Introduction

Each year HealthScape Advisors, a Chartis Company, analyzes the competitive landscape for Medicare Advantage (MA) and solicits feedback from health plan leaders responsible for government programs lines of business to help inform that perspective. This year, we are publishing our health plan leaders survey in advance of the full study. This brief provides valuable insights into health plan leaders’ perspectives on the current state of the MA market, future outlook, and strategic priorities for the year ahead. 

The MA market has faced significant disruption over the last few years (e.g., rising medical cost/utilization, Stars headwinds, risk adjustment model changes). One leader noted that “these pressures, coupled with legislative/regulatory uncertainty, make it difficult to forecast industry-wide trends and performance.” 

Amid this uncertainty, MA leaders are focused on weathering the storm and navigating the disruption. Signs indicate that the forecast is becoming more favorable, and leaders are striking a more optimistic tone for the upcoming year, with increased focus on cost control and financial sustainability.

Key takeaways from the survey include:

  • Leaders have lower expectations for their company’s enrollment outlook in 2026 relative to 2025, but they are less concerned about overall long-term industry growth. 
  • Most leaders expect their plan’s 2026 benefit packages to be equal to this year’s, potentially signaling less drastic cuts compared to 2025. 
  • Leaders’ outlooks for the MA industry over the next 5 years are generally more positive than when we surveyed leaders last year.
  • MA leaders will be focused on overall profitability, legislative and regulatory uncertainty, and medical cost growth in the year ahead.
  • Leaders anticipate more collaboration with providers, despite expecting less participation among providers in their networks.
  • Star ratings, risk adjustment, and medical cost are the highest priority MA functions for leaders in the year ahead.

Membership growth expectations: Tempered expectations at the company level but optimism for industry-wide growth 

MA leaders are relatively less optimistic about MA growth for their organizations in 2026 compared to 2025. While 44% of leaders are generally positive about their organization’s enrollment growth, 25% expect worse enrollment growth, which is a greater percentage than last year’s survey. At the same time, leaders are generally more optimistic about overall industry growth than last year. When asked their perspective on industry-wide enrollment, 91% expect the same or better performance in 2026, compared to just 74% the year prior. This change indicates that given shifting market dynamics and a new political backdrop, MA leaders see opportunity on the horizon but are not focused on growth in the immediate term. 

Benefit package adjustments: Stability in 2026 

Half of MA leaders expect 2026 benefit packages to be about the same as this year’s, with an additional 10% of leaders expecting richer benefits. Fewer leaders expect benefits to decrease in 2026 (40%) compared to last year’s survey (48%), potentially signaling less drastic benefit cuts relative to 2025. While the Advance Notice signaled higher increases to MA payment rates than the historical average, leaders still seem to be hedging their benefit offerings to focus on financial performance.

5-year industry outlook: More positive than this time last year 

MA leaders have a more positive outlook on the MA industry for the next 5 years than when we surveyed leaders last year. 59% said they were positive or extremely positive, compared to just 47% last year. The percentage of leaders with a pessimistic outlook decreased significantly as well. Just 6% of leaders have a negative outlook, compared to 21% during last year’s survey. Several factors may contribute to the increased positive outlook, including the elimination of election uncertainty and a more favorable view of MA with potentially less administrative burden under the current administration.

Top 3 issues impacting MA: Profitability is paramount 

Profitability was consistently a top concern, followed by medical cost growth, regulatory uncertainty, and risk adjustment performance. In last year’s survey, 50% of MA leaders indicated that Stars ratings was a top 3 concern, compared to just 25% this year. Our recent analysis of 2025 Star ratings indicates that plan leaders saw the writing on the wall in 2024, as the average enrollment-weighted Star rating fell to the lowest levels since 2015. More recent legal wins by plans against the Centers for Medicare & Medicaid Services (CMS) in 2024 over Star ratings may have given plans greater optimism about opportunities to improve or maintain positive Star ratings in 2026. 

Top 3 issues impacting MA

Provider collaboration and network participation: Networks to narrow around more collaborative partners 

MA leaders expect increased collaboration with their provider network (69%) but also anticipate provider network MA participation to decrease in 2025 (53%). With disputes between payers and providers on the rise, MA leaders are recognizing that success in the market requires finding common ground.  One leader commented that “carriers have to find a better way of collaborating with providers, and the more we collectively realize we are in this MA business together and try to work on controlling overall costs of care the better.”

This may indicate that MA leaders are prioritizing their existing relationships and more meaningful value-based arrangements to help address critical revenue and cost levers in MA. 

Priorities for MA: MA remains a priority, with financial sustainability as the central focus 

The vast majority of leaders (78%) view MA as a top three enterprise priority, underscoring the strategic importance of this market within the broader book of business. Cost/financial sustainability was consistently named the top MA priority in our survey. Growth of their existing portfolio and compliance were distant second and third. Smaller percentages of MA leaders identified service area expansion and product diversification among their top three priorities. 
 

When it comes to highest priority MA functions, more than 80% of leaders identified Star ratings, risk adjustment, and medical cost. MA leaders’ prioritization of these key MA performance and profit levers underscores their focus on profitability and sustainability.  

Lay the foundation for future growth: Five core actions

While MA leaders are generally optimistic about the market, they realize they still have to position themselves to take advantage of this future growth opportunity. Health plans are focused on sustainability and profitability while waiting for regulatory guidance from the new administration to become clearer. 

With these findings in mind, we have identified a set of actions that align with health plans’ priorities for financial sustainability and lay the foundation for future growth:

  • Secure quick revenue/savings wins to fund growth and improvement: Focus on the accuracy of processes that influence financial performance (e.g., critical member flags that drive revenue are accurate; payment policies are implemented correctly). These internal operational performance initiatives are within the plan’s control and can often drive more near-term recoveries or savings.
  • Assess and utilize revenue and cost levers: Ensure the health plan understands the root cause drivers impacting critical revenue and cost levers (e.g., risk adjustment, Stars, medical cost). Set realistic goals for performance based on this understanding, identifying opportunities to improve lever performance. Prioritize execution in a clear roadmap to achieve desired performance. 
  • Evolve payer-provider partnerships: Create new financial and partnership constructs with critical provider stakeholders to align incentives for success, solve for pain points, and avoid network disruption that negatively impacts members.  
  • Address member disruption after the annual enrollment period (AEP): Plans that experienced significant membership gains due to market disruption should leverage available data sets to understand market movement and identify critical plan interventions to rapidly assess and manage this new membership. 
  • Optimize product portfolio: Diversify and/or rationalize the product portfolio to drive profitable growth and leverage key competencies. Identify “flanking” strategies to support growth in less-crowded but growing markets (e.g., special needs plans, employer group waiver plans, veteran-focused plans).

Survey methodology

In January 2025, HealthScape surveyed leaders responsible for Medicare Advantage at 32 health plans across the country, including nationals, Blues, and provider-sponsored plans. HealthScape compared survey responses to those of previous years to understand trends and shift in sentiment or perspective.