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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.
Market performance with static labels and colored tooltips
Non-SNP grew steadily through 2024 (~4% YoY, 400–450K annual adds) but slowed in 2025 and flattened in 2026, posting a ~269K net loss and near-zero growth—highlighting a shift toward more specialized MA segments.
| State | 2025 | 2026 | Net Change | YoY % |
|---|---|---|---|---|
| California | 2,206,395 | 2,200,637 | -37,569 | -0.3% |
| Florida | 1,804,461 | 1,797,800 | -19,087 | -0.4% |
| Texas | 1,558,593 | 1,586,625 | +9,193 | 1.8% |
| Pennsylvania | 1,082,173 | 1,102,430 | +7,667 | 1.9% |
| New York | 995,634 | 1,010,252 | -21,036 | 1.5% |
| Payor | 2025 | 2026 | Net Change | 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 Corp. | 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% |
Non-SNP performance in 2026 was muted, with slight declines in California and Florida and modest gains in Texas and Pennsylvania. Additional softness was observed in West Virginia (7% YoY growth) and New Jersey (6%).Growth was concentrated in North Carolina (+15.8K) and Alabama (+11.8K), while 26 states saw losses—led by Illinois (-75.6K), Ohio (-48.3K), and Massachusetts (-40.9K)—highlighting ongoing structural pressure on traditional Non-SNP enrollment.
In Non-SNP, Humana led with +833K members (+21% YoY), while Devoted added ~171K, driving concentrated growth. In contrast, UnitedHealth (-609K), Elevance (-306K), and CVS (-186K) saw major losses, signaling significant reshuffling within the segment.
Performance overview in brand primary theme
D-SNP growth surged in 2023–2024 (22% and 17%), slowed to 4% in 2025, and rebounded in 2026 to 6.37M members with +218K net adds—reinforcing its role as a durable MA growth driver
| 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 |
D-SNP growth in 2026 was led by New York (+12.8%), with solid gains in Texas and California, while Puerto Rico remained stable and Florida saw slight contraction. Strong net adds came from Massachusetts (+40K), Ohio (+38K), and Michigan (+19K), offset by declines in Minnesota (-28K), Maryland (-5K), and Delaware (-3K), with only about 10 states posting AEP losses overall.
In D-SNP, Humana led AEP gains (+140K), with CareSource adding ~48K as a rising challenger. UnitedHealth, despite remaining the largest carrier, posted the biggest AEP loss (~96K), while HCSC also saw notable declines.
Chronic Condition Special Needs Plan - Primary Brand Theme
C-SNP is one of the fastest-growing MA segments, accelerating from +14% in 2023 to +43% in 2024, peaking at +68% in 2025, and rising another +49% in 2026 to 1.63M members—solidifying its role as a key structural growth engine.
| 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 |
C-SNP growth in 2026 was led by Florida (+51.8K), California (+41.3K), and Ohio (+18.4K), with strong double-digit gains across several large and mid-sized states. Only seven states saw declines—largest in Puerto Rico (-8.1K), Georgia (-4.7K), and Kentucky (-2.3K)—while Hawaii and Nebraska entered and Vermont exited, underscoring continued geographic expansion.
In C-SNP, Humana added ~58K members (+50%+ YoY) and Devoted surged ~55K, while CVS scaled rapidly to 41K members. UnitedHealth remains the largest but saw ~17K AEP losses, and Molina declined (-6K AEP, -40% YoY), signaling growth shifting toward aggressive challengers.
Institutional Special Needs Plan performance summary
I-SNP remains a small, niche segment, growing gradually from 92.8K (2022) to 124.7K (2026) with low-single-digit gains, though net enrollment has been volatile—underscoring limited scalability compared to faster-growing C-SNP and D-SNP.
| 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 activity in 2026 was small and mixed, with New York flat, moderate gains in Ohio and Texas, and AEP pullbacks in Florida and Texas. Limited growth pockets (Indiana +1K, Louisiana +926) were offset by losses in 22 of 44 states, reflecting continued volatility in this niche segment.
In I-SNP, UnitedHealth remains the largest but posted the biggest decline, with Elevance also down (-671). Growth was driven by smaller players, notably Curana (+1K, +80% YoY), along with Rifkin and Mitchell, highlighting niche-led expansion amid incumbent pullbacks.
In 2026, growth was driven by Local HMO (+7% YoY, +726K), while Cost plans rebounded (+21%) and MSA grew off a small base. In contrast, Local PPO declined (-342K AEP), Regional PPO fell 33% YoY, and PFFS and MMP phased out—reinforcing HMO-led momentum.
| Plan Type | 2025 | 2026 | Net Change | YoY (%) |
|---|---|---|---|---|
| Cost | 157,440 | 190,020 | +32,843 | 21% |
| Local HMO | 18,286,125 | 19,477,859 | +726,441 | 7% |
| Local PPO | 9,762,834 | 9,750,684 | -342,415 | -0.12% |
| MSA | 768 | 1,263 | +498 | 64% |
| PFFS | 35,482 | 33,818 | -3,713 | -5% |
| Regional PPO | 216,079 | 144,531 | -48,047 | -33% |
Historical and projected HMO plan performance summary
Local HMO has shown steady, strengthening growth, reaching 19.5M members in 2026 with its largest net gain (+726K) and 6.5% YoY growth—solidifying its role as the primary engine of MA expansion.
Local HMO growth was concentrated in large states, led by Texas, with strong gains in New York (+13.6%), California, Florida, and Ohio. Massachusetts (+41%) and South Carolina (+30%) stood out, with Massachusetts posting the largest net increase (~88K). However, 13 states saw losses—most notably Minnesota (-76% YoY, -118.7K) and Wisconsin (-24K)—while Vermont and Wyoming have no HMO presence.
HMO leadership shifted in 2026, with Humana adding ~490K members (3.1M total), while SCAN and Devoted each grew by 114K+ and HCSC expanded strongly. In contrast, Elevance (-252K, -17%) and BCBS Michigan (-56%) saw sharp declines, reflecting growth concentrated among select players.
Comparative analysis of PPO plan performance and growth trends
Local PPO surged in 2023–2024 with strong double-digit growth, slowed in 2025, and flattened in 2026 with slight net losses—signaling a shift from rapid expansion to stabilization and early cooling.
Local PPO saw net losses in 35 states in 2026. Growth was selective, led by Michigan (+27K) and Minnesota (+62K AEP), with smaller gains in Kentucky, Rhode Island, and Utah. However, major markets declined, including Pennsylvania (-67K, -9%) and California (-60K, -34%), highlighting uneven momentum across states.
In PPO, Humana led with +563K AEP adds (+27%), while Devoted (+135K) and Aware (+45%) scaled rapidly. In contrast, UnitedHealth (-682K, -21% YoY), CVS (-140K), and HCSC (-84.7K) declined, signaling share shifts toward selective challengers.
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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