Medicare Advantage (MA) enrollment is still growing—but at a pace that signals a clear shift in strategy from the nation’s largest insurers.
As of February, nearly 35.5 million people were enrolled in MA plans, up from about 34.4 million a year earlier. That represents roughly 3% growth—well below the double-digit annual increases the program enjoyed in prior years.
The slowdown reflects a broad pullback by major carriers grappling with rising medical costs, regulatory changes, and shrinking margins. A Healthcare Dive analysis of newly released CMS data shows insurers aggressively reshaped their MA footprints during the latest open enrollment period, exiting markets and redesigning plans to shed less profitable members.
UnitedHealthcare, the largest MA carrier, enrolled just under 9.4 million members in February, down 9% from 10.3 million in October before open enrollment began.
Other major players also contracted. Elevance reduced MA enrollment by 14%, Centene by 4%, and CVS Health’s Aetna division by 3% across local and regional MA plans with prescription drug coverage. CVS now covers just over 4 million MA members, down from 4.2 million in the fall. Elevance’s enrollment dropped from 2.2 million to 1.9 million, while Centene fell to under 1 million members.
Humana stands out as the exception—and the risk-taker.
The Louisville-based insurer added more than 1 million MA members, growing to over 7 million enrollees from 5.8 million before open enrollment. The expansion positions Humana to potentially overtake UnitedHealthcare as the largest MA carrier. But that growth comes at a cost: Humana projects adjusted earnings of $9 per share this year, roughly half of 2025’s level and well below analyst expectations.
Kaiser Permanente also expanded modestly, increasing MA enrollment by 1% to roughly 2 million members.
Meanwhile, smaller and mid-sized players capitalized on the turbulence. Devoted Health more than doubled its membership to nearly 470,000, and Alignment Health grew 21% to almost 280,000 members. Other regional plans, including SCAN Group and CareSource, also posted gains.
Despite the reshuffling, UnitedHealth, Humana, and CVS continue to dominate the MA market, which now covers more than half of all Medicare beneficiaries.
However, volatility may persist. A separate MA open enrollment period runs through the end of March, and the payment policy remains unsettled. The Trump administration’s proposal to keep MA rates flat for 2027 has drawn sharp industry criticism, with insurers arguing they need higher reimbursement to offset rising utilization. At the same time, regulators are tightening oversight of risk adjustment practices and reviving audits amid concerns about overpayments and coding intensity.
The era of unchecked MA expansion appears over. The next phase will test whether insurers can balance growth, profitability, and regulatory compliance in a far more constrained environment.
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