2026 MA Pullback Starts
A number of high profile exits from Medicare Advantage (MA) and standalone Part D (PDP) were announced today.
Elevance Health announced it will cut some MA plans and fully exit the PDP program.
The PDP exit is not surprising but sends a message that the program is in trouble after some political yet bad policy changes made by Democrats to Part D cost-sharing the Inflation Reduction Act. The changes have destabilized an already fragile program. Elevance has 400,000 PDP members and is the sixth-largest plan in PDP.
Given its continuing financial woes, Elevance, too, will eliminate unprofitable MA plans and says that will impact 150,000 individual and group MA members. But Elevance will continue its investments in Special Needs Plans (SNPs) in 2026, a huge trend in the industry. Elevance currently has 2.3 million MA enrollees.
In an another announcement, due to financial issues, Minnesota-based UCare will exit the MA market in 2026 except for SNPs. It has about 187,000 MA members in Minnesota and Wisconsin. It is the second largest MA carrier in the market.
Further, Oregon-based Samaritan Health Plans will exit MA in 2026. Samaritan has nearly 14,000 MA members in its HMO and D-SNP plans.
So, expected displacement for 2026 is already increasing. We know that United has already said it will seek to shed more than 600,000 lives in 2026 by ending unprofitable plans. CVS Health’s Aetna announced it will end nearly 90 Medicare Advantage plans across 34 states in 2026. Most are Preferred Provider Organizations (PPOs).
All told, with the latest announcements, it appears the displacement number is likely about 1 million already for 2026 and that will rise. In 2025, up to 2 million were displaced. In normal years, less than 100,000 face the requirement to change.
Additional articles: https://www.modernhealthcare.com/insurance/mh-ucare-medicare-advantage-plans-2026/ and https://www.modernhealthcare.com/insurance/mh-elevance-health-medicare-advantage-plans-2026/ and https://www.beckerspayer.com/payer/medicare-advantage/ucare-to-exit-medicare-advantage-market-in-2026/ and https://www.beckerspayer.com/payer/medicare-advantage/oregon-payer-to-exit-medicare-advantage-market/
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#medicareadvantage #margins #enrollment #2026 #partd #pdp #elevancehealth
Trump Administration Expands Catastrophic Coverage Access
Faced with the prospect of a median rate hike in the Exchanges of 18% due to the likelihood that enhanced premium subsidies in the Exchange will be sunset, the Trump administration is scrambling to ensure affordability. It announced today that more consumers will qualify to pick high-deductible catastrophic health plans during open enrollment for 2026.
The announcement extends hardship exemptions to anyone who earns more than 250% or less than 100% of the federal poverty level who is newly ineligible for tax credits. These policies will be available on the Exchanges in all states but California, Connecticut, Maryland, and the District of Columbia, and off the Exchanges nationwide. Previously, hardship exemptions were mostly granted under specific circumstances.
While I am a robust coverage supporter, I support the move given the precarious times we are in. More employer coverage is expected to erode and normal tier coverage will become out of reach for many who do not have access to premium subsidies. While there will be concerns about accessing the services truly needed and being among the underinsured, it is better than no care.
Some have raised that this could be much ado about nothing. Theoretically the plan design could be offered by plans as part of the Bronze offerings and prices likely are not that different. Another concern: catastrophic plans have a separate risk pool than the metal tiers. If such catastrophic plans grow, it pulls healthier consumers out of the metal tier pools, which could impact premiums further in the metal tier plans.
In other news, a recent ruling staying certain aspects of a new Exchange rule could be yet another challenge for health plan rate-setting. It could open up yet more rate filing changes depending on the outcome of an emergency request by the administration for the judge to pull back some of the decision.
Additional articles: https://www.modernhealthcare.com/politics-regulation/mh-catastrophic-health-plans-open-enrollment-2026/ and https://www.healthcaredive.com/news/hhs-expands-catastrophic-plans-affordable-care-act/759273/ and https://www.cms.gov/newsroom/fact-sheets/expanding-access-health-insurance-consumers-gain-access-catastrophic-health-insurance-plans-2026 and https://www.cms.gov/newsroom/press-releases/hhs-expands-access-affordable-health-insurance and https://www.beckerspayer.com/policy-updates/cms-expands-eligibility-for-catastrophic-health-plans/ and https://www.modernhealthcare.com/insurance/mh-aca-enrollment-rule-appeal-prices-2026/
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#exchanges #healthcare #healthcarereform #catastrophic #coverage
— Marc S. Ryan
