New Analysis Shows Rising Costs and Reduced Health Benefits for Medicare Advantage Beneficiaries in 2026
WASHINGTON — Better Medicare Alliance (BMA), the nation’s leading research and advocacy organization supporting Medicare Advantage, today released a comprehensive Avalere Health analysis offering the clearest picture yet of how recent policy changes are shaping the 2026 Medicare Advantage experience for millions of seniors.
The findings show that beneficiaries will face higher out-of-pocket costs, fewer health benefits, and reduced individual plan choices as plans implement multiple regulatory and legislative changes for the plan year 2026. The analysis underscores growing challenges for the more than 35 million seniors who depend on Medicare Advantage for comprehensive, affordable coverage.
“For the second year in a row, millions of Medicare Advantage beneficiaries will feel the strain of higher costs and reduced benefits—the continued impacts of policy changes and funding cuts from the previous administration,” said Mary Beth Donahue, President & CEO of Better Medicare Alliance. “A strong Medicare Advantage relied upon by over 35 million beneficiaries depends on consistent, predictable policy. We look forward to working with Congress and the administration on solutions to protect the program for America’s seniors.”
Key findings:
- Higher out-of-pocket costs. The median maximum out-of-pocket limit will rise from $5,400 to $5,900, a 9% increase, with fewer plans offering lower-MOOP options.
- Reduced supplemental benefits. Many individual plans are scaling back crucial health supports such as transportation, meals, nutrition, and OTC benefits, and fewer will offer Special Supplemental Benefits for the Chronically Ill (SSBCI).
- Fewer individual plans, more SNPs. Individual plan offerings will decline by 9.1%, while Special Needs Plans will grow nearly 20%.
- Localized disruptions. In 34 counties across six states (California, Montana, Oregon, South Dakota, Vermont and Wyoming), all existing plans will exit for 2026, even as some states see increases in overall plan availability.
- Multiple policy changes driving pressure. New regulatory and statutory requirements — including HCC V28, the IRA Part D redesign, Star Ratings changes, and expanded oversight — are affecting the resources available for benefits in 2026.
As policymakers shape Medicare Advantage’s future, this analysis highlights the urgent need for policy stability to protect affordability and preserve the benefits seniors depend on. Better Medicare Alliance will continue working with lawmakers to advance solutions that strengthen the program for beneficiaries.
The full Avalere Health analysis is available here.
Avalere conducted this analysis using CMS Medicare Advantage Landscape and Plan Benefit Package data for 2022–2026.
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Better Medicare Alliance is a community of more than one million grassroots beneficiaries and 200+ ally organizations working to improve health care through a strong Medicare Advantage. Learn more at www.bettermedicarealliance.org.