As major insurers pull back on their Medicare Advantage offerings, health system-owned plans told Becker’s they’re eyeing an opportunity to regain ground ahead of the annual enrollment season.
“We’re hopeful that CMS and the current administration are really going to understand the value of provider-led, provider-sponsored health plans, particularly in Medicare Advantage,” Ben Gerber, CEO of WVU Medicine’s Peak Health, said. “The nationals have not necessarily done the best job in promoting consumer experience or in reducing the cost of healthcare. Provider-sponsored Medicare Advantage plans are in a unique position to do things that look a little bit different.”
“When you hear some of the negative press the nationals have gotten, we view that more as an opportunity,” Mr. Gerber added. “We think it’s good for consumers to have choice in Medicare Advantage plans, but we also think they want a different option — one that’s a little more local, more consumer-friendly, with less red tape and fewer denials.”
Facing federal cost-containment measures and rising medical expenses, several of the largest MA insurers are cutting supplemental benefits, exiting markets and eliminating products to improve profit margins. UnitedHealthcare, Humana and CVS Health have all taken steps over the last year to reshape their Medicare Advantage portfolios in response to declining profitability in the space.
“We have made the difficult decision to exit plans that currently serve over 600,000 members, primarily in less managed products such as PPO offerings,” UnitedHealthcare CEO Tim Knoll told investors in July. “We have taken similar approaches for Medicare supplement, Group MA, and standalone Part D pricing for next year.”
Humana expects to lose up to 500,000 Medicare Advantage members by the end of 2025 as it exits unprofitable plans and geographies. That is an improvement over earlier projections, as the company has already recaptured 40% of affected members into new offerings. Humana executives said the changes reflect two years of adjustments related to rising medical utilization trends and regulatory changes under CMS.
“We’re the only plans to reduce benefits in any way in 2024, and we reduced more benefits that were more significant than just about all of our competitors in 2025,” George Renaudin, president of Humana’s insurance segment, told investors in July.
CVS Health also adopted a “margins over membership” approach in 2024 for its MA offerings, with leadership projecting a loss of up to 10% of its MA members as the company exited unprofitable counties.
“Some of the biggest players in the industry from a national perspective are making significant moves around Medicare Advantage,” Don Antonucci, CEO of Providence Health Plan, said. “That has a ripple effect, and we want to make sure we’re set up the right way.”
“For example, with health plans that move away from their Medicare Advantage PPO products or double down on their HMO, that can create, in some cases and in some markets, a significant opportunity for market share and meaningful membership in a different way. We’re keeping our eye on that as we learn more going into the fall and open enrollment,” he said.
Despite the national pullbacks, total Medicare Advantage enrollment is still growing, though at a slower rate. Between 2024 and 2025, enrollment grew 4%, compared to 7% the year before. In 2025, 34 million Medicare beneficiaries, or 54% of the eligible population, are enrolled in Medicare Advantage plans, up from 33 million (53%) in 2024.
Health system-owned Medicare Advantage plans have also seen overall growth in recent years but continue to underperform against the large national carriers regarding market share. In 2024, provider-sponsored plans made up 13% of the MA market, down from 17% in 2019. Several health systems also exited the MA business entirely during that time.
“I do think it’s an opportunity. Over time, the playing field is going to level somewhat, which is going to be a challenge for the nationals. For the community health plans, I think it’s going to be a benefit,” Rob Hitchcock, president and CEO of Intermountain’s Select Health, said.
“What you want is a healthy mix. You do want the national players to be strong, but you also want the community health plans to be strong,” he added.
