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Welcome to the 2025 AEP for CY2026 enrollments. While this year brings significant changes to the Medicare Advantage landscape, we're confident that agents will navigate these challenges successfully – just as you always have.
The 2026 contract year marks a pivotal moment in Medicare Advantage. For the first time in over 20 years, MA enrollment is projected to decline. Out-of-pocket costs are rising even as premiums fall. Plan options are shrinking while Special Needs Plans expand dramatically.
It's a year of contrasts – and a year where your expertise matters more than ever.
Let's dive into what you need to know to make this AEP successful for you and your clients.
A Year of Significant Change
The Medicare Advantage market is experiencing unprecedented shifts in 2026. After two decades of continuous growth, MA enrollment is projected to decrease for the first time since the early 2000s.
According to CMS, enrollment is expected to drop to 34 million in 2026, down from 34.9 million in 2025. This represents approximately 48% of all Medicare beneficiaries, compared to 50% in 2025 (CMS).
While CMS anticipates enrollment may exceed these projections based on historical patterns, the trend is clear: the MA market is contracting.
What's Driving This Change?
Several factors are causing this shift:
- Carriers are scaling back offerings in response to rising costs and increased member utilization
- Major insurers like UnitedHealthcare, Humana, and Aetna have reduced the number of states and counties they serve
- Some carriers are exiting markets entirely (like UCare's complete exit from Minnesota)
- Financial pressures from the Inflation Reduction Act is forcing difficult decisions
The total number of MA plans nationwide will decrease slightly from 5,633 in 2025 to approximately 5,600 in 2026. On average, beneficiaries will have access to 39 total MA plans (down from 42 in 2025) and 32 MA-PD plans (down from 34).
Despite this contraction, most people will still have access to many MA plans: over 99% of Medicare beneficiaries will have access to at least one MA plan, and 97% will have access to 10 or more plan choices.
Premiums Are Decreasing
The average monthly MA plan premium is projected to drop from $16.40 in 2025 to $14.00 in 2026—a decrease of $2.40 (CMS).
For MA plans that include prescription drug coverage, the average Part D premium component will decrease from $13.32 to $11.50—a drop of $1.82 (CMS).
Even better, approximately 59% of MA plan offerings remain at $0 premium, meaning the majority of your clients can still find zero-premium options in their area.
Why Are Premiums Decreasing?
The combination of continued rebates from CMS, ongoing market competition, and carriers prioritizing enrollment retention has kept premiums competitive despite rising costs.
Additionally, CMS took unprecedented action with Part D bids this year—rejecting excessive premium increases and negotiating with carriers—which has had a stabilizing effect across both standalone PDPs and MA-PD plans.
Read more: CMS Rejects Plan Bids for the First Time & Other 2026 AEP Updates
Supplemental benefits like dental, vision, and hearing coverage remain stable in 2026, continuing to provide value that differentiates MA plans from Original Medicare.
The Challenge: Rising Out-of-Pocket Costs
Now, for the reality of the situation: while premiums are down, out-of-pocket costs when beneficiaries actually need care are going up—significantly.
According to an Avalere analysis conducted for Better Medicare Alliance, the national median Maximum Out-of-Pocket (MOOP) limit will increase from $5,400 in 2025 to $5,900 in 2026 (Avalere/Better Medicare Alliance). That's a 9.3% increase and represents nearly a $900 jump over just two years.
A beneficiary attracted by a $0 premium may face substantially higher costs if they actually need medical care throughout the year.
Other cost concerns:
- 11% fewer plans will offer MOOP limits below the CMS maximum in 2026
- There are 335 fewer non-special needs plans available, limiting options for finding lower-cost alternatives
- Plans are increasingly shifting costs to consumers through higher deductibles and cost-sharing
Your clients need to understand that the lowest premium isn't always the best value—especially for those who anticipate using medical services throughout the year. This isn't anything new, but it's becoming even more important than ever.
Special Needs Plans Continue to Grow
While the overall MA market contracts, one segment is booming: Special Needs Plans.
Get trained up: New D-SNP and C-SNP Agent Training Guides Available for Download
SNPs are expanding dramatically in 2026, with 1,797 SNPs available—a 33% increase over 2025.
- Chronic Condition SNPs (C-SNPs): 556 plans available, representing a 42% increase. These plans serve beneficiaries with specific severe or disabling chronic conditions like diabetes, cardiovascular disease, or chronic heart failure.
- Dual Eligible SNPs (D-SNPs): 1,085 plans available, a 15% increase. D-SNPs remain the largest SNP segment and serve beneficiaries who qualify for both Medicare and Medicaid.
If you're not already familiar with SNPs, now is the time to learn. These specialized plans often provide more comprehensive benefits and lower cost-sharing for eligible beneficiaries, making them excellent options for certain client segments.
The expansion of C-SNPs and D-SNPs represents a significant opportunity to better serve clients with chronic conditions or dual eligibility—two populations that often struggle most with healthcare costs.
New Provider Directory Requirements
CMS is introducing significant changes to provider directory management and transparency for 2026.
All Medicare Advantage carriers must now:
- Share provider directory information with CMS to be published on a CMS/HHS website
- Notify CMS of any updates to the provider directory within 30 days of changes
- Attest at least annually that the directory data is accurate
- Submit directory information to CMS by January 1, 2026
MA plans remain ultimately responsible for directory accuracy, even if they delegate directory management to another entity.
Temporary Special Enrollment Period
To address potential inaccuracies in the newly integrated provider directory data, CMS is offering a temporary SEP for 2026 only (AHCA).
This SEP allows beneficiaries who enroll in an MA plan via Medicare Plan Finder and discover within three months that their preferred provider is not in-network to change their plan. The beneficiary can switch to another MA plan, disenroll and return to Original Medicare, or enroll in a PDP with Original Medicare.
Non-Commissionable Plans: A Growing Challenge
One of the most disruptive trends affecting agents in 2026 is the explosion of non-commissionable plans.
In previous years, agents might have seen 50-100 non-commissionable plans. This year, hundreds of MA plans appear on non-commissionable lists.
While the impact isn't as severe as in the Part D market, it's still significant. Carriers facing pressure to keep premiums low while managing increased costs and regulatory changes are finding ways to cut expenses, and agent compensation has become an easy target.
Star Ratings Remain Relatively Stable
There's some good news on the quality front: average Medicare Advantage star ratings rose slightly from 3.96 in 2025 to 3.98 in 2026—better than many industry experts expected (CMS data file).
This is particularly significant because CMS made the highest ratings more difficult to achieve, including raising standards after the pandemic and eliminating outliers from calculations (Healthcare Dive).
Star ratings directly impact insurer bonuses and rebates, which influences plan benefits and premiums. Stable ratings help maintain plan competitiveness and benefit offerings.
However, there's significant variation among major carriers:
- UnitedHealthcare: Maintained approximately 77% of members in 4+ star plans
- Humana: Declined from 25% to about 20% of members in 4+ star plans
- Aetna: Leads at 81% of members in 4+ star plans (down from 89%)
- Elevance: Improved from 40% to 53% of members in 4+ star plans
- Centene: Jumped dramatically from 1% to over 18% in 4+ star plans
Plans that saw ratings decline may elect to cut supplemental benefits or increase premiums to protect margins—something to watch as we head into 2027 planning.
IntegrityCONNECT: Your Essential Tool for 2026
With increased complexity, shrinking compensation, and clients who need more guidance than ever, efficiency isn't optional – it's pretty essential.
That's where IntegrityCONNECT comes in.
IntegrityCONNECT is Integrity's all-in-one growth engine, and it's transforming how agents work with clients and grow their business. This comprehensive platform seamlessly connects you with your clients and carriers, streamlining every aspect of your workflow from initial contact to application submission.
The results speak for themselves: agents using IntegrityCONNECT are submitting up to 79% more applications.
Key features include:
- Comprehensive Quoting & Enrollment: Quote and enroll clients across Medicare Advantage, Medicare Supplement, Part D, and more—all within one platform.
- Client Relationship Management: Track interactions, set reminders, and maintain detailed client profiles to provide personalized service.
- Ask Integrity®: The industry's first AI-powered, voice-activated solution that serves as your personal assistant. Ask Integrity helps you access client information instantly, prepare for meetings, and ensure compliance with SOA requirements.
- Client Sync: A powerful new way to connect with your clients through your Agent-Personalized Website. Clients can sync their preferences through PlanEnroll (Medicare) and MyIntegrity (Life Insurance). When they update health information, medications, or coverage details, you're instantly notified so you can offer better guidance.
- Lead Management: Access real-time leads and manage your pipeline efficiently.
Best of all? IntegrityCONNECT is available at no cost to all Integrity agents, including New Horizons agents. This isn't a trial or limited version—it's the full platform with all features included.
Ready to learn more about IntegrityCONNECT? Register for an upcoming training session or reach out to us for one-on-one personalized training.
For more information, visit https://integrity.com/agents/.
Navigating Medicare Plan Finder Updates
Beyond IntegrityCONNECT, make sure you're familiar with the enhanced Medicare Plan Finder features rolling out for 2026.
The new provider network comparison tools will help your clients verify whether their doctors and hospitals are in-network before they enroll. The AI-powered prescription cost estimator can compare costs across local pharmacies, helping clients find the most affordable options.
Learn more about the updates: Medicare Plan Finder Updates - Enhanced Benefit Details for Your Clients
Conclusion
For the first time in over two decades, Medicare Advantage enrollment is declining. Out-of-pocket costs are rising substantially even as premiums fall. Plan options are shrinking. Non-commissionable plans are proliferating. The compensation landscape is shifting beneath our feet.
But here's what we know about independent insurance agents: you're resilient.
You've weathered storms before—market disruptions, regulatory changes, economic pressures—and you've always found ways to adapt, innovate, and continue serving seniors who need your expertise.
The core mission hasn't changed: helping Medicare beneficiaries navigate their healthcare options and find coverage that meets their needs and budgets.
So let's make this AEP our best one yet. Good selling!
