In 2026, 4.6 million Medicare Advantage beneficiaries, or 16% of enrollees, experienced disruptions to their health plan, according to a recent brief from the Alliance of Community Health Plans and consulting firm HealthScape Advisors.
Hospitals have been dropping MA plans, often citing prior authorization issues and slow reimbursement. Meanwhile, health insurers have been exiting markets amid steep medical costs and an evolving regulatory landscape. Earlier research published in JAMA indicated 1 in 10 MA enrollees had to leave their plan heading into 2026 due to market exits. Separately, the recent ACHP brief said there has been a 10% decline in the count of MA plans nationwide, marking another year of scaling back.
But as larger players retreat — Humana, for one, has already announced a pullback for 2027 affecting about 600,000 members — some regional health plans have spotted an opportunity to gain membership. For example, MA enrollment for Health Alliance Plan by Henry Ford Health hit 132,566 members as of June 30, up from 90,935 the year prior. ACHP’s brief said 26,000 MA beneficiaries have one of the alliance’s member plans as their only MA option.
Still, not every regional insurer is betting aggressively on MA, including Albuquerque, N.M.-based Presbyterian Healthcare Services’ plans. The system is cutting back its MA offerings, affecting 30,000 members.
“For Presbyterian, continuing in this market would limit our ability to invest in the care, workforce and access to serve New Mexicans where they need us most,” Presbyterian said in a statement previously shared with Becker’s.
Ceci Connolly, president and CEO of the Alliance of Community Health Plans, joined an upcoming episode of the “Becker’s Payer Issues Podcast” to discuss her expectations, as MA plans gear up for the annual enrollment period.
“I think for many seniors that can be terribly unnerving and confusing and so difficult,” she said about the need to switch plans. “Not only do they have to find a new plan, but that can involve finding new doctors, so it’s really worrisome from the view of beneficiaries.”
Ms. Connolly said some ACHP member plans bolstered their call lines to accommodate older adults in need of support. The plans have also been working with community partners and brokers to communicate with those affected by disruption.
“I have to be candid with you. This puts a lot of burden on smaller local plans, and they have limited dollars and resources,” she said.
Unlike many bigger players, nonprofit plans do not serve shareholders. Ms. Connolly said ACHP members are content with a 1%-to-2% margin most years, but these plans require “practical business people” to maintain their presence.
She specifically named risk adjustment and the intake of higher-acuity members as challenges health plans need to navigate. She said ACHP has been collaborating with CMS to streamline risk adjustment, the process of modifying payments to MA plans based on enrollees’ expected health costs. ACHP has been pushing for an inferred risk model, which would remove coders from the process and focus on physician visits, filled prescriptions and lab work. Ms. Connolly recognized progress made with enrollment caps and risk-adjustment flexibility for enrollees who are switching carriers.
While Ms. Connolly acknowledged that market disruption is not a new issue, she said the country’s variation with disruption is notable. The brief highlighted how enrollment disruptions hit 26% of rural beneficiaries, and most counties saw fewer plan offerings.
“It’s a concerning trend, not only for nonprofit regional plans that are staying there in their local communities — serving their neighbors every single day — but it really should alarm policymakers because we could be left with a real checkerboard kind of coverage for America’s seniors if we don’t have some intervention pretty soon,” she said.
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