Each year, KFF (formerly known as the Kaiser Family Foundation) releases valuable insights into Medicare Advantage. Their latest analyses shed light on how the program is evolving in 2025—from enrollment trends to plan costs, added benefits, and prior authorization requirements.
Enrollment Growth Slows but Remains Strong
As of 2025, 54% of eligible Medicare beneficiaries are enrolled in a Medicare Advantage plan. While enrollment continues to grow, the pace has slowed compared to previous years. One notable trend is the steady rise in Special Needs Plans (SNPs)—now covering 1 in 5 Medicare Advantage members. Also worth noting: the market remains dominated by a small number of large insurance companies, limiting competition in many regions.
Premiums and Rebates: What Enrollees Are Paying
A key takeaway from the second KFF analysis is that 76% of people in Medicare Advantage plans with drug coverage pay no premium beyond their standard Medicare Part B premium. In fact, more plans are now offering rebates against that Part B premium—up from 12% in 2024 to 32% in 2025.
However, most of those rebates are modest. About half of enrollees receiving a rebate get less than $10 per month, while only 36% get a rebate of $50 or more.
Prior Authorization Still Widespread
For those enrolled in Medicare Advantage, prior authorization remains common, especially for higher-cost services. Here’s how it breaks down:
- 99% require prior authorization for skilled nursing facility stays
- 98% for Medicare Part B drugs
- 96% for inpatient hospital stays (acute)
- 93% for psychiatric hospital stays
- 80% for outpatient psychiatric care
These requirements can lead to delays or added paperwork for patients and providers alike.
What This Means for You
Whether you’re already enrolled in Medicare Advantage or considering your options, it’s important to stay informed. Trends in plan availability, costs, and coverage rules can all impact your health care experience and budget.
If you have questions or want help evaluating your Medicare options, contact us at Eriksen Insurance. We’re here to help you navigate the details and make informed choices that fit your needs.