Medicare Advantage Disenrollment Surge: Impacts and Trends
A recent study published in JAMA on February 18 reveals that 10% of Medicare Advantage (MA) enrollees are expected to disenroll from their plans by 2026 due to insurers withdrawing from the market. This marks a significant increase from historical averages, signaling substantial shifts in the insurance industry landscape.
The Medicare Advantage sector is facing considerable changes in 2025, as insurers reduce plan offerings in response to increasing usage rates and modifications in federal reimbursements. Historically, enrollment in Medicare Advantage plans has seen steady growth over the past 20 years, with plans doubling in the last seven years. This expansion typically resulted in fewer market disruptions for beneficiaries in the past.
Researchers from Johns Hopkins Bloomberg School of Public Health and Georgetown University analyzed data from the Centers for Medicare & Medicaid Services (CMS). They examined county-level enrollment figures, plan crosswalk information, and landscape files. Their study focused on Medicare Advantage participants in non-employer HMO and PPO plans across all U.S. states and the District of Columbia, using data from 2017 to 2025, and projected into 2026.
Key Findings and Impact
The average rate of forced disenrollments rose sharply from a historical 1% (2018-2024) to 6.9% in 2025, and it is expected to reach 10% for the 2026 plan year. The rate for non-special needs plans is anticipated to be 12.4%. Of the 28.6 million MA enrollees included in the study, approximately 2.9 million will need to find new plans for 2026, while about 25.8 million are expected to retain their existing coverage.
Factors influencing forced disenrollment included enrollment in PPO plans, smaller plans, plans with lower star ratings, or residence in rural areas with less Medicare Advantage market presence. Disenrollment rates did not vary significantly based on county income, risk score, or Medicaid eligibility.
Disenrollment statistics varied by insurer. Among smaller insurers, 48.8% of disenrollments occurred compared to 27.1% from retained enrollees. Blue Cross Blue Shield accounted for 8.9% of disenrollments, while Humana represented 2.2%. UnitedHealthcare members facing disenrollment accounted for 13.9%, compared to 22.6% of retained members. Aetna, Elevance Health, Cigna Healthcare, Kaiser Permanente, and Centene showed smaller disparities between affected and retained groups.
Twelve states have more than 20% of their MA members experiencing forced disenrollment, with Vermont experiencing the most significant impact, affecting 92.2% of its enrollee base. These developments highlight significant upcoming changes within the Medicare Advantage market that insurers and beneficiaries should closely monitor for regulatory compliance requirements and risk management strategies.