Why fewer seniors are expected to enroll in Medicare Advantage next year — and opt for original Medicare instead
Medicare Advantage may drop to 48% of the market in 2026. – Getty Images
Medicare Advantage, the private-plan alternative to traditional Medicare, may finally see a hiccup in its blistering subscriber growth.
Enrollment in Medicare Advantage is projected to be 34 million subscribers in 2026, a decrease from 34.9 million in 2025, according to plan forecasts provided by the Centers for Medicare and Medicaid. That marks a drop from 50% of the overall Medicare market in 2025 to about 48% in 2026, CMS said.
Still, CMS itself expects Medicare Advantage enrollment “will be more robust than the plans’ projections and that enrollment will be stable.” But even “stable” marks a contrast to the growth seen in recent years — Medicare Advantage had 25% of the market in 2010 and has gained market share each year since.
“If enrollment is stable or declines, it would be a break from what we’ve seen for decades,” said Matthew Fiedler, senior fellow at the Center on Health Policy at the Brookings Institution.
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The forecasts come as the open-enrollment period for Medicare approaches — from Oct. 15 to Dec. 7 each year — when beneficiaries can review and update their health and drug coverage for the following year. With the rising cost of healthcare, beneficiaries may look at ways to cut costs. This all comes in the wake of the federal government shutdown, which was triggered in part by a standoff between the two parties as Democrats refused to back a Republican bill they say will make it more difficult for Americans to afford healthcare.
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Medicare Advantage plans offer extra benefits such as vision and dental coverage, but that comes with the trade off of a limited choice of doctors and requirements for specialist referrals. Medicare Advantage also caps annual out-of-pocket costs.
“Medicare Advantage enrollment has grown in tandem with increasing benefit richness in recent years, but carriers are currently focused more on profitability than growth. As MA plan benefits become less generous, we anticipate more seniors may choose original Medicare instead,” said Cobi Blumenfeld-Gantz, chief executive of Chapter, a company that helps subscribers choose Medicare and Medicare Advantage plans.
“I expect this will be a longer-term trend as more seniors become aware of the downsides of Medicare Advantage plans, from limited physician networks to prior authorization requirements. Medicare Advantage plans have been marketed very aggressively by unscrupulous brokers, but original Medicare with a supplement plan is a superior option for most who can afford one,” Blumenfeld-Gantz said. “In a world with complete information and rational choice, Medicare Advantage would represent far less than 48% of total enrollments. That is the world we are slowly moving towards.”
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The Congressional Budget Office (CBO) has projected that Medicare Advantage will control about 64% of the market by 2034.
The insurers behind the Medicare Advantage market have been exiting certain unprofitable markets or discontinuing plans amid higher-than-expected medical expenses among subscribers and changes in government payments that have squeezed margins.
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“Some plans are pulling back a little bit,” said Stephen Zuckerman, Institute fellow in the health-policy division at the Urban Institute. “But it’s not a major collapse of the market in any way, shape or form.”
The market remains lucrative as the government pays 22% more per Medicare Advantage enrollee, or about $83 billion a year more, than if that person had been enrolled in traditional Medicare, according to the Medicare Payment Advisory Commission, the independent federal agency that advises the U.S. Congress on issues affecting the Medicare program.
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In the longer term, analysts expect Medicare Advantage to continue growing its market share.
“MA is still pretty attractive to people with the benefits and one-stop shopping and I think that it is still going to be attractive going forward. I expect enrollment to be stable or continue to grow. I’d be surprised if it actually declined,” said Jeannie Fuglesten Biniek, associate director for the program on Medicare policy at KFF. “I expect it to continue to increase, but not at the same rate as it did from 2018 to 2023.”
Overall, access to Medicare Advantage plans will remain stable for 2026, with more than 99% of Medicare beneficiaries having access to at least one plan, and 97% of Medicare beneficiaries having access to 10 or more plan choices, according to CMS. The total number of available Medicare Advantage plans nationally will decrease slightly from 5,633 in 2025 to 5,600 in 2026, CMS said.
While the forecasts for 2026 are purely projections that could be a blip, Fiedler expects Medicare Advantage’s market share will grow in the long run.
“My best guess is that unless we see a real sea-change in policy, we’ll see some continued increase in MA’s share of the market,” Fiedler said.
Read next: Is Humana dropping your Medicare Advantage plan? Here’s what you need to know.
