As we approach 2026, the Medicare Advantage (MA) landscape is poised for significant changes.
With over half of Medicare beneficiaries now enrolled in MA plans, understanding the nuances of top providers is crucial for making informed healthcare decisions.
This article delves into the anticipated updates for 2026 and offers a comparative analysis of leading MA providers.
Anticipated Changes in Medicare Advantage for 2026
The Centers for Medicare & Medicaid Services (CMS) have proposed several updates set to impact MA plans in 2026:
● Payment Increase: CMS proposes a 4.3% payment increase to MA plans for 2026, translating to approximately $21 billion in additional funds.
● Risk Adjustment Model: The completion of a three-year phase-in of the updated risk adjustment model is expected, aiming to enhance payment accuracy based on enrollees’ health statuses.
● Out-of-Pocket Prescription Costs: Under the Inflation Reduction Act, annual out-of-pocket prescription drug costs will be capped at $2,100 in 2026, slightly up from the $2,000 cap in 2025.
Comparing Advantage Plans in 2026
When comparing Advantage plans in 2026, several key factors should be considered:
1. Star Ratings
CMS assigns star ratings to MA plans, ranging from one to five stars, based on quality and performance metrics. These ratings influence bonus payments to providers and serve as a benchmark for beneficiaries. Notably, the percentage of enrollees in plans rated four stars or higher has decreased from 74% in 2024 to 62% in 2025, indicating a trend that may continue into 2026.
2. Provider Networks
Access to a broad network of healthcare providers ensures flexibility and convenience. CMS has proposed that MA organizations submit their provider directory data for inclusion in the Medicare Plan Finder by 2026, enhancing transparency and aiding beneficiaries in making informed choices.
3. Supplemental Benefits
Many MA plans offer additional benefits beyond standard Medicare coverage, such as dental, vision, and wellness programs. Evaluating these supplemental offerings is essential to determine the overall value of a plan.
Top Medicare Advantage Providers for 2026
Here’s a comparative overview of leading MA providers based on current data and anticipated trends:
| Provider | Projected 2026 Star Rating | Notable Features | Considerations |
| Humana | 3.5 stars | Extensive network, comprehensive supplemental benefits | Recent rating declines may impact bonus payments and plan attractiveness. |
| UnitedHealth | 4 stars | Robust plan options, strong national presence | Faces challenges with rising medical costs and reimbursement rates. |
| CVS Health | 4.5 stars | High member satisfaction, diverse plan offerings through Aetna | Recent improvements in ratings; potential for increased enrollments. |
Note: Star ratings are subject to change based on CMS evaluations.
Key Considerations for Beneficiaries
When selecting an MA plan for 2026, consider the following:
● Assess Personal Healthcare Needs: Ensure the plan covers necessary services and includes preferred healthcare providers.
● Review Plan Costs: Examine premiums, deductibles, and out-of-pocket maximums to determine affordability.
● Stay Informed on Policy Changes: CMS proposals, such as expanded coverage for anti-obesity medications under Part D, may influence plan benefits and costs.
In conclusion, the Medicare Advantage landscape in 2026 is evolving, with significant changes on the horizon. By staying informed and carefully evaluating plan options, beneficiaries can select coverage that best aligns with their healthcare needs and financial considerations.
