Medicare Advantage has been in some turmoil over the last couple of years, as payment methods have come under scrutiny and been changed and some issues around prior authorization practices have arisen. The program has been a big source of profit for health plans, but with increases in utilization and an end to some of the payment games, now many plans are dropping geographic areas and cutting membership. So how has this affected membership overall? The Kaiser Family Foundation released a recent report on the topic. Despite the turmoil, Medicare Advantage has continued to grow and 55% of all beneficiaries are in the program for 2026. About a fourth of the Medicare Advantage enrollees are in what is called a “Special Needs” plan, which means they are also enrolled in Medicaid or have certain serious diseases. These plans account for most of the recent growth in Medicare Advantage enrollment. Around 16% of MA enrollees come from group plans, usually employer-sponsored to provide benefits for retirees.
Medicare Advantage enrollment in concentrated among a few large health plan companies. UnitedHealthCare has a 26% market share and Humana a 20%, so these two firms account for almost half of all MA enrollment. UnitedHealth has intentionally lowered its membership over the last two years, dropping unprofitable geographies, while Humana is focused exclusively on MA. Humana added about 1.3 million members in 2026 while UnitedHealth dropped about 650,000. Aetna and Kaiser are the next largest organizations. Total MA enrollment rose by a little over 1 million beneficiaries in 2026, a similar growth rate to prior years. Projections are that the program will have over 60% of all Medicare members in the next few years. (KFF Report)
Medicare Advantage continues to be popular because for most people there is no premium associated with enrollment, cost-sharing amounts are lower and there are supplemental benefits not offered by fee-for-service Medicare. If the government continues with payment reform, and it should, we will see if the plans are able or willing to continue to offer these more generous benefits.
