Medicare open enrollment kicked off earlier this month and will run until Dec. 7. From some big players exiting Medicare Advantage to boosts in regulatory legislation, there has been more uncertainty with navigating the space.
Becker’s caught up with six health payer leaders in the Medicare business for a pulse check.
Editor’s note: Responses have been lightly edited for clarity and length.
Margaret Anderson. President of Health Alliance Plan (Detroit): Last year marked a 10-year high in Medicare Advantage members switching plans — a clear indication that seniors are actively seeking better value, more comprehensive coverage and greater affordability. This annual enrollment period, we anticipate even greater movement, driven by evolving market dynamics.
Our focus remains steadfast: Affordability, access, and quality. Our goal is simple — keep premiums low and copays affordable. As market noise intensifies, our team is committed to leading with clarity and staying true to our mission.
Karen Johnson. CEO of Clever Care Health Plan (Huntington Beach, Calif.): As we enter Medicare open enrollment season, I’m excited about the opportunity for us to improve access to culturally competent healthcare to many more people in Southern California. We’re focused on ensuring our product offerings are well-positioned for the market, our messaging is cutting through the noise and we’re prepared to respond quickly to changing dynamics. It’s about being both strategic and nimble while staying true to our mission of delivering care that truly understands the communities we serve.
Eric Hunter. President and CEO of CareOregon (Portland): Medicaid and Medicare are deeply connected for the people we serve, which is why [dual-eligible special needs plans] remain so important — especially during this annual enrollment period. Like many plans, we’ve had to make difficult choices for 2026 in response to rising costs, the end of the federal value-based insurance design model and the effects of Medicaid redeterminations. Our focus is simple: Protect member access, operate sustainably and continue serving dual-eligible Oregonians with compassion and accountability.
In Oregon, that meant exiting one rural county where we couldn’t responsibly sustain our D-SNP without jeopardizing stability elsewhere. These decisions underscore a larger challenge for the industry: Safety-net D-SNPs need a financing and regulatory model that truly supports coordinated care across Medicaid and Medicare. Until that alignment improves, plans like ours will continue to face hard choices — but we’ll keep doing the work to ensure the people who rely on us get the care they need.
Dawn Maroney. President of Alignment Health and CEO of Alignment Health Plan (Orange, Calif.): As healthcare leaders, we must ask, “Why are some plans pulling out or pulling back?” And, more importantly, “How can we, as leaders of health systems that truly care, do better in serving the most vulnerable and fastest-growing population?” The reality is simple: People are going to need more care, not less. From Alignment’s perspective, our priority is to make sure seniors continue to see us as a trusted partner — one that delivers simplicity, stability and peace of mind when it comes to their health benefits and care. We help them navigate the volatility in the market and guide them to trusted tools like Medicare star ratings and plan finder. We’re also connecting members with high-quality provider networks and working with policymakers to make Medicare Advantage better for all.
Here’s how I’m thinking about the season:
Industry volatility: What concerns me most this year around market changes or exits are industry fluctuations paired with the reprioritization of ethical standards. Unfortunately, some bad actors are prioritizing compensation over the best interests of seniors, steering them toward plans that maximize incentives or compensation rather than meet their health needs. In some cases, seniors aren’t even being shown all available plan options because certain agents or provider groups aren’t contracted with the plan due to compliance or quality concerns. That’s not what Medicare Advantage was designed to be. It should be about trust, transparency and doing what’s right for every senior.
Empowering seniors with trusted resources: We encourage seniors to use trusted tools like Medicare.gov’s plan compare finder, where they can view CMS star ratings. At Alignment, 100% of our members are in plans rated four stars or higher – a reflection of our commitment to quality.
Building high-quality provider networks: Growth is important, but the right kind of growth matters more. We focus on connecting members with clinically aligned, high-quality provider networks that help them navigate a coordinated care system built for better outcomes and a better experience.
Partnering with policymakers and regulators: In addition to serving our members, we’re working closely with regulators and policymakers to make sure Medicare Advantage is done right – not just for today, but for the future. This program serves millions of seniors, and it’s vital that we protect its integrity while improving it for those who depend on it most.
Leanne Berge. CEO of Community Health Plan of Washington and Community Health Network of Washington (Seattle): Community Health Plan of Washington, a not-for-profit, community-affiliated health plan, is experiencing many of the same market factors as Medicare Advantage plans across the country: Increased costs of care for aging and medically-complex members, increased costs for supplemental benefits and changes over the past several years in star-rating thresholds or “cut points,” affecting additional funding. As a regional plan founded by Community Health Centers, who remain the foundation of our primary care network, we seek to balance market pressures with our commitment to serving our communities and offering comprehensive, managed care for eligible beneficiaries. In response, for the 2026 plan year, CHPW has made the difficult decision to eliminate our Medicare-only MA plans so we can focus entirely on serving D-SNP members. Through our D-SNP plans, we can strengthen the continuity of care between our Medicaid and Medicare-eligible members, focus on an enhanced care management model to achieve highest quality performance and member satisfaction and provide supplemental benefits that most directly improve our members’ health.
Krista Hoglund. President of Jefferson Health Plans (Philadelphia): As we approach Medicare open enrollment, Jefferson Health Plans is navigating the same headwinds affecting all insurance markets — rising healthcare costs, especially in pharmaceuticals, and increasing acuity pressures are impacting Medicare Advantage, as well. Retention remains a top priority, both from a business perspective and in how we deliver care as a provider-owned plan. In a challenging regulatory environment with volatility in carrier products, we’re committed to transparency and consistency. Jefferson Health Plans is part of an integrated delivery and financing system that includes Jefferson Health and Thomas Jefferson University. This unique structure allows us to create synergy and alignment across care, education and coverage — optimizing opportunities for our members and the communities we serve.
