2026 Medicare Advantage Data Reveal Shifts in Benefit Design
Overview
Recently released 2026 Medicare Advantage data show that, while premiums are holding steady, some seniors will face higher out-of-pocket limits, fewer lower-cost options, and scaled-back supplemental benefits.
Better Medicare Alliance (BMA) is sharing initial findings from an analysis it commissioned from Avalere Health.
Analysis of 2026 Benefit Designs
Avalere Health analyzed the 2026 Medicare Advantage Landscape and Plan Benefit Package (PBP) files to assess trends in plan benefit design. The total number of Medicare Advantage plans is declining slightly, from 5,084 in 2025 to 5,030 in 2026 (a decrease of 54 plans). The decrease is driven by a reduction in individual plans of 335 plans (from 3,664 to 3,329). SNP offerings will increase by 281 plans (from 1,420 to 1,701).
Key Findings
Out-of-Pocket Limits
- The national median maximum out-of-pocket (MOOP) increased from $5,400 in 2025 to $5,900 in 2026, a 9.3% increase and $900 more than in 2024.
- Median MOOP levels will increase in 38 states and Washington, DC.
Supplemental Benefits
- Supplemental benefits are additional health plan offerings that go beyond traditional Medicare coverage to support members’ broader health and social needs. Consistent with 2025, most plans will continue to offer vision, dental, and hearing benefits in 2026.
- The percent of individual plans offering fitness, meals, nutrition, over-the-counter (OTC) items, and transportation benefits will decrease from 2025 to 2026, while the percent offering acupuncture, in-home support services, and telehealth will increase.
- Among SNPs, the percent of plans offering acupuncture, meals, and transportation will decrease, while the percent offering fitness, hearing, in-home support services, nutrition, and OTC benefits will increase.
Special Supplemental Benefits for the Chronically Ill (SSBCI) are additional benefits that some Medicare Advantage plans can offer to help people with serious or ongoing health conditions. Benefits within the SSBCI category typically address social needs, such as providing food, non-medical transportation, and housing, and are limited to beneficiaries with certain qualifying chronic conditions (e.g., diabetes). The percent of individual plans offering at least one SSBCI will decrease in 2026, while the percent of SNPs offering at least one of these benefits will be consistent with 2025.
Table 1: Percent on Plans Offering Major Supplemental Benefits, 2025-2026
| Benefit | Individual Plans | Special Needs Plans | ||
| 2025 | 2026 | 2025 | 2026 | |
| Acupuncture | 31% | 333% | 31% | 27% |
| Dental | 98% | 98% | 93% | 93% |
| Fitness | 96% | 93% | 84% | 87% |
| Hearing | 97% | 98% | 93% | 94% |
| In-Home Support Services | 6% | 7% | 17% | 25% |
| Meals | 65% | 58% | 74% | 66% |
| Nutrition | 30% | 25% | 30% | 44% |
| OTC Benefit | 73% | 66% | 92% | 94% |
| Telehealth | 97% | 99% | 95% | 95% |
| Transportation | 29% | 23% | 81% | 67% |
| Vision | 99% | 99% | 96% | 96% |
| Offering at least 1 SSBCI Offering | 16% | 12% | 87% | 87% |
Additional Benefits
- The number of plans offering reduction in cost sharing—which lower members’ out-of-pocket costs for services such as doctor visits or hospital stays—will decrease from 209 in 2025 to 128 in 2026.
- The number of MA plans offering a reduced Part B premium—where the plan pays part or all of a member’s standard Medicare Part B monthly premium—will decrease from 1,556 in 2025 to 1,369 in 2026.
BMA’s View
The current Medicare Advantage policy environment is creating mounting pressures that are forcing plans to make difficult decisions about benefit design and affordability, leading some to reduce service areas or exit markets altogether. As regulatory and financial constraints intensify, plans are facing higher costs that translate into fewer supplemental benefits and less generous cost-sharing protections for enrollees. These pressures not only limit innovation and flexibility but also risk undermining the stability and value that beneficiaries have come to expect from Medicare Advantage coverage. Without meaningful policy adjustments, continued strain on plans could lead to a narrowing of options and increased financial burden for millions of older adults and people with disabilities who depend on these benefits.
What’s Next
BMA will soon share a comprehensive summary of 2026 plan availability and benefit design. We will also continue urging policymakers to protect affordability and stability in Medicare Advantage.
Methodology and Limitations
Avalere analyzed MA plan benefits data in the 2025-2026 Landscape files and Q4 2025-Q1 2026 Plan Benefit Package (PBP) files released by the CMS. All metrics were by Non-SNPs and SNPs where appropriate. Avalere excluded MSA, PFFS, Employer Group Waiver, PACE, Cost, and Demo plans from the analysis.
Due to different naming conventions that plans use to describe their supplemental benefits—primarily those not associated with specific rubric/category in the PBP file structure—Avalere’s counts may be an underestimate of the availability of specific supplemental offerings. The analysis reflects MA plans (defined on the contract-plan-segment level) in the 50 states, including DC.