Medicare Advantage
AEP 2026 Analysis and Databook
MA growth has structurally slowed to just +1.0% YoY, becoming increasingly concentrated as the Top 5 carriers still control ~70% of enrollment while several large nationals retreat through margin-driven retrenchment. Growth is rotating toward focused operators and regionally entrenched PSPs, with C-SNP specifically outpacing D-SNP growth at a rate of nearly 3:1, creating a differentiated entry wedge for clinically integrated plans and condition-focused startups.
Key findings
- ▸MA enrollment grew just +1.0% YoY (+361k) in 2026, down sharply from +3.9% (+1.3M) a year earlier, and the slowdown looks structural rather than cyclical.
- ▸Scale stopped being a growth advantage: UnitedHealthcare, CVS/Aetna, Elevance, and Centene all lost enrollment YoY, while Humana was the only top-6 carrier to grow more than 2%.
- ▸SNP is the growth engine, up 11% (+799k); among the 10 largest SNP organizations, C-SNP outpaced D-SNP nearly 3:1 (+430k vs. +170k).
- ▸C-SNP is a differentiated entry wedge: clinically targetable without the Medicaid-integration complexity of D-SNP, and a fit for clinically integrated plans, regionals, PSPs, and condition-focused startups.
- ▸For-profit carriers drove roughly half of 2026's enrollment decline; HCSC's acquisition of Cigna's MA book moved ~700k members under the Blues umbrella, masking a broader Blues retreat.
- ▸Built with the Aequalis Payer Insights Platform from county-level CMS enrollment data.