Hospitals are the Patient Advocate

Hospital and Provider Education

By The Numbers

Payers who own Medicare Advantage plans aggressively market these plans directly to those eligible for Medicare, especially during open enrollment time. As a result, more individuals are choosing Medicare Advantage over Original Medicare compared to 10 years ago. While premiums may be lower and the “bundled” nature of Medicare Advantage plans may seem attractive, the complex nature of Medicare Advantage plans is driving up the cost of healthcare and many patients are faced with suddenly becoming out-of-network or having excessive out-of-pocket costs with Medicare Advantage plans.

More than half of eligible Medicare beneficiaries are enrolled in Medicare Advantage in 2026.

In 2026, more than half (55%) of eligible Medicare beneficiaries – 35.2 million out of 64.2 million Medicare beneficiaries with both Medicare Parts A and B – are enrolled in Medicare Advantage plans (Figure 1). The share of Medicare beneficiaries in Medicare Advantage plans varies by state and by county (Appendix Figures 1 and 2). Medicare Advantage enrollment as a share of the eligible Medicare population has jumped from 19% in 2007 to 55% in 2026.

Between 2025 and 2026, total Medicare Advantage enrollment grew by about 1.1 million beneficiaries, or 3% – a similar growth rate to the prior year (4%). The Congressional Budget Office (CBO) projects that the share of all Medicare beneficiaries enrolled in Medicare Advantage plans will rise to 63% by 2034 and remain at 63% for 2035 and 2036 (Figure 2).

In 2026, about six in ten Medicare Advantage enrollees are in individual plans that are open for general enrollment.

About 6 in 10 Medicare Advantage enrollees (61%), or 21.4 million people, are in plans generally available to all Medicare beneficiaries for individual enrollment (Figure 3). That is an increase of 0.2 million enrollees compared to 2025, though individual plans comprised a slightly smaller share of total Medicare Advantage enrollment in 2026 (61%) compared to 2025 (62%), and their share of enrollment has declined since 2010 when they comprised 71% of all enrollees. The decline in the share of enrollment in individual plans is due to faster enrollment growth in special needs plans (SNPs), especially since 2018.

Special needs plans (SNPs) comprise a growing share of Medicare Advantage enrollment.

Nearly 8.2 million Medicare beneficiaries are enrolled in special needs plans (SNPs), an increase of more than 900,000 enrollees since 2025, and accounted for 85% of the net increase in Medicare Advantage enrollment over the last year. SNPs restrict enrollment to beneficiaries with significant or relatively specialized care needs, or who qualify because they are eligible for both Medicare and Medicaid. SNPs comprise a growing share of Medicare Advantage enrollment, accounting for 23% of enrollees in 2026 compared with 21% of enrollees in 2025 (Figure 4).

The increase in SNP enrollment is consistent with the increasing number of SNP plans available on average and more dual-eligible individuals having access to these plans since the Bipartisan Budget Act of 2018 made SNPs a permanent part of the Medicare Advantage program. Growth in SNP enrollment may also stem from the sharp increase in rebate payments, which have more than doubled since 2017 and are higher than for individual plans, which enables SNPs to offer extra benefits that are attractive to dual-eligible individuals.

Further, the Medicare Advantage Value-Based Insurance Design Model (VBID), which launched in 2017, gave plans the ability to provide additional interventions to enrollees such as reduced cost sharing and extra benefits based on their socioeconomic status (e.g., LIS eligibility), along with other targeting criteria. This meant many enrollees in SNPs, including those dually eligible for Medicare and Medicaid, may have been eligible for additional benefits. For example, plans enrolled in the model were able to offer benefits such as food and produce, assistance with utilities, and transportation for non-medical needs, among others, to a broader group of enrollees, when many of those benefits were typically reserved for enrollees who met the stricter definition of eligibility for Special Supplemental Benefits for the Chronically Ill (SSBCI). However, CMS discontinued this model in 2025 due to the “unprecedented cost” of this model, including increased rebates and increased Part D expenditures.

D-SNPs. Most SNP enrollees (78%) are in plans for beneficiaries dually enrolled in both Medicare and Medicaid (D-SNPs), a decline from 83% in 2025. While D-SNPs are designed specifically for dually-eligible individuals, among the 3.9 million dually-eligible enrollees with full benefits enrolled in Medicare Advantage plans, 28% were enrolled in Medicare Advantage plans that are generally available to all beneficiaries (not designed specifically for the dually-eligible population).

C-SNPs. Another 20% of SNP enrollees are in plans for people with severe chronic or disabling conditions (C-SNPs) – an increase from 16% in 2025. C-SNP enrollment in 2026 (about 1.7 million people) is 45% higher than it was in 2025 – an increase of about 518,000 enrollees. Nearly all (97%) C-SNP enrollees are in plans for people with diabetes or cardiovascular conditions in 2026, the same as in 2025.

I-SNPs. And 2% of SNP enrollees in 2026 are in plans for beneficiaries requiring a nursing home or institutional level of care (I-SNPs), the same as 2025. Enrollment in I-SNPs increased slightly in 2026 124,000 enrollees, an increase of about 9,000 enrollees since 2025.

SNP enrollment varies across states. In the District of Columbia and Puerto Rico, SNP enrollees comprise about half of all Medicare Advantage enrollees (51% in DC and 49% in PR). In eleven states, SNP enrollment accounts for at least a quarter of Medicare Advantage enrollment: 46% in MS, 40% in AR, 37% in NY, 36% in LA, 33% in FL, 32% in SC, 30% in GA, 27% in OK and AL, 26% in CT, and 26% in RI. In the remaining 39 states, fewer than a quarter of Medicare Advantage enrollees are in SNPs, including Alaska and Vermont, which have no SNP enrollment.

Enrollment in a D-SNP comprises the largest share of enrollment in SNPs in all states except New Hampshire where C-SNP enrollment is higher, though overall SNP enrollment only represents 2% of Medicare Advantage enrollment in New Hampshire. C-SNP enrollment represents a relatively large share of Medicare Advantage SNP enrollment in Illinois, Utah, South Carolina, Delaware, Nevada, and Oregon, where 40% or more of SNP enrollment is in C-SNPs.

Slightly less than one in five (16% or about 5.7 million) Medicare Advantage enrollees are in a group plan offered to retirees by an employer or union.

Group enrollment as a share of total Medicare Advantage enrollment is 16%, the lowest share since 2010, though it has generally fluctuated between 17% and 20% of enrollment. At the same time, the number of enrollees has increased from 1.8 million in 2010 to 5.7 million in 2026. The 2026 enrollment in group plans is a slight decrease from 2025 (a decrease of about 31,000 enrollees), the first time since 2010 that enrollment in this type of plan has declined year-to-year (Figure 5). With a group plan, an employer or union contracts with an insurer and Medicare pays the insurer a fixed amount per enrollee to provide benefits covered by Medicare. For example, 13 states provided health insurance benefits to their Medicare-eligible retirees exclusively through Medicare Advantage plans in 2024.

As with other Medicare Advantage plans, employer and union group plans may provide additional benefits and/or lower cost sharing than traditional Medicare and are eligible for bonus payments if they obtain required quality scores. The employer or union (and sometimes the retiree) may also pay an additional premium for these supplemental benefits. Group enrollees comprise a quarter or more of Medicare Advantage enrollees in seven states: 100% in AK, 60% in VT, 34% in MI, 31% in NJ, 28% in MD and WV, and 25% in IL.

Medicare Advantage enrollment is highly concentrated among a small number of parent organizations.

The average Medicare beneficiary is able to choose from Medicare Advantage plans offered by 8 parent organizations in 2026, the same as in 2025 and 2024, and nearly three in ten (29%) can choose among Medicare Advantage plans offered by 10 or more parent organizations.

UnitedHealth Group and Humana account for nearly half of all Medicare Advantage enrollees nationwide in 2026.

Despite most beneficiaries having access to plans operated by several parent organizations, Medicare Advantage enrollment is highly concentrated among a small number of parent organizations (Figure 6). UnitedHealth Group Inc. accounts for 26% of all Medicare Advantage enrollment in 2026 (a decline from 29% in 2025), or 9.3 million enrollees. Humana Inc. accounts for 20% of all Medicare Advantage enrollment in 2026 (an increase from 17% in 2025), or 7 million enrollees. Together, UnitedHealth Group Inc. and Humana Inc. account for nearly half (46%) of all Medicare Advantage enrollees nationwide, the same share as in 2025. In more than a quarter of counties (28% or 889 counties), these two organizations account for at least 75% of Medicare Advantage enrollment. These counties include East Baton Rouge (Baton Rouge), LA (81%), Travis County (Austin), TX (78%), Jackson County (Kansas City), MO (76%), and Palm Beach, Florida (75%).

Three other parent organizations comprise more than 5% of Medicare Advantage enrollment: CVS Health Corporation (12%), Kaiser Foundation Health Plan Inc. (6%), and Elevance Health Inc, (5%). (In contrast, as of 2025, CVS Health and Centene Corporation dominate the market for stand-alone prescription drug plans (PDP) that supplement traditional Medicare, with both organizations accounting for just over half of enrollment in PDPs).

Humana and Kaiser Permanente were the only large insurers to increase enrollment from 2025 to 2026.

In absolute numbers, Humana had the largest growth in enrollment, with 1.3 million more beneficiaries enrolled in a plan sponsored by Humana in March 2026 than in March 2025 (Figure 7). Of the largest insurers (5% of enrollment or more), Kaiser Permanente had the second largest growth in enrollment, with an increase of nearly 87,000 beneficiaries between March 2025 and March 2026. However, some smaller insurers had even larger growth – Devoted Health had an increase of nearly 258,000, SCAN Group had an increase of 136,000, and Aware Integrated had an increase of 89,000 beneficiaries between March 2025 and March 2026 (data not shown).

In contrast, enrollment in UnitedHealth plans declined, decreasing by nearly 647,000 beneficiaries between March 2025 and March 2026, and Elevance had the second largest enrollment drop, losing 346,000 beneficiaries, while enrollment in CVS plans declined by nearly 29,000.