Introduction
The Medicare Advantage (MA) market entered 2026 in a markedly different phase than the rapid expansion years that followed the pandemic. While total enrollment continues to grow — reaching nearly 29.6 million Individual MA beneficiaries and 5.7 million Group MA members — the pace of expansion has clearly moderated.
Yet beneath this topline deceleration lies a far more dynamic story. Enrollment mix is shifting away from traditional Non-SNP products toward specialized and higher-acuity segments, particularly Dual-Eligible (D-SNP) and Chronic (C-SNP) plans. Local HMOs have strengthened their dominance, while PPO momentum has cooled. At the same time, market leadership is being reshaped, with select growth-focused carriers capturing share as several legacy incumbents experience meaningful attrition.
This analysis provides a comprehensive 2026 view of the MA landscape — examining national trends, state-level dynamics, segment performance across MA-Only and MAPD, Special Needs Plans (SNPs), and plan type evolution. Drawing on enrollment data from the Centers for Medicare & Medicaid Services (CMS), the report highlights where growth is accelerating, where pressure is building, and how competitive positioning is evolving across the market.
Medicare Advantage 2026: Individual MA — The Growth Deceleration
The Medicare Advantage (MA) market continues to expand, reaching 29.6 million individual beneficiaries in 2026 across 5,592 plans offered by 170 payors. While total enrollment has steadily increased each year since 2022, the pace of growth has clearly moderated. Year-over-year (YoY) growth peaked at over 7% in 2023 and 2024, before slowing to 4.6% in 2025 and further decelerating to just over 3% in 2026. Net enrollment tells a similar story — annual additions have declined materially from approximately 839K in 2023 to just under 150K in 2026. In short, the Medicare Advantage 2026 market is still growing — but the era of rapid acceleration has transitioned into a phase of moderate expansion.
29.6M
Total Enrollment 2026
3.1%
YoY Growth
(vs 7.3% in 2024)
149K
Net Additions
(vs 839K in 2023)
170
Active Payors
in Market
Enrollment Trend — Individual MA (2022–2026)
| Year |
Enrollment |
YoY Growth |
Net Enrollment |
| 2022 | 23,868,620 | — | — |
| 2023 | 25,572,465 | +7.1% | +838,908 |
| 2024 | 27,445,728 | +7.3% | +723,585 |
| 2025 | 28,700,036 | +4.6% | +429,455 |
| 2026 | 29,598,175 | +3.1% | +149,657 |
Key Trend: Across the Medicare Advantage 2026 market, net enrollment has declined from 839K additions in 2023 to just 150K — an 82% drop over three years despite continued positive overall growth. All enrollment figures are sourced from
Centers for Medicare & Medicaid Services (CMS) enrollment data.
Enrollment by Plan Description
| Plan Description |
2025 Enrollment |
2026 Enrollment |
Share 2025 |
Share 2026 |
| Renewal Plan | 19,070,721 | 19,280,298 | 66.5% | 65.2% |
| Renewal Plan with SAR | 3,920,127 | 4,202,567 | 13.7% | 14.2% |
| Renewal Plan with SAE | 2,353,659 | 1,680,413 | 8.2% | 5.7% |
| Consolidated Renewal Plan | 1,908,612 | 2,055,742 | 6.7% | 7.0% |
| New Plan | 1,360,511 | 2,163,208 | 4.7% | 7.3% |
| Initial Contract | 62,267 | 195,320 | 0.2% | 0.7% |
Notable Shift: Renewal Plans with SAR expanded from just 1.6% in 2023 to 14.2% in 2026 (4.2M members), indicating significant portfolio restructuring. New Plans have doubled their share to 7.3%, while Renewal Plans with SAE declined sharply — reflecting active market repositioning.
Top 5 States — Individual MA
| State |
2025 |
2026 |
YoY |
| California | 2,816,302 | 2,905,262 | +3.2% |
| Florida | 2,687,567 | 2,772,866 | +3.2% |
| Texas | 2,123,202 | 2,223,999 | +4.8% |
| New York | 1,680,994 | 1,793,219 | +6.7% |
| Pennsylvania | 1,348,910 | 1,386,130 | +2.8% |
Top 5 Payors — Individual MA
| Organization |
2025 |
2026 |
YoY |
| UnitedHealth Group | 7,970,694 | 7,639,358 | −4.2% |
| Humana Inc. | 5,197,950 | 6,240,192 | +20.0% |
| CVS Health | 2,799,617 | 2,724,507 | −3.0% |
| Elevance Health | 1,890,615 | 1,518,973 | −20.0% |
| Kaiser Foundation | 1,374,327 | 1,434,564 | +4.0% |
Competitive Shift: Three of the top five payors saw AEP declines in 2026. Humana delivered a breakout year with ~20% YoY growth, adding over 1 million members and emerging as the clear scale gainer. Devoted also stood out, nearly doubling enrollment. Momentum shifted meaningfully toward select growth players.
02
Group Medicare Advantage
Medicare Advantage 2026: Group MA — From Expansion to Early Decline
Individual MA continues to expand, but at a slowing pace. In contrast, Group MA grew steadily in 2023 (+5.9%) and 2024 (+5.4%), adding over 250K members each year. Growth slowed sharply in 2025 to just +0.5%, with minimal net additions. In 2026, enrollment declined by 0.7%, resulting in a net loss of ~39K members. In short, Individual MA is still growing — though decelerating — while Group MA has shifted from expansion to early-stage decline.
Enrollment Trend — Group MA (2022–2026)
| Year |
Group MA Enrollment |
YoY Growth |
Net Enrollment |
| 2022 | 5,080,689 | — | — |
| 2023 | 5,382,563 | +5.9% | +258,433 |
| 2024 | 5,672,672 | +5.4% | +266,655 |
| 2025 | 5,703,216 | +0.5% | +20,984 |
| 2026 | 5,663,356 | −0.7% | −38,551 |
Inflection Point: Individual MA is still growing (though decelerating) while Group MA has shifted from expansion to early-stage decline.
Top 5 States — Group MA
| State |
2025 |
2026 |
YoY |
| California | 742,144 | 745,084 | +0.4% |
| Michigan | 504,132 | 499,550 | −0.9% |
| Texas | 464,563 | 468,176 | +0.8% |
| New York | 326,323 | 328,116 | +0.5% |
| Illinois | 264,677 | 270,495 | +2.2% |
Top 5 Payors — Group MA
| Organization |
2025 |
2026 |
YoY |
| UnitedHealth Group | 1,846,072 | 1,626,678 | −11.9% |
| CVS Health | 1,301,982 | 1,314,349 | +0.9% |
| Humana Inc. | 563,987 | 709,404 | +25.8% |
| Kaiser Foundation | 572,631 | 576,064 | +0.6% |
| BCBS Michigan | 473,755 | 456,204 | −3.7% |
Regional Standouts: Puerto Rico led expansion, adding ~12K members to reach 101.7K. Illinois (+2.2%) outperformed other large states. Beyond the top tier, Guidewell (+43%), Blue Cross Louisiana (+25%), HCSC (+24%), Aware Integrated (+87%), Independence Health Group (+83%), and Horizon Mutual (+98%) demonstrated strong double-digit growth off smaller bases.
MA-Only & MAPD — Diverging Trajectories
Standalone MA enrollment accelerated meaningfully in 2026, growing 13% YoY to reach nearly 987K members, increasing its share from 3.05% to 3.34%. While still a small portion of the overall market, its growth rate outpaced MAPD for the third consecutive year. In contrast, MAPD continues to dominate with over 28.6M members and roughly 97% market share, but its growth has steadily moderated from 7–8% in earlier years to just 3% YoY in 2026. The mix shift suggests gradual momentum toward standalone MA products, even as MAPD remains structurally dominant.
MA-Only vs MAPD — Market Share Trend (2022–2026)
| Year |
MA-Only Enrollment |
MA YoY |
Share MA |
MAPD Enrollment |
MAPD YoY |
Share MAPD |
| 2022 | 687,659 | — | 2.89% | 23,104,097 | — | 97.11% |
| 2023 | 766,583 | +11% | 3.01% | 24,699,461 | +7% | 96.99% |
| 2024 | 815,145 | +6% | 2.97% | 26,609,188 | +8% | 97.03% |
| 2025 | 874,263 | +7% | 3.05% | 27,801,634 | +4% | 96.95% |
| 2026 | 987,481 | +13% | 3.34% | 28,590,067 | +3% | 96.66% |
Mix Shift Signal: Standalone MA has outpaced the MAPD growth rate for the third consecutive year, signaling gradual momentum toward standalone products — even as MAPD remains structurally dominant at 97% share.
Top 5 States — MA-Only
| State | 2025 | 2026 | YoY |
|---|
| Wisconsin | 95,280 | 101,185 | +6% |
| Minnesota | 71,224 | 88,676 | +25% |
| Texas | 56,172 | 59,498 | +6% |
| North Carolina | 47,912 | 54,198 | +13% |
| Pennsylvania | 34,164 | 37,552 | +10% |
Top 5 States — MAPD
| State | 2025 | 2026 | YoY |
|---|
| California | 2,798,819 | 2,887,631 | +3% |
| Florida | 2,659,925 | 2,735,540 | +3% |
| Texas | 2,065,156 | 2,163,458 | +5% |
| New York | 1,660,959 | 1,769,950 | +7% |
| Pennsylvania | 1,314,306 | 1,347,898 | +3% |
Top 5 Payors — MA-Only
| Organization | 2025 | 2026 | YoY |
|---|
| Humana Inc. | 331,983 | 376,476 | +13% |
| UnitedHealth Group | 174,258 | 185,496 | +6% |
| Medica Holding | 74,412 | 107,361 | +44% |
| CVS Health | 58,703 | 71,954 | +23% |
| Aware Integrated | 47,171 | 53,632 | +14% |
Top 5 Payors — MAPD
| Organization | 2025 | 2026 | YoY |
|---|
| UnitedHealth Group | 7,794,864 | 7,453,194 | −4% |
| Humana Inc. | 4,859,909 | 5,860,504 | +21% |
| CVS Health | 2,739,319 | 2,651,310 | −3% |
| Elevance Health | 1,865,417 | 1,502,563 | −19% |
| Kaiser Foundation | 1,365,037 | 1,425,893 | +4% |
Standout: Medica expanded 44% YoY from 74K to 107K in standalone MA — one of the fastest-growing players in the segment. In MAPD, Humana captured share decisively (+21%) while UnitedHealth, CVS, and Elevance all declined.
Medicare Advantage 2026 SNP Overview — The Structural Shift to Specialization
The SNP mix continues to shift structurally. Chronic (C-SNP) has expanded steadily, more than tripling its share from 1.7% in 2022 to 5.5% in 2026, reflecting accelerated focus on condition-specific products. Dual-Eligible (D-SNP) has also strengthened, rising from 17.1% to 21.5%, solidifying its role as a core growth pillar. In contrast, Non-SNP share has steadily declined from 80.9% to 72.6%, indicating a gradual reallocation toward specialized plans. Institutional SNP remains stable and relatively small at 0.4%. Overall, the Medicare Advantage 2026 market is clearly tilting toward higher-acuity, targeted segments.
SNP Mix — Share of Total MA Enrollment (2022–2026)
| SNP Type |
2022 |
2023 |
2024 |
2025 |
2026 |
Change '22→'26 |
| C-SNP Chronic |
1.7% | 1.8% | 2.4% | 3.8% |
5.5% |
▲ +3.8pp |
| D-SNP Dual-Eligible |
17.1% | 19.4% | 21.1% | 21.0% |
21.5% |
▲ +4.4pp |
| I-SNP Institutional |
0.4% | 0.4% | 0.4% | 0.4% |
0.4% |
— Flat |
| Non-SNP (Traditional) |
80.9% | 78.4% | 76.1% | 74.8% |
72.6% |
▼ −8.3pp |
Non-SNP — Effective Stagnation
Non-SNP Enrollment Trend
| Year | Enrollment | Net | YoY |
|---|
| 2022 | 19,303,426 | — | — |
| 2023 | 20,042,434 | +404,895 | +3.8% |
| 2024 | 20,873,793 | +450,272 | +4.2% |
| 2025 | 21,463,370 | +164,760 | +2.8% |
| 2026 | 21,478,891 | −268,899 | +0.1% |
Top 5 States — Non-SNP
| State | 2025 | 2026 | YoY |
|---|
| California | 2,206,395 | 2,200,637 | −0.3% |
| Florida | 1,804,461 | 1,797,800 | −0.4% |
| Texas | 1,558,593 | 1,586,625 | +1.8% |
| Pennsylvania | 1,082,173 | 1,102,430 | +1.9% |
| New York | 995,634 | 1,010,252 | +1.5% |
Top 5 Payors — Non-SNP
| Organization | 2025 | 2026 | Net Enrollment | YoY |
|---|
| Humana Inc. | 4,145,494 | 5,007,991 | +833,523 | +21% |
| UnitedHealth Group | 5,113,920 | 4,515,832 | −608,951 | −12% |
| CVS Health | 2,319,299 | 2,204,586 | −186,114 | −5% |
| Kaiser Foundation | 1,254,111 | 1,288,072 | +12,776 | +3% |
| Elevance Health | 1,145,029 | 791,087 | −305,720 | −31% |
Structural Pressure: 26 states recorded net losses in Non-SNP. Sharpest declines: Illinois (−75.6K), Ohio (−48.3K), and Massachusetts (−40.9K). Humana's dominant 21% gain (+833K) masks broader redistribution away from traditional Non-SNP plans across most carriers.
Dual-Eligible (D-SNP) — Durable Structural Growth
D-SNP Enrollment Trend
| Year | Enrollment | Net | YoY |
|---|
| 2022 | 4,069,752 | — | — |
| 2023 | 4,969,641 | +400,939 | +22.1% |
| 2024 | 5,803,338 | +162,125 | +16.8% |
| 2025 | 6,021,500 | +46,409 | +3.8% |
| 2026 | 6,365,405 | +218,040 | +5.7% |
Top 5 States — D-SNP
| State | 2025 | 2026 | YoY |
|---|
| New York | 665,262 | 750,390 | +12.8% |
| Florida | 679,632 | 667,794 | −1.7% |
| California | 476,192 | 508,066 | +6.7% |
| Texas | 399,828 | 423,014 | +5.8% |
| Puerto Rico | 301,293 | 303,036 | +0.6% |
Top 5 Payors — D-SNP
| Organization | 2025 | 2026 | Net Enrollment | YoY |
|---|
| UnitedHealth Group | 2,247,138 | 2,308,409 | −96,041 (AEP) | +3% |
| Humana Inc. | 832,916 | 897,000 | +140,920 | +8% |
| Elevance Health | 610,529 | 577,699 | −15,619 | −5% |
| CVS Health | 476,844 | 476,568 | +9,330 | 0% |
| Centene Corporation | 373,256 | 371,094 | +25,106 | −1% |
D-SNP Rebound: After a temporary slowdown in 2025, D-SNP rebounded with 218K net additions. New York led with 12.8% YoY growth. Beyond the top five, Massachusetts (+40K), Ohio (+38K), and Michigan (+19K) added strong AEP momentum. CareSource added ~48K members, emerging as a key challenger.
Medicare Advantage 2026 — Chronic Condition (C-SNP): Fastest-Growing Segment
39 / 46
States with AEP Gains
C-SNP Enrollment Trend
| Year | Enrollment | Net | YoY |
|---|
| 2022 | 402,662 | — | — |
| 2023 | 457,974 | +32,771 | +13.7% |
| 2024 | 654,341 | +111,958 | +42.9% |
| 2025 | 1,096,970 | +223,124 | +67.7% |
| 2026 | 1,629,227 | +201,327 | +48.5% |
Top 5 States — C-SNP
| State | 2025 | 2026 | YoY |
|---|
| Florida | 195,436 | 299,124 | +53.1% |
| Texas | 156,383 | 205,590 | +31.5% |
| California | 129,590 | 192,020 | +48.2% |
| Illinois | 59,746 | 80,106 | +34.1% |
| South Carolina | 57,201 | 77,852 | +36.1% |
Top 5 Payors — C-SNP
| Organization | 2025 | 2026 | Net Enrollment | YoY |
|---|
| UnitedHealth Group | 550,065 | 758,343 | −17,247 (AEP) | +38% |
| Humana Inc. | 217,072 | 331,262 | +58,060 | +53% |
| Elevance Health | 131,774 | 147,891 | +3,732 | +12% |
| Alignment Healthcare | 40,526 | 68,303 | +18,173 | +69% |
| Devoted Health | 3,214 | 57,362 | +54,962 | +1,685% |
Breakout Segment: C-SNP has grown from 402K members in 2022 to 1.63M in 2026 — a 4× expansion in four years. Devoted Health's 1,685% YoY growth signals aggressive new entrants reshaping the competitive landscape. Hawaii and Nebraska entered C-SNP for the first time in 2026.
Institutional (I-SNP) — Niche and Stable
I-SNP Enrollment Trend
| Year | Enrollment | Net | YoY |
|---|
| 2022 | 92,780 | — | — |
| 2023 | 102,416 | +303 | +10.4% |
| 2024 | 114,256 | −770 | +11.6% |
| 2025 | 118,196 | −4,838 | +3.5% |
| 2026 | 124,652 | −811 | +5.5% |
Top 5 Payors — I-SNP
| Organization | 2025 | 2026 | YoY |
|---|
| UnitedHealth Group | 59,571 | 56,774 | −5% |
| Rifkin Managed Care | 8,704 | 10,439 | +20% |
| Mitchell Family Office | 6,378 | 7,190 | +13% |
| Longevity Health | 5,985 | 6,613 | +10% |
| SNP Holdings | 3,775 | 3,943 | +4% |
Niche Dynamics: I-SNP remains a small, specialized segment with 124.7K members. 22 of 44 states recorded net losses, underscoring uneven expansion. Growth concentrated among smaller specialized operators — Curana Health (+80% YoY) and Rifkin Managed Care (+20%) — while UnitedHealth saw modest decline.
Plan Type Evolution — HMO Strengthens, PPO Stalls
Growth in Medicare Advantage 2026 remained concentrated in Local HMO, which added over 726K members and grew 7% YoY, reinforcing its position as the primary market driver. Cost plans also rebounded strongly with 21% YoY growth, while MSA, though small, expanded sharply off a low base. In contrast, Local PPO flattened with slight negative movement of −342K net loss in AEP, and Regional PPO continued its structural decline with a 33% YoY contraction. PFFS also softened, and MMP effectively phased out. Overall, momentum clearly favoured HMO-led growth, with legacy and niche plan types shrinking further.
Plan Type Summary — 2025 vs 2026
| Plan Type |
2025 Enrollment |
2026 Enrollment |
Net Enrollment |
YoY |
| Local HMO | 18,286,125 | 19,477,859 | +726,441 | +7.0% |
| Local PPO | 9,762,834 | 9,750,684 | −342,415 | −0.12% |
| Cost Plans | 157,440 | 190,020 | +32,843 | +21% |
| Regional PPO | 216,079 | 144,531 | −48,047 | −33% |
| PFFS | 35,482 | 33,818 | −3,713 | −5% |
| MSA | 768 | 1,263 | +498 | +64% |
| MMP | 241,308 | — | — | Phased out |
Local HMO — Consistent and Compounding
HMO Enrollment Trend
| Year | Enrollment | Net | YoY |
|---|
| 2022 | 15,735,237 | — | — |
| 2023 | 16,618,711 | +414,114 | +5.6% |
| 2024 | 17,368,802 | +166,949 | +4.5% |
| 2025 | 18,286,125 | +538,553 | +5.3% |
| 2026 | 19,477,859 | +726,441 | +6.5% |
Top 5 States — HMO
| State | 2025 | 2026 | YoY |
|---|
| California | 2,669,547 | 2,808,164 | +5.2% |
| Florida | 1,810,133 | 1,893,096 | +4.6% |
| Texas | 1,506,304 | 1,651,616 | +9.6% |
| New York | 1,154,043 | 1,310,940 | +13.6% |
| Ohio | 893,704 | 938,405 | +5.0% |
Top 5 Payors — HMO
| Organization | 2025 | 2026 | Net Enrollment | YoY |
|---|
| UnitedHealth Group | 4,956,990 | 5,306,327 | +12,967 | +7% |
| Humana Inc. | 2,675,907 | 3,104,599 | +489,917 | +16% |
| Kaiser Foundation | 1,373,492 | 1,433,347 | +26,887 | +4% |
| Elevance Health | 1,716,271 | 1,422,840 | −251,653 | −17% |
| CVS Health | 1,185,546 | 1,207,208 | +29,012 | +2% |
HMO Standouts: Massachusetts delivered the single largest net HMO increase (~88K, +41% YoY) among all states. Texas and Pennsylvania each added ~81K. Minnesota recorded the sharpest pullback — enrollment dropped 76% YoY with a net loss of ~118.7K. BCBS Michigan also declined 56% year over year.
Local PPO — From Acceleration to Stall
PPO Enrollment Trend
| Year | Enrollment | Net | YoY |
|---|
| 2022 | 6,745,175 | — | — |
| 2023 | 7,919,177 | +726,819 | +17.4% |
| 2024 | 9,234,315 | +673,966 | +16.6% |
| 2025 | 9,762,834 | +1,725 | +5.7% |
| 2026 | 9,750,684 | −342,415 | −0.1% |
Top 5 States — PPO
| State | 2025 | 2026 | YoY |
|---|
| Florida | 843,230 | 854,124 | +1.3% |
| Pennsylvania | 580,924 | 530,217 | −8.7% |
| Georgia | 536,360 | 522,038 | −2.7% |
| Texas | 529,713 | 516,278 | −2.5% |
| Michigan | 465,597 | 513,783 | +10.3% |
Top 5 Payors — PPO
| Organization | 2025 | 2026 | Net Enrollment | YoY |
|---|
| Humana Inc. | 2,406,644 | 3,048,333 | +562,657 | +27% |
| UnitedHealth Group | 2,869,685 | 2,260,064 | −682,026 | −21% |
| CVS Health | 1,578,831 | 1,516,367 | −139,763 | −4% |
| Aware Integrated | 184,491 | 268,030 | +76,217 | +45% |
| Devoted Health | 67,527 | 213,454 | +135,221 | +216% |
PPO Redistribution: UnitedHealth shed ~682K PPO members (−21% YoY) — the sharpest pullback among major carriers. Humana captured 563K in gains (+27%), while Devoted Health scaled 216% from a smaller base. 35 states recorded net PPO losses. Pennsylvania, the second-largest PPO market, declined nearly 9% YoY.
"Growth will depend less on overall market lift and more on disciplined pricing, benefit optimization, and focused execution in high-acuity and high-growth states."
Conclusion & Outlook
Medicare Advantage 2026 — What It Means for 2027
The Medicare Advantage 2026 market reflects a clear transition from broad-based acceleration to more selective, strategy-driven growth. While overall enrollment continues to expand, momentum is increasingly concentrated in specialized segments — particularly D-SNP and C-SNP — and in Local HMO products.
Traditional Non-SNP and PPO segments have flattened, and Group MA has entered early-stage decline. Competitive dynamics are shifting decisively, with targeted growth players — led by Humana, Devoted, and a cohort of regional challengers — capturing share while several large incumbents experience material retrenchment.
Looking ahead to 2027, growth in the Medicare Advantage market is likely to remain positive but measured. Expansion will depend less on overall market lift and more on disciplined pricing, benefit optimization, and focused execution in high-acuity and high-growth states. Plans that align product design with specialized populations and operational efficiency will be best positioned to outperform in the next phase of MA evolution.
