Medicare Advantage Membership Insights and Challenges for 2026

During the annual enrollment period from October 15 to December 7, several insurance companies reported increased Medicare Advantage (MA) memberships projected for 2026. While the MA sector sees growth, it also faces challenges such as regulatory compliance requirements, company withdrawals, and rising healthcare costs impacting benefits. Insurers are navigating these issues to ensure stable payer and provider relationships.

Notably, UnitedHealthcare anticipates a reduction of up to 1.4 million MA members by 2026, while Elevance Health predicts steady enrollment between 1.8 million and 1.9 million members. In contrast, some carriers report membership growth. Alignment Healthcare projects an increase to nearly 296,000 members following a successful annual enrollment, and Clever Care Health Plan has expanded its membership by 50%.

Membership Growth in Medicare Advantage Plans

Several insurers have announced membership increases for 2026. Alignment Healthcare saw a 31% rise to 275,300 members, aiming for up to 296,000 by the year's end. Clever Care gained 15,000 new members, marking significant growth. Meanwhile, SCAN Health Plan's enrollment surged by 40.6%, totaling 440,000 members.

Key Industry Developments

Beyond Medicare Advantage, industry developments include Optum's launch of AI-driven prior authorization tools to enhance provider claims submissions. Additionally, changes in network affiliations are unfolding, with facilities in Tennessee and Georgia, formerly CHI Memorial, now out-of-network with Cigna Healthcare. On the Medicaid front, Florida Decides Healthcare is pushing for a 2028 ballot measure to drive Medicaid expansion, indicating dynamic regulatory changes in the industry.