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Slowing Growth, Structural Shifts, and the Rise of Specialized Plans
A comprehensive analysis of enrollment trends, competitive dynamics, SNP expansion, and plan type evolution across the Medicare Advantage landscape.
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.
The MA market is still growing—but the era of rapid acceleration has transitioned into moderate expansion.
Year-over-year growth peaked at over 7% in 2023–2024 before slowing to 4.6% in 2025 and further decelerating to just 3.1% in 2026. Net additions declined from ~839K in 2023 to under 150K in 2026.
| Plan Type | Members | Share | Δ |
|---|---|---|---|
| Renewal Plan | 19.3M | 65.2% | -1.3% |
| Renewal w/ SAR | 4.2M | 14.2% | +0.5% |
| Renewal w/ SAE | 1.7M | 5.7% | -2.5% |
| New Plan | 2.2M | 7.3% | +2.6% |
| Consolidated Renewal | 2.1M | 7% | +0.3% |
| Initial Contract | 195K | 0.7% | +0.5% |
Renewal Plans dominate at 65.2%, though declining from 72.9% peak. Renewal Plans with SAR surged from 1.6% (2023) to 14.2% (2026), signaling major portfolio restructuring. Renewal Plans with SAE declined to 1.68M (from 2.35M), while New Plans gained momentum, rising to 7.3% share in 2026—more than doubling since 2022. Initial contracts also grew from 62K to 195K, signaling a clear shift from traditional renewals toward restructured and newly introduced plan types.
California remains the largest MA market (~2.9M), while Florida continues steady expansion. Texas led net growth (+35.7K), and New York posted the strongest percentage gain despite a slight AEP dip. Pennsylvania saw moderate growth. In contrast, Minnesota (-35.6K) and Idaho (-17.7K) experienced notable declines, reflecting localized volatility amid growth concentrated in large states.
Three of the top five payors saw declines—most notably UnitedHealth (-725K) and Elevance (-318K). Humana delivered a breakout year with ~20% YoY growth (+1M members). Devoted also stood out, nearly doubling enrollment with ~249K net additions. Meanwhile, Kaiser posted steady, moderate growth, reaching 1.43M members in 2026. Overall, momentum shifted meaningfully toward select growth players.
Group Plans
Individual MA is still growing—though decelerating—while Group MA has shifted from expansion to early-stage decline.
Group MA grew steadily in 2023 (+5.9%) and 2024 (+5.4%). Growth slowed sharply in 2025 to +0.5%. In 2026, enrollment declined by 0.7%, resulting in a net loss of ~39K members—the first contraction.
In the Group MA segment, Puerto Rico led expansion, adding ~12K members to reach 101.6K, followed by Louisiana (+2K) and Illinois (+1K). On the downside, Minnesota recorded the sharpest pullback, losing ~9.9K members to total 59.6K, followed by declines in California with 745K members. While Michigan saw slight softening and Texas and New York posted modest low single-digit gains. Illinois stood out with comparatively stronger growth.
UnitedHealth remained the largest Group MA carrier (1.63M) but declined ~12% YoY, the sharpest drop among majors. Humana led growth with +26% YoY (~153K adds), while CVS, Kaiser, and Elevance saw marginal gains.
Beyond the top tier, Guidewell (+43% YoY), Blue Cross Louisiana (+25%), and Health Care Service Corporation (+24%) demonstrated strong double-digit growth, while select regional players such as Aware Integrated (+87%), Independence Health Group (+83%), and Horizon Mutual (+98%) expanded rapidly off smaller bases.
Standalone MA is gaining momentum while MAPD remains structurally dominant but decelerating.
Performance overview with zero label overlapping
Performance overview with optimized label positioning
Standalone MA grew 13% YoY to ~987K members, lifting share to 3.34% and outpacing MAPD for the third straight year. MAPD remains dominant at 28.6M (~97% share) but slowed to 3% growth, signaling a gradual shift toward standalone MA.
Standalone MA growth was concentrated in Midwest and Southern states, led by Wisconsin (101K) and Minnesota (+25% YoY), with strong gains in North Carolina and Pennsylvania. MAPD growth remained centered in large markets, led by New York (+7%) and Texas (+5%), while California and Florida saw steady ~3% growth.
Humana, UnitedHealth, and CVS remain top players across MA and MAPD. All three grew in standalone MA, but in MAPD, UnitedHealth and CVS declined (3–4%) while Humana gained share. Medica stood out in MA (+44% YoY), highlighting broader growth in MA versus concentrated share shifts in MAPD.
Special Needs Plans
The MA market is clearly tilting toward higher-acuity, targeted segments. The SNP mix is shifting toward specialization: C-SNP more than tripled (1.7% → 5.5%), and D-SNP rose to 21.5%, reinforcing its growth role. Non-SNP declined (80.9% → 72.6%), while I-SNP remains stable at 0.4%, signaling a clear tilt toward higher-acuity segments.
C-SNP more than tripled its share from 1.7% (2022) to 5.5% (2026). D-SNP rose from 17.1% to 21.5%. Non-SNP declined from 80.9% to 72.6%.
Market performance with static labels and colored tooltips
| State | 2025 | 2026 | Net Change |
|---|---|---|---|
| California | 2.2M | 2.2M | -20K |
| Florida | 1.9M | 1.9M | -30K |
| Texas | 1.5M | 1.5M | -10K |
| Pennsylvania | 1.1M | 1.1M | -15K |
| New York | 1.0M | 1.0M | +10K |
| Payor | 2025 | 2026 | Net Change |
|---|---|---|---|
| Humana | 3.9M | 4.7M | +833K |
| UnitedHealth | 5.5M | 4.9M | -609K |
| CVS Health | 3.2M | 3.0M | -186K |
| Kaiser | 1.7M | 1.7M | +20K |
| Elevance | 1.8M | 1.5M | -306K |
Performance overview in brand primary theme
| State | 2025 | 2026 | Net Change |
|---|---|---|---|
| New York | 700K | 790K | +90K |
| Florida | 620K | 650K | +30K |
| California | 580K | 610K | +30K |
| Texas | 450K | 480K | +30K |
| Puerto Rico | 300K | 320K | +20K |
| Payor | 2025 | 2026 | Net Change |
|---|---|---|---|
| UnitedHealth | 1.8M | 1.7M | -96K |
| Humana | 900K | 1.0M | +140K |
| Elevance | 600K | 570K | -30K |
| CVS Health | 500K | 480K | -20K |
| Centene | 400K | 420K | +20K |
New York led with 12.8% growth. Humana delivered strongest AEP performance (+140K). UnitedHealth recorded highest AEP loss (-96K).
Chronic Condition Special Needs Plan - Primary Brand Theme
| State | 2025 | 2026 | Net Change |
|---|---|---|---|
| Florida | 200K | 252K | +52K |
| Texas | 150K | 210K | +60K |
| California | 120K | 170K | +50K |
| Illinois | 80K | 115K | +35K |
| S. Carolina | 60K | 90K | +30K |
| Payor | 2025 | 2026 | Net Change |
|---|---|---|---|
| UnitedHealth | 350K | 333K | -17K |
| Humana | 180K | 238K | +58K |
| Elevance | 100K | 130K | +30K |
| Alignment | 70K | 95K | +25K |
| Devoted | 3K | 58K | +55K |
Florida led with +51.8K AEP additions. Devoted delivered breakout momentum (+55K, 1,685% YoY). Humana added ~58K with 53% growth.
Institutional Special Needs Plan performance summary
| State | 2025 | 2026 | Net Change |
|---|---|---|---|
| New York | 18K | 19K | +500 |
| California | 12K | 12K | +200 |
| Florida | 10K | 10K | +100 |
| Texas | 9K | 9K | +200 |
| Pennsylvania | 7K | 7K | -100 |
| Payor | 2025 | 2026 | Net Change |
|---|---|---|---|
| UnitedHealth | 45K | 42K | -3K |
| Rifkin | 8K | 10K | +2K |
| Mitchell Family | 5K | 5K | +200 |
| Longevity Health | 5K | 5K | +300 |
| SNP Holdings | 3K | 3K | +100 |
I-SNP remains niche and relatively stable. UnitedHealth dominates but saw the highest net decline (-2.7K). Growth concentrated among smaller specialized operators.
The MA market is clearly tilting toward higher-acuity, targeted segments.
Distribution across HMO, PPO, and Special Plans
| Plan Type | Enrollment | YoY Change | Net Change |
|---|---|---|---|
| Local HMO | 19.5M | +7% | +416,427 |
| Local PPO | 9.75M | -0.12% | -342,415 |
| Regional PPO | 97K | -33% | -48,047 |
| Cost | 189K | +21% | +32,843 |
| PFFS | 70K | -5% | -3,713 |
| MSA | 1.3K | +64% | +498 |
Historical and projected HMO plan performance summary
Texas led momentum. Humana added ~490K members (16% YoY). Elevance saw the sharpest decline (-252K, -17%).
Comparative analysis of PPO plan performance and growth trends
Growth has shifted from broad-based acceleration to strategy-driven, concentrated in specialized segments and select carriers.
D-SNP and C-SNP are gaining share as Non-SNP and PPO segments flatten. Local HMO remains the primary market engine.
Targeted growth players are capturing share while several large incumbents retrench—a fundamental redistribution of scale.
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