What’s Happening
CMS projects that Medicare Advantage (MA) enrollment will decline to 34 million beneficiaries in 2026, down from 35 million this year—the first decrease in nearly two decades. According to the agency’s data, the three largest national carriers are scaling back plan offerings by roughly 11%:
UnitedHealth is exiting Vermont and 109 counties, discontinuing 100 plans that serve 600,000 members. The company is also shifting more members from PPOs to HMOs, where costs are easier to manage.
Humana is retreating from three states and 194 counties, reducing its presence to 85% of U.S. counties.
CVS/Aetna is exiting Wyoming and 100 counties but expanding its Special Needs Plan (SNP) offerings across 16 states.
Carriers cite funding cuts, higher healthcare utilization, and CMS’s updated risk-adjustment model (Version 28)—which reduces reimbursement for higher-risk members by about 3%—as primary reasons for their retrenchment.
Key Takeaways
Medicare Advantage enrollment will decline for the first time in 20 years, signaling market recalibration after years of rapid growth.
National insurers are scaling back plan offerings by 11%, prompting regional plans to expand into new, higher-risk markets.
Operational strain and payer volatility are rising, as funding cuts and new CMS risk-adjustment rules squeeze margins.
Industry partners that enable financial forecasting, care coordination, and administrative automation will be critical to help health systems adapt.