneficiaries and tomorrow’s retirees?

As these questions drive the policy agenda, stakeholders from Capitol Hill to community clinics will weigh in on how best to evolve America’s most popular health insurance program.

MEDICARE ADVANTAGE MARKET SHOWS ALARMING LACK OF COMPETITION

A new analysis from Kaiser Family Foundation (KFF) reveals that Medicare Advantage markets are overwhelmingly dominated by one or two insurers, raising concerns about limited consumer choice and reduced competitive pressure.

Key Findings:

• In 2024, 97% of U.S. counties were classified as either highly (79%) or very highly (18%) concentrated.

• Two carriers (UnitedHealthcare and Humana) were the top insurers in two-thirds of counties, accounting for 59% of total enrollment.

• Ninety percent of Medicare beneficiaries lived in counties where at least half of enrollees were covered by plans from just one or two insurers. Note: there are many carriers in South Florida, so this is not true for that market.

• Rural areas face even greater consolidation: 39% of the most rural counties were very highly concentrated, compared to just 6% of urban counties.

Implications: This high concentration may diminish incentives for insurers to offer better benefits or lower costs, undermining the original goal of Medicare Advantage—to foster competition and improve care. Despite these trends, regulatory attention has been minimal, with the last major federal intervention occurring in 2017.

For policymakers and stakeholders, the report underscores the need to reassess market dynamics and consider reforms that promote greater insurer diversity and consumer choice.

About Paul Cholak

Paul is a licensed, independent health and life insurance agent and has over forty years of benefits experience and specializes in helping Medicare beneficiaries obtain health insurance. However, he offers a complete array of life and health insurance products to individuals of all ages.

He guides Medicare beneficiaries through the steps of getting insurance and is available to help clients both BEFORE and AFTER they've made their purchase decision.

Disclaimer for Part C and D plans: "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY: 1-877-2048) to get information on all your options."

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