AEP 2026: The Market Has Spoken
Breaking Down the Biggest Medicare Advantage Shake-Up in Years
- November 12, 2025
- 7 min read
The wait is over. After weeks of anticipation and a delayed data release, CMS has finally dropped the 2026 Medicare Advantage landscape data—and payers have come out in full force. While the industry is already strategizing for 2027, the real story lies in understanding what just happened.
Which payers doubled down? Which retreated? Where are the growth opportunities, and where did consolidation hit hardest?
This analysis cuts through the noise to reveal the patterns that matter: 889 bold new launches, 765 strategic exits, and a market realignment affecting over 3.13 million beneficiaries. Whether you’re planning your 2027 bids or evaluating competitive positioning, these insights show you exactly where payers expanded, where they contracted, and what it means for your strategy.
Lives Impacted
New Launches
Lives Impacted: Landscape Overview
The 2026 Medicare Advantage landscape reflects significant transformation with 889 new launches, 4,231 renewals, 1,508 SAE plans, 1,496 SAR plans, and 765 terminations across different counties. These shifts impact over 3.13 million beneficiaries, with 372K lives affected by payer exits, underscoring the ongoing transformation and competitive realignment within the Medicare Advantage market.
New Launches
Renewals
SAE Plans
SAR Plans
Terminations
Lives by Payer Exits
Plan Type Analysis
Special Needs Plans (SNPs) Comparison Matrix
| Metric | Non-SNP | D-SNP | C-SNP | I-SNP |
|---|---|---|---|---|
| Counties Covered | 3,134 | 3,030 | 2,421 | 2,121 |
| New Entries | 655 | 583 | 431 | 216 |
| County Exits | 1,054 | 603 | 139 | 9 |
| Lives Impacted (Total) | 2.8M | 269.6K | 53.9K | 1.9K |
| Payer Exit Impact | 335K | 27.9K | 9.6K | 48 |
SAE by Special Needs Plans Type
SAE by Plan Type
HMO & PPO Market Dynamics
County-Level Plan Activity
The 2026 Medicare Advantage landscape reflects significant plan movement across segments at the county level, with HMOs showing the most activity and robust SAE/SAR presence across all plan types.
| Plan Type | Terminations | New Plans | SAE Plans | SAR Plans |
|---|---|---|---|---|
| HMO | 405 | 583 | 967 | 721 |
| Local PPO | 341 | 305 | 529 | 735 |
| C-SNP | 36 | 217 | 257 | 71 |
| D-SNP | 94 | 212 | 344 | 194 |
| I-SNP | 18 | 9 | 60 | 35 |
| Non-SNP | 617 | 451 | 847 | 1196 |
Key Insights
- HMOs lead with the highest activity—583 new plans and 405 terminations—supported by 967 SAE and 721 SAR plans, maintaining their market prominence.
- C-SNPs show notable expansion with 217 new plans and minimal terminations (36), backed by 257 SAE plans, reflecting increased focus on chronic condition management.
- Non-SNP plans experienced significant restructuring with 617 terminations but 451 new launches, supported by 847 SAE and 1,196 SAR plans.
Leading Payers Analysis
United, CVS, and Elevance are the top three in lives impacted, with UnitedHealth Group maintaining the widest county presence at 2,787 counties.
Comprehensive Payer Comparison: Lives Impacted & Market Activity
| Plan Type | Terminations | New Plans | SAE Plans | SAR Plans |
|---|---|---|---|---|
| HMO | 405 | 583 | 967 | 721 |
| Local PPO | 341 | 305 | 529 | 735 |
| C-SNP | 36 | 217 | 257 | 71 |
| D-SNP | 94 | 212 | 344 | 194 |
| I-SNP | 18 | 9 | 60 | 35 |
| Non-SNP | 617 | 451 | 847 | 1196 |
Key Insights
- HMOs lead with the highest activity—583 new plans and 405 terminations—supported by 967 SAE and 721 SAR plans, maintaining their market prominence.
- C-SNPs show notable expansion with 217 new plans and minimal terminations (36), backed by 257 SAE plans, reflecting increased focus on chronic condition management.
- Non-SNP plans experienced significant restructuring with 617 terminations but 451 new launches, supported by 847 SAE and 1,196 SAR plans.
Geographic Moves
County-level changes
Devoted Health
Now in 53 of 67 counties
Universal Coverage
5 Major Payers
- UnitedHealth Group
- Humana
- Highmark Health
- CVS Health
- Independence Health
Plan Type Mix
2026 Distribution
HMO Surge
Fastest growing segment
Market Leaders
By plan count
Highmark Health
Optimizing
CVS Health
Selective Focus
UPMC Health
+5 Plans
Member Costs
2026 Averages
Average Premium
Monthly
Max Out-of-Pocket
Annual
Cost Distribution
Drug Deductibles
Sharp increase
HMO Surge
+81% from $233
$0 Deductible Plans
Down from 48%
Plans Over $600
of 253 non-zero-drug deductible
Why It Matters
Pennsylvania's unique market dynamics
#3 Growth State
+16 plans in 2026 alone
HMO Dominance
186 plans, +27% growth
Premium Market
$30.40 average monthly
While most states see contraction, Pennsylvania proves growth is still possible with the right strategy
+38% 4-Year Expansion
Why HealthworksAI
Be first. Be right. (Not either/or)
Fastest signal → action
- Landscape <36h, PBP/Crosswalk 48h
- Enrollment Forecast 96h (91.2% benchmark)
County precision, not averages
- Defend/Grow/Shrink maps, broker targets
- One-pagers so field teams act where shelf space just opened
Benefits that actually convert
- Benefit sensitivity quick-tests by ZIP (Rx, dental $, flex, utilities) to reallocate budget from low-ROI perks to high-lift levers
20-min readout: top counties, rival moves, benefit levers, commission signals.
Insights from CMS Landscape (<36h turnaround)
