Newsletter

MEDICARE ADVANTAGE ENROLLMENT: WINNERS AND LOSERS

The following article by Nona Teper and Kevin Davis appeared in the February 18 issues of Modern Healthcare.

Medicare Advantage enrollment reached 35.5 million in February, up 3.2% from a year ago. (Pat Fanelli/Modern Healthcare illustration)

Medicare Advantage enrollment growth slowed over the past year, new data from the Centers for Medicare and Medicaid Services show.

As of February 1, 35.5 million people were enrolled in Medicare Advantage plans, a 3.2% increase from a year before, according to a Modern Healthcare analysis of CMS data. That compares to a 4% increase in 2025.

Health insurance companies had projected enrollment would contract. Major carriers including UnitedHealth Group subsidiary and market leader UnitedHealthcare, Elevance Health, CVS Health subsidiary Aetna, and Centene shed members as they scaled back and sought to restore profit margins in the segment. Humana, second in Medicare Advantage market share, gained 1.2 million policyholders.

After being a cash cow for decades, Medicare Advantage has evolved into a drag on earnings over the past three years.

High medical costs, a difficult coding change, and lower bonus payments spurred insurers to exit geographic markets, favor HMOs over PPOs and cut back on benefits to reduce their exposure. Some smaller companies have quit the program completely, which Molina Healthcare also plans to do at the end of the year.

Health insurance companies and investors are looking ahead anxiously at next year because CMS has proposed holding Medicare Advantage payments virtually flat and tightening the program’s risk-adjustment system.

Humana saw the largest membership gains for 2026 while UnitedHealthcare shrank the most.

As bigger insurers fled markets or the program itself, smaller players grew. Blue Cross and Blue Shield of Minnesota and Medica reported some of the largest gains after UCare stopped selling Medicare Advantage plans,a for instance.

Companies such as Devoted Health and Scan Health Plan strove to grow their Medicare Advantage businesses and succeeded by adding members.

Yet the insurers that won market share must now contend with the members and costs their rivals sought to avoid.

Enrollment in Medicare Advantage Special Needs Plans outpaced standard Medicare Advantage plans as membership increased 12.2% to 8.2 million.

VIRTUALLY FLAT INCREASE IN MEDICARE ADVANTAGE PAYMENTS PROPOSED FOR 2027

Medicare Advantage insurers are in line for a meager boost to payments next year under a proposed rule the Centers for Medicare and Medicaid Services issued on January 26. Leading carriers such as UnitedHealthcare and Humana got a shock when the Centers for Medicare and Medicaid Services proposed virtually flat Medicare Advantage payments next year — not the bigger raise Wall Street expected — along with limits on tactics that have boosted revenue at taxpayer expense.

The draft regulation calls for a 0.09% payment increase. The investment bank TD Cowen, for example, expected a 5%-6% rise, according to a research note the investment bank published. CMS has exerted tighter control over Medicare Advantage spending under both President Joseph Biden and under President Trump.

“Health plans welcome reforms to strengthen Medicare Advantage. However, flat program funding at a time of sharply rising medical costs and high utilization of care will impact seniors’ coverage,” a spokesperson for the health insurance trade group AHIP said in a news release. “If finalized, this proposal could result in benefit cuts and higher costs for 35 million seniors and people with disabilities when they renew their Medicare Advantage coverage in October.”

CMS accepted comments on the proposed rule through February 25 and is slated to publish the final rule by April 6.

MEDICARE SPECIAL NEEDS PLAN ENROLLMENT: WINNERS AND LOSERS

This article was written by Tim Broderick for Modern Healthcare on February 19.

Medicare Advantage Special Needs Plan enrollments continue to outpace sign-ups for standard Medicare policies.

Membership in Special Needs Plans, or SNPs, was 8.2 million as of February 1, up 12.2% from a year before, according to a Modern Healthcare analysis of Centers for Medicare and Medicaid Services data. That compares to 10.1% growth in 2025. Nearly one-quarter of Medicare Advantage beneficiaries are now covered under SNPs.

Health insurance companies struggling to restore profit margins in traditional Medicare Advantage are leaning into the higher-margin market for Dual Eligible Special Needs Plans, or D-SNPs, for people who qualify for both Medicare and Medicaid; Chronic Condition Special Needs Plans, or C-SNPs; and Institutional Special Needs Plans, or I-SNPs, for beneficiaries in long-term care facilities.

UnitedHealth Group subsidiary UnitedHealthcare posted the greatest SNP enrollment gains from 2025-2026, while Elevance Health experienced the greatest SNP membership loss.

Market leader UnitedHealthcare, CVS Health subsidiary Aetna, Devoted Health and other insurers are betting they can manage care and expenses for the Medicare beneficiaries with the greatest needs. Molina Healthcare will only sell SNPs next year as it retreats from standard Medicare Advantage plans.

Most of UnitedHealth’s growth came from C-SNPs, which are designed for beneficiaries with ailments such as cardiovascular disease, diabetes, and kidney failure.

Insurers offered more new C-SNPs this year than any other type of Medicare Advantage plan, and enrollment jumped 48.6% to 1.6 million, marking the second consecutive year C-SNPs grew the most. Aetna and Devoted Health more than doubled their C-SNP memberships after expanding to new geographic markets.

A federal push to better integrate Medicare and Medicaid benefits, along with the cancellation of CMS’ Value-Based Insurance Design model, also fueled participation.

Still, D-SNPs remain the largest form of Special Needs Plan, and enrollment rose 5.7% to 6.4 million. This partially reflects insurers converting Medicare-Medicaid Plan enrollees to D-SNPs.

In this hypercompetitive market, the fastest-growing companies acquired their way to the top.

Health Care Service Corp.’s $3.3 billion purchase of Cigna’s Medicare Advantage business propelled the Blue Cross and Blue Shield licensee’s D-SNP membership nearly 900% to more than 76,800. CareSource’s buyout of Commonwealth Care Alliance and ElderServe Health likewise elevated its position.

Meanwhile, I-SNPs remain the smallest, slowest growing segment of this market. I-SNP enrollment grew 5.4% to 128,700.

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."

Contact Us

Local: 561-734-3884 (TTY: 711)

Toll-free: 877-734-3884 (TTY:711)