HealthIntel Weekly: Medicare Advantage Benefits Drops Sharply in 2026
Welcome to HealthIntel Weekly. Every week, we pull together the latest health care reports, research, and upcoming webinars so you don’t have to dig for them.
What’s New:
Medicare Advantage plans were offering less overall value to beneficiaries in 2026, according to a Milliman white paper. Average “value added” — a measure of supplemental benefits, cost-sharing reductions and premium impacts relative to traditional Medicare — across general enrollment MA plans fell by more than 8% from 2025 to 2026, the largest decline in MA. The total member (Part C + Part D) premium increased by about $2 per member per month from 2025 to 2026, the first increase in at least a decade. Meanwhile, Part D and Part C benefit value decreased by $4 PMPM and $17 PMPM, respectively. Supplemental benefits, particularly dental and over-the-counter benefit cards, saw notable cutbacks. Part D coverage also became leaner, with higher deductibles and the conversion of brand copayments to coinsurance. Nearly 2.7 million non-special needs plan beneficiaries were affected by plan exits or service-area reductions.
Private health insurers’ financial performance weakened across most markets in 2024 as rising medical utilization and post-pandemic adjustments pressured margins, according to a KFF analysis. Per-enrollee gross margins declined year over year across Medicare Advantage, Medicaid managed care, individual, and employer group markets. Gross margins per enrollee for fully insured group plans fell 7% from 2023 to 2024, marking the first year-over-year decline in that market since 2021. Medicare Advantage continued to generate the highest margins, at about $1,655 per enrollee, though this represented a 17% drop from 2023 amid higher care use and payment policy changes. Medicaid managed care experienced the steepest decline, with margins falling 19% as states resumed eligibility redeterminations. Medical loss ratios also rose across several markets, reaching roughly 90% in Medicare Advantage and 91% in Medicaid managed care.
The growing use of contract pharmacies under the federal 340B drug pricing program does not appear to improve access to HIV medications for Medicare beneficiaries treated at federally qualified health centers, according to an Avalere Health white paper. Using data from the Office of Pharmacy Affairs Information System from 2018 to 2022, the analysis found no meaningful differences in prescription use tied to contract pharmacy relationships. While the share of FQHCs using at least one contract pharmacy remained stable at about 30%, the average number of contract pharmacies per FQHC more than doubled, rising from eight to 18 during the study period, with many located more than 50 miles away. Despite this expansion, the proportion of Medicare beneficiaries receiving at least one HIV drug fill declined, and patients using contract pharmacies filled prescriptions at similar rates as those using in-house or non-contract pharmacies. The findings suggest the availability and growth in contract pharmacy relationships have not translated into increased access or utilization of HIV drugs among Medicare beneficiaries with HIV receiving care at FQHCs.
Next Up:
The Duke-Margolis Capital Impact Council: Advancing Private Investment That Improves Health Care and Health
Margolis Institute for Health Policy, March 6, 2026, 12 p.m. (ET)
The Outlook for Obesity From 2026 to 2030: From Consolidation to Acceleration
IQVIA, March 18, 2026, 11 a.m. (ET)
Panelists:
Sarah Rickwood, Vice President, Thought Leadership, IQVIA
Luke Greenwalt, Vice President, Thought Leadership & Innovation, IQVIA U.S.
Pharmacy Benefit Manager Reform: Fact or Fiction?
Health Affairs, March 24, 2026, 2:30 p.m. (ET)
Panelists:
Benjamin Rome, Harvard Medical School
Laura Tollen, Health Affairs