Medicare Advantage’s Risk Strategy

Medicare Advantage (MA) plans are increasingly targeting patients with complex chronic conditions, even as overall plan availability declines. Open enrollment for 2026 has seen a reduction in standard MA offerings in 35 states, with major insurers like Aetna and UnitedHealthcare shrinking their presence and some, such as Ochsner Health Plan and Blue Cross Blue Shield of Vermont, exiting certain markets. Contributing factors include reimbursement changes under the Biden administration, rising healthcare costs, and increased utilization of medical services.

Specialized chronic condition plans, or C-SNPs, are expanding rapidly, with a projected 42% increase next year. These plans cater to seniors with illnesses such as diabetes, heart failure, or kidney disease, and often provide additional benefits like extended hospital coverage, coordinated care, and sometimes no monthly premiums. Insurers benefit financially, as the government reimburses MA plans at higher rates for sicker enrollees. Startups like Devoted Health are leading the growth in C-SNPs, while established insurers also maintain these offerings.

Although overall MA enrollment may decrease by about 900,000 next year, premiums and benefits are expected to remain stable. Experts suggest that strategic targeting of high-need populations reflects market maturity rather than reduced choice. Patients must actively seek out these specialized plans or consult knowledgeable brokers to ensure eligibility and optimal coverage.

Goldman, M. (2025, October 20). Medicare Advantage plans embrace riskier patients. Axios. https://www.axios.com/2025/10/20/medicare-advantage-plans-riskier-patients?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top