Category: Medicare Advantage

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Medicare Advantage Research & Data

Putting 2026 Medicare Advantage Plan Changes into Context

Despite headlines about insurers pulling back from certain markets, a report by Arnold Ventures reveals that the Medicare Advantage market remains highly robust in 2026. According to the data, over 99% of Medicare-eligible individuals still have access to at least two plan options.

While the average number of plans available per beneficiary slightly decreased from 2025, seniors still choose from an average of 39 plans, a massive 67% increase compared to 2019. Insurers have primarily reduced redundant plan variations rather than exiting major geographical footprints altogether.

However, the report notes that roughly 165,000 beneficiaries in highly specific rural counties in states like Vermont, Colorado, and Minnesota did face meaningful reductions in options, highlighting the ongoing disparity between urban and rural Medicare Advantage access.

Download the full brief from Arnold Ventures (PDF)

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Medicare Advantage Medicare Policy & Trends Research & Data

Medicare Advantage in 2026: Premiums, Limits, and Prior Authorization Trends

A recent analysis by KFF provides a comprehensive look at the Medicare Advantage landscape in 2026. While enrollment growth has slightly decelerated, a record 55% of all eligible Medicare beneficiaries are now enrolled in private plans.

For 2026, the average beneficiary has access to 39 different plan options, with 31 of those being zero-premium plans. The average out-of-pocket limit for in-network services sits at $5,421, providing a safety net for enrollees with high medical needs.

Despite concerns over tightening federal payments, the availability of supplemental benefits like dental, vision, and hearing has remained stable. However, prior authorization continues to be universally applied, with 99% of enrollees in plans that require approval for certain services.

Read the full KFF analysis here

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Information Medicare Advantage Plan Changes

What to Do If Your Medicare Advantage Plan Exits Your County

If you’ve received a notice that your Medicare Advantage plan is leaving your county at the end of the year, don’t panic — but do act quickly. Millions of seniors have faced similar disruptions in 2026 as insurers reshuffle their offerings.

When a plan exits, you’re granted a Special Enrollment Period (SEP). You can either enroll in another Medicare Advantage plan that serves your area, or return to Original Medicare and purchase a Medigap policy (with guaranteed-issue rights in many cases). The key is to compare your options before the SEP window closes.

Visit Medicare.gov to see all plans available in your ZIP code, or call 1-800-MEDICARE for free, unbiased counseling through your State Health Insurance Assistance Program (SHIP).

Compare plans at Medicare.gov

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Medicare Advantage Medicare Policy & Trends

Assessing Recent Regulatory Action on Medicare Advantage Spending

A new piece in Health Affairs examines the Centers for Medicare and Medicaid Services’ (CMS) ongoing efforts to rein in excess spending within the Medicare Advantage program. The 2027 Advance Notice, released early in 2026, proposed a tight 0.09% payment increase for insurers, signaling a stricter regulatory environment.

One of the most notable proposals is CMS’s intent to remove diagnosis codes captured exclusively through “unlinked chart reviews” when calculating risk scores. Researchers estimate this coding intensity has historically led to billions in overpayments to private plans compared to traditional fee-for-service Medicare.

The article suggests these regulatory adjustments are a necessary first step to ensure the financial sustainability of the $647-billion-a-year program while protecting the quality of care for beneficiaries.

Read the full policy breakdown at Health Affairs

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Information medicare Medicare Advantage Medicare Plans

Explore your Medicare coverage options

Choosing between Medigap and Medicare Advantage remains one of the most important decisions for new Medicare beneficiaries, and the tradeoffs have shifted in 2026.

Medigap plans offer predictable out-of-pocket costs and access to any Medicare provider nationwide, but premiums are higher and prescription drug coverage requires a separate Part D plan.

Medicare Advantage plans often feature low or zero premiums and include extra benefits like dental and vision, but provider networks are limited and prior authorization requirements can create care delays.

Financial planners recommend that beneficiaries who travel frequently or have complex medical needs consider Medigap, while those who prioritize low monthly costs and supplemental benefits may find Medicare Advantage more suitable.

Compare plans through Medicare.gov.

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medicare Medicare Advantage Special Needs Plans

Special Needs Plans: The Fastest-Growing Part of Medicare Advantage

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Special Needs Plans, known as SNPs, are now driving the majority of Medicare Advantage enrollment growth as they serve beneficiaries with specific health conditions, institutional care needs, or dual Medicare-Medicaid eligibility.

Three types of SNPs are available: Chronic Condition SNPs for conditions like diabetes or heart disease, Institutional SNPs for nursing home residents, and Dual Eligible SNPs for those on both Medicare and Medicaid.

These plans tailor provider networks, drug formularies, and care coordination to the specific needs of their members, often including benefits traditional Medicare Advantage plans do not offer.

Beneficiaries who qualify for an SNP can enroll at any time during the year, not just during the Annual Enrollment Period, making them an important option for those with changing health needs.

Learn more about SNPs from CMS.

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Costs Medicare Advantage

Medicare Advantage Faces Reality Check as Costs Rise

Rising costs and tighter regulations are forcing changes across Medicare Advantage that could impact seniors directly, from higher premiums to reduced benefits. (Source: MarketWatch)

Key Takeaways

  • Industry facing first major profitability pressure
  • Supplemental benefits likely to be reduced
  • Review your 2027 Annual Notice of Changes carefully

Source: MarketWatch

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Market Trends Medicare Advantage

Insurers Pull Back Medicare Advantage Plans Nationwide

Insurers are scaling back Medicare Advantage offerings, leaving some counties with fewer options as rising costs reshape the market. (Source: Investopedia)

Key Takeaways

  • Major insurers scaling back offerings
  • Rural counties hit hardest
  • Seniors facing fewer choices for 2027

Source: Investopedia

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CMS Updates Medicare Advantage

CMS Receives Record Pushback on Medicare Advantage Changes

CMS faces record industry backlash over proposed changes to Medicare Advantage payment models, with unprecedented public comments submitted. (Source: Healthcare Dive)

Key Takeaways

  • Record number of public comments submitted
  • Industry warns of benefit reductions
  • Final rule expected soon

Source: Healthcare Dive

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Market Trends Medicare Advantage

Medicare Advantage Growth Slows Dramatically in 2026

Growth in Medicare Advantage is slowing sharply to just 3.2 percent, with niche Special Needs Plans now driving 83 percent of new enrollments. (Source: MarketWatch)

Key Takeaways

  • Growth dropped to 3.2 percent from 7 to 10 percent annually
  • Special Needs Plans drive 83 percent of new enrollment
  • Traditional Medicare Advantage reaching saturation

Source: MarketWatch