Proposals Related to: Part D beneficiary choice
In recent years, while enrollment in Medicare Advantage plans has grown, the availability of stand-alone prescription drugs plans (PDPs) for individuals in traditional Medicare has declined. Premiums for PDPs are many times higher than for drug benefits offered through MA plans, partly because MA plan sponsors can use some of their Part C payments to “buy down” Part D drug costs. In 2025, the number of PDPs dropped by 35 percent, and PDPs with premiums that fell below the benchmarks to qualify as premium-free to enrollees who receive Part D’s low-income subsidy dropped by 29 percent.
These trends have occurred for a number of structural reasons as well as several important changes to Part D’s benefit design that took place in 2025. If, over time, plan sponsors do not offer any private PDPs or if there is too little PDP competition, beneficiaries who prefer traditional Medicare would no longer have affordable options for obtaining prescription drug coverage.
Among the changes to Part D’s benefit design was to initiate the Medicare Prescription Payment Program (MPPP), which allows enrollees to smooth cost sharing over the year rather than pay large amounts such as deductibles at the start of the year. However, the MPPP is not advantageous for all beneficiaries, such as those who pay relatively low copays.
Proposals in this category would have CMS set up publicly-run PDPs or would require Part D plans to educate enrollees about why the MPPP makes sense for some but not all people.
NOTE: Entries with grey backgrounds are Georgetown estimates. Entries with white backgrounds are either descriptive information or analysis made by or for the proposal authors.
| Proposal | Effects on beneficiaries | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Short description | Category | Author | Federal savings (-$) or costs (+$) | Access to plans | Enrollee costs | Supplemental benefits | Part B premiums | Other affected stakeholders | |
Key:
- Federal savings or costs. When available, we provide original estimates from source materials by the proposal author(s) or from the Congressional Budget Office. Authors prepared estimates for some proposals at a time when plan enrollment and payments differ from today, and thus estimates of savings or costs should be interpreted cautiously. When no author’s estimate was available, Georgetown provided an estimate, as indicated by grey highlighting. Click Details for more information about savings or costs for a specific proposal.
Estimates in source materials prepared by the author(s) cover different numbers of years and windows of time. To give website users a consistent sense of magnitude, we categorized proposals by whether its estimate was approximately less than $10 billion over 5 years or greater than or equal to that amount. Thus, in this column,- +$ indicates anticipated costs to the federal government of less than $10 billion over 5 years.
- +$$ indicates anticipated costs of $10 billion or more over 5 years.
- –$ indicates anticipated savings to the federal government of less than $10 billion over 5 years.
- –$$ indicates anticipated savings of $10 billion or more over 5 years.
- We list a question mark for proposals in which the author(s) would need to specify more detail to estimate federal spending.
- Effects on beneficiaries. When available, the estimate was provided by the proposal author(s) within the cited source materials. When no author’s estimate was available, Georgetown provided an estimate, as indicated by grey highlighting. In the four columns under this header,
- Up arrows indicate anticipated greater access to plans, higher costs (premiums and cost sharing) for plan enrollees, more availability of extra benefits, or higher Part B premiums applicable to all beneficiaries.
- Down arrows indicate the reverse effects.
- Combined up and down arrows indicate mixed effects, such as up for some categories of beneficiaries and down for others.
- Categories may also be reported as “minimal or no effect” or “not applicable.”
- We list a question mark for proposals in which the author(s) would need to specify more detail to estimate effects on beneficiaries.
- Click Details for more information about beneficiary effects for a specific proposal.
- Other affected stakeholders. This column reports any stakeholders other than Medicare beneficiaries likely to be affected significantly by the proposal. Click Details for more information about a specific proposal.