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Medicare Advantage 2026
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.
- December 2025
- 7 min read
- Healthcare Analytics Report
TOTAL ENROLLMENT
29.6M
Individual MA
GROUP MA
5.7M
Members
PLANS OFFERED
5,592
Across 170 payors
YOY GROWTH
3.1%
Decelerating
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.
Individual MA Market
The MA market is still growing—but the era of rapid acceleration has transitioned into moderate expansion.
2026 ENROLLMENT
29.6M
▲ 3.1% YoY
NET ADDITIONS
150K
▼ 65% vs 2025
PLANS
5,592
Across market
PAYORS
170
Active carriers
Enrollment Growth & YoY Rate
Performance overview 2022 – 2026
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.
Enrollment by Plan Description
2026 Share Distribution
| 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.
Top States
Enrollment by State (2025 vs 2026)
Regional performance comparison
Net Enrollment Change
Growth by volume per state
Market Leaders
Carrier Enrollment (2025 vs 2026)
Top carrier market performance
Net Enrollment Shift
Carrier growth vs loss (2025-2026)
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).
Group Plans
Group MA Market
Individual MA is still growing—though decelerating—while Group MA has shifted from expansion to early-stage decline.
2026 ENROLLMENT
5.66M
▼ 0.7% YoY
NET CHANGE
-39K
First decline
PEAK GROWTH
5.9%
In 2023
2026 GROWTH
-0.7%
Contraction
Group MA Enrollment & YoY Rate (2022–2026)
Performance overview for group-specific plans
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.
Market Leaders
State Enrollment (2025 vs 2026)
Regional enrollment volume comparison
Net Enrollment Change
State-level growth vs loss (2025-2026)
Top States
Carrier Enrollment (2025 vs 2026)
Market share comparison for top carriers
Net Enrollment Shift by Carrier
Carrier growth vs loss (2025-2026)
UnitedHealth remains largest at 1.63M but declined ~12% YoY. Humana delivered ~26% growth (+153K members).
Segment Analysis
MA-Only vs MAPD
Standalone MA is gaining momentum while MAPD remains structurally dominant but decelerating.
MA-ONLY 2026
987K
▲ 13% YoY
MAPD 2026
28.6M
▲ 3% YoY
MA SHARE
3.3%
Up from 2.9%
MAPD SHARE
96.7%
Still dominant
MA-Only Enrollment & YoY Rate (2022–2026)
Performance overview for MA-Only specific plans
MAPD Enrollment & YoY Rate (2022–2026)
Performance overview for Medicare Advantage Prescription Drug plans
Growth Rate Comparison: MA-Only vs MAPD
Year-over-Year growth trend comparison (2023-2026)
Standalone MA accelerated meaningfully in 2026, growing 13% YoY—outpacing MAPD for the third consecutive year. MAPD growth has moderated from 7–8% to just 3% in 2026.
Top States
MA-Only Top States (YoY %)
States with highest Year-over-Year growth percentage
MAPD Top States (YoY %)
Regional growth performance for MAPD plans
Market Leaders
MA-Only Top Payors
Enrollment comparison by major carrier (2025 vs 2026)
MAPD Top Payors
Enrollment comparison by major carrier (2025 vs 2026)
Medica stood out in MA-Only with 44% YoY growth. In MAPD, Humana gained 21% while UnitedHealth (-4%) and Elevance (-19%) declined.
Special Needs Plans
SNP Overview
The MA market is clearly tilting toward higher-acuity, targeted segments.
SNP Mix Evolution (2022–2026)
Annual shift in Special Needs Plan enrollment mix
2022
2023
2024
2025
2026
NON-SNP 2026
72.6%
▼ 2.2% Declining share
D-SNP 2026
21.5%
▲ 0.5% Core pillar
C-SNP 2026
5.5%
▲ 1.7% Fastest growing
I-SNP 2026
0.4%
Stable niche
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%.
Non-SNP
2026 ENROLLMENT
21.5M
▲ 0.1%
NET CHANGE
-269K
First negative
STATES W/ LOSS
26
Broad pressure
Non-SNP Enrollment & YoY Rate (2022–2026)
Market performance with static labels and colored tooltips
State Enrollment (2025 vs 2026)
| 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 Enrollment (2025 vs 2026)
| 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 |
D-SNP (Dual-Eligible)
2026 ENROLLMENT
6.37M
▲ 6% YoY
PEAK GROWTH
22%
In 2023
NET ADDITIONS
+218K
Rebounding
D-SNP Enrollment & YoY Rate (2022–2026)
Performance overview in brand primary theme
State Enrollment (2025 vs 2026)
| 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 Enrollment (2025 vs 2026)
| 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).
C-SNP (Chronic Condition)
2026 ENROLLMENT
1.63M
▲ 49% YoY
GROWTH SINCE 2022
4x
From 403K
STATES GAINING
39/46
Broad expansion
C-SNP Enrollment & YoY Rate (2022–2026)
Chronic Condition Special Needs Plan - Primary Brand Theme
State Enrollment (2025 vs 2026)
| 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 Enrollment (2025 vs 2026)
| 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.
I-SNP (Institutional)
2026 ENROLLMENT
125K
▲ 5% YoY
NET ENROLLMENT
-811
Volatile
STATES W/ LOSS
22/44
Uneven
I-SNP Enrollment & YoY Rate (2022–2026)
Institutional Special Needs Plan performance summary
State Enrollment (2025 vs 2026)
| 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 Enrollment (2025 vs 2026)
| 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.
Plan Type
HMO vs PPO
The MA market is clearly tilting toward higher-acuity, targeted segments.
2026 Enrollment by Plan Type
Distribution across HMO, PPO, and Special Plan Types
Plan Type Details (2025 vs 2026)
| 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 |
Local HMO
2026 ENROLLMENT
19.5M
▲ 6.5% YoY
NET ADDITIONS
+416K
Best in 5 years
STATES W/ LOSS
13
Concentrated growth
HMO Enrollment & YoY Rate (2022–2026)
Historical and projected HMO plan performance summary
Top States (2025 vs 2026)
2025
2026
Top Payors — Net Shift
Texas led momentum. Humana added ~490K members (16% YoY). Elevance saw the sharpest decline (-252K, -17%).
Local PPO
2026 ENROLLMENT
9.75M
▼ 0.1% Stalling
NET CHANGE
-342K
AEP loss
STATES W/ LOSS
35
Widespread
PPO Enrollment & YoY Rate (2022–2026)
Comparative analysis of PPO plan performance and growth trends
Top States — Net Change
Top Payors — Net Shift
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