Medicare Advantage enrollment falling in 2026

What’s Changing in Medicare Advantage for 2026

According to CMS and recent reporting:

• Enrollment in Medicare Advantage is projected to fall in 2026 – from an estimated 34.9 million in 2025 to about 34 million in 2026.  
• That drop would mean MA plans would represent roughly 48% of the Medicare population in 2026, down from about 50% in 2025.  
• On the premium side, CMS projects the average monthly premium for all MA plans to decline – from about $16.40 in 2025 to $14.00 in 2026.  
• For standalone Part D drug plans: average premiums are projected to decrease from $38.31 (2025) to $34.50 (2026); and for MA plans that include Part D coverage, the average premium drops from $13.32 to $11.50.  
• Plan availability remains fairly strong: more than 99% of Medicare beneficiaries will still have access to at least one MA plan, and 97% will have access to 10 or more MA options. The total number of MA plans nationally is expected to decrease slightly (from 5,633 in 2025 to about 5,600 in 2026).  
• Importantly: While insurer projections suggest a drop, CMS notes that based on historical experience and trends, enrollment may be more robust than plans project and could in fact be “stable”.  

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Why the Change? What’s Driving This Shift

Several headwinds and dynamics are influencing the MA program’s growth trajectory:

• After years of strong growth in MA enrollment, growth has been decelerating. Analysts point to rising utilization (post-COVID care rebound), slower rate increases, and regulatory pressures as contributing factors.  
• Some major insurers are responding by scaling back MA offerings for 2026—exiting certain geographic markets, reducing benefit offerings, or withdrawing plans in less profitable territories.  
• Although premiums are going down for many MA plans, other cost pressures remain – for example, higher utilization, tighter margins, and benefit design changes may be coming.  
• The fact that CMS warns that the official estimate (34 million) may understate actual enrollment suggests some uncertainty in the market about how consumers will respond and how the competitive landscape will evolve.  

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What This Means for Providers & Medical Practices

For medical practices that bill MA plans (or are considering participating), there are several implications worth considering:

• Network contracting and referral flows could shift. As MA plans pull back or reconfigure, providers may see changes in network coverage, benefit design, or plan availability in their region. This could impact patient enrollment in specific MA products and therefore revenue streams tied to MA-covered patients.
• Benefit design changes may affect patient behavior. Lower premiums may entice beneficiaries, but if plans reduce non-medical supplemental benefits (e.g., dental, vision, transportation) or tighten networks/prior-auth requirements, utilization patterns may shift.
• Enrollment volatility means billing/RCM teams need to stay alert. For a practice like yours (@ Zoo Health, a revenue cycle-management specialist), changes in MA enrollment could affect payer mix, reimbursement timing, and denial patterns. It may be wise to monitor local MA plan market exits, membership churn, and contract changes.
• Opportunity for growth or differentiation. If some MA plans reduce their footprint, there may be openings for providers to engage with other plans, negotiate better terms, or differentiate clinically (e.g., value-based care, enhanced benefits) to capture patient population shifts.
• Patient education becomes even more critical. As enrollment shifts, practices may need to support patients in plan decisions (e.g., switching from MA to traditional Medicare + Medigap) or to anticipate access issues if their MA plan changes networks. Practices that anticipate and respond proactively gain trust and improve retention.

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Action Steps: What Your Practice Should Do Now

1. Review your MA contracts and alignments by region — Check each plan’s 2026 renewal, network changes, or exit announcements.
2. Assess payer-mix and expected MA patient volume — Estimate how a ~1 million drop in MA enrollees nationally (or equivalent in your region) might influence your practice’s revenue mix.
3. Engage patients early — Communicate with MA-enrolled patients about their plan options for 2026, any benefit changes, and provider network continuity.
4. Work with your billing/RCM partner (like Zoo Health) to model potential changes in claims volume, denial risks, and revenue cycle impacts due to MA plan shifts.
5. Leverage benefit design changes as talking points — If MA premiums drop, but benefits stay stable, this is a positive message. If benefits are being reduced, prepare to discuss with patients and mitigate surprise coverage gaps.
6. Stay tuned for CMS updates and plan-finder tool release — The full plan designs will become available in early October. This helps your administrative teams prepare for open enrollment (Oct 15–Dec 7) and provider network confirmations.  

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Bottom Line

The trendline for Medicare Advantage is shifting: after years of steady growth, 2026 is projected to see a modest decline in enrollees and lower average premiums. While CMS believes enrollment may be more stable than the estimates suggest, the change signals significant headwinds. For medical practices and billing/R CM service providers, this environment calls for increased vigilance around payer mix, plan network changes, patient education and operational readiness. Staying ahead of these shifts can turn uncertainty into a strategic advantage.

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“Original reporting and data: ‘Medicare Advantage Enrollment Projected to Decline in 2026’ — Healthcare Dive, Oct 2025.”

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