Medicare Advantage Reckoning Hits 2026 Enrollment: Mark Meiselbach, PhD

The Medicare Advantage (MA) landscape is shifting from a period of predictable growth to one of significant volatility, as close to 10% of all enrollees—roughly 2.9 million individuals—are projected to face forced disenrollment in 2026, according to new research from Mark Meiselbach, PhD, a health economist and assistant professor in the Department of Health Policy and Management at Johns Hopkins Bloomberg School of Public Health, and his team. Meiselbach explains that this trend stems from necessary market corrections intended to address historical government overpayments.

The economic and policy implications of these exits are highly uneven. Rural beneficiaries are disproportionately affected, and the Star Rating System has created a landscape of “winners and losers,” where high-rated plans receive bonuses and higher payments that allow for more attractive benefits, while lower-rated plans struggle to compete.

In this interview with The American Journal of Managed Care^® (AJMC^®), Meiselbach notes, “In some senses, this is sort of a necessary consequence of changing and correcting the market, if you will, but the distribution is not going to be even.” To protect enrollees from the “downward spiral” seen in states like Vermont, which faces a staggering 92.2% disenrollment rate, he recommends policy levers such as strengthening traditional Medicare with an out-of-pocket maximum and providing better transparency tools to help seniors compare provider networks and drug coverage when their plans exit the market.

This interview has been lightly edited for clarity.

AJMC: Your findings suggest that roughly 1 in 10 Medicare Advantage enrollees may face forced disenrollment in 2026. From a policy standpoint, does this indicate a market correction or a sign of structural instability that regulators should address?

Meiselbach: I think it's hard to say that it's one or the other. In some ways, we've recognized that we are probably overpaying for Medicare Advantage, and so efforts to reduce how much we pay are going to mean that some plans can no longer be profitable, and if the plan's not profitable, the insurer is going to probably stop offering that plan. In some senses, this is sort of a necessary consequence of changing and correcting the market, if you will, but the distribution is not going to be even. And so enrollees in some markets may be left without any Medicare Advantage plans to choose from. They may have been relying on certain services that are offered by the plan: transportation services, coverage of certain drugs, and things like that. To the extent we can, as we make these major changes, try to make the navigation process easier for those enrollees.

AJMC: Your study also points to higher disenrollment among rural beneficiaries and those in lower-rated plans. Are there policy levers—such as payment adjustments, network adequacy requirements, or incentives for rural participation—that could reduce inequities for individuals who may experience coverage disruptions?

Meiselbach: I think that you could make corrections for harder-to-serve rural areas. For example, you could adjust benchmark payments. However, I think more broadly, the Star Rating System really creates a system of winners and losers. On the one hand, it's meant to incentivize plans to offer a high-quality product, and that's good. However, it confers a lot of benefits to the high Star-rated plans and fewer to the lower Star-rated plans. For example, the high Star-rated plans are getting additional bonuses, so they're being paid more. They're also able to offer more through rebates in supplemental benefits and other offerings to enrollees to attract more enrollment. It just sort of shows up on the plan choice environment that it's a high Star-rated plan, which also would attract enrollees. You're giving a lot of benefits around the Star rating, and some of the Star rating may not be totally controllable by plans, and in fact, in some rural areas, it might be harder to achieve a high Star rating. Those are sort of structural factors that might affect rural areas.

AJMC: Is this it through no fault of the carrier? Are the circumstances where the people are located to blame?

Meiselbach: It’s not entirely out of the control of the carriers. I think a lot of them are plan satisfaction measures, for example, and customer service and things like that that the plans can really try to achieve. Other sorts of process measures—having blood pressure under control and things like that—that the plans can make efforts to improve on these margins, and I think often do, but some of it might be sort of out of a plan’s control.

AJMC: Should CMS consider stronger safeguards or notification standards for beneficiaries when plans exit markets, similar to protections seen in other insurance markets? If so, what might those look like?

Meiselbach: I believe enrollees would know they have to re-enroll by the open enrollment period, and so in some senses, enrollees are given time to reselect their plans. I think some things might be achieved by really strengthening traditional Medicare as sort of an outside option. If we have situations like in Vermont, where the MA market is totally collapsing, then we want to make sure that the traditional Medicare option is sort of not all that different from MA. A lot of that looks like strengthening supplemental insurance policy or setting an out-of-pocket maximum on the traditional Medicare side and potentially offering some of the supplemental benefits that are already available in Medicare Advantage, like dental and vision, that many rely on.

AJMC: Why was the result in Vermont such an outlier? It was 92.2%, far beyond any of the others.

Meiselbach: I don’t have a specific I can point to, that this is the one reason this is happening in Vermont. But this is the second year in a row where there’s been major exits from Vermont. There were major exits from the MA market last year in Vermont, and those plans were unprofitable. That’s why they exited. And then where did their enrollees go when those plans exited? They went to the remaining plan. You’ve got sort of a downward spiral that seems to have played out in Vermont, and what's not clear to me is if the same sort of downward spiral might be occurring in other states and we just observed step 1 in 2026.

AJMC: Given that smaller carriers appear more likely to exit, do you see a risk that current payment and risk-adjustment policies inadvertently favor large national insurers?

Meiselbach: I do, yes. I think that audits and litigation in some cases might correct against some of this, but there’s no doubt that the major carriers are sort of better at—I don’t want to say gaming—responding to the incentives in the system. They're good at capturing all the diagnoses that enrollees have to be well and reimbursed via risk adjustment. They know what it takes to achieve higher Star Rating plans, or when it makes sense to consolidate plans such that your enrollees move to the higher Star-rated plans, the major carriers have the capacity to perform better across many of these margins. In an environment where you're shrinking the reimbursements overall, it may be the case that the winners are the major carriers, relatively, and not the smaller ones.

AJMC: How should policy makers then think about balancing stability with competition? Is this possible?

Meiselbach: Yes. I think making it a more even playing field would help. Some policies to address risk adjustment, I think, will likely harm the big carriers more. They’ve sort of been better at gaming the system thus far, and so if we sort of limit their ability to benefit more from risk adjustment, then we might improve competition and make an even more even playing field.

AJMC: If you were advising Congress or CMS today, what is one policy change you believe would most effectively reduce the risk or impact of future waves of disenrollment without discouraging insurer participation?

Meiselbach: I think anything that makes it easier for enrollees to understand how much the plans they might newly select compare to the plan that they were on—so tools to understand whether provider networks will be disrupted or coverage of the drugs I rely on, the medications I rely on, supplemental benefits. So, tools that allow enrollees to directly compare the overlap between the plan they're on and the plan they're choosing, I think would be helpful. And as I said earlier, I also think that strengthening the outside option of traditional Medicare, making it a more viable product for all enrollees, potentially would also sort of give that public option, that fallback solution that should, at a minimum, I think, have an out-of-pocket maximum.

There’s a difference between the sort of standard MA plans here and the Special Needs Plans. We broke them out [in our study]. Obviously not every enrollee has access to the Special Needs Plans. They're for enrollees with special needs, many of them being dually eligible Medicaid and Medicare beneficiaries. But if you just look at the standard MA product, the Medicare-only enrollees, it's actually 12% of them who will be losing their plans. The SNP plans have, over the last few years, been growing more rapidly and generally seem to be achieving higher profit margins. And so most of the incidents of these recent effects are in the standard MA products, such as the composition of MA is sort of shifting now toward relatively serving the dual-eligible population more than the standard Medicare beneficiaries.