Medicare Advantage (MA) continues to grow, but the market dynamics behind that growth are changing. As enrollment gains slow and competition becomes more targeted, MA plans can no longer rely solely on market expansion.
Growth is more concentrated among members with higher clinical complexity, chronic conditions, and dual eligibility, signifying that enrollment shifts are pointing towards an MA reset. This creates urgency and opportunity to turn enrollment movements into an advantage, depending on a plan’s ability to efficiently move from generalized outreach to connected, data-driven engagement.
Enrollment continues to rise, but the pace has slowed from years of rapid expansion. As MA enrollment now exceeds half of all Medicare beneficiaries, fewer people need to convert from traditional Medicare.
In 2026, 35 million people—54% of eligible Medicare beneficiaries—are enrolled in MA. Enrollment grew by 1.1 million members from 2025, but year-over-year growth slowed to 3%, compared with an average of 9% from 2007 through 2024, according to KFF analysis of CMS enrollment data.
The industry is moving from acquisition to performance-driven growth, where the plans best positioned to succeed are those that can retain members, improve Star Ratings performance, manage rising medical complexity, and connect members to the right services at the right time. Plans seeing expansion must onboard new members effectively, while those facing declines must focus on retention and high-value quality opportunities.
A major driver of MA transformation is the rise of special needs plans (SNPs). SNP growth is increasingly concentrated among dual-eligible and chronic condition populations, which means the future MA member is more likely to have complex clinical, behavioral, social, and financial needs.
Dual-eligible members may need a different onboarding experience than other members, and those with chronic conditions may need targeted reminders, transportation and appointment scheduling assistance, or education about benefits.
Enrollment shifts also create strategic implications for Star Ratings, quality, and risk adjustment. Member experience and health outcomes are carrying greater weight, and plans need year-round visibility into where members are struggling.
But many plans still operate with fragmented workflows, with quality, care management, and vendor teams contacting the same member separately. What may look like distinct programs to the plan can feel duplicative or disconnected to the member, resulting in increased abrasion and reduced trust.
By bringing together quality gaps, care management needs, and member preferences and contact history, plans can prioritize the next best action and determine which program or channel should lead.
To turn enrollment shifts into a strategic advantage, plans need a disciplined engagement framework. Segmenting the members who are most likely to miss critical gaps—including new D-SNP or C-SNP enrollees, members without recent primary care visits, changed providers, and those facing other social barriers—can prioritize interventions based on clinical value and Stars impact.
Matching outreach intensity to opportunity with low-touch reminders, such as text or email, may work well for members who simply need a nudge. Interactive digital tools, interactive voice response (IVR), or secure microsites may be appropriate for members who need education or reinforcement. Additionally, live-agent support can help resolve issues, while high-touch clinical navigation should be reserved for members with the most complex needs.
Often, the most expensive outreach is not the one with the highest cost, but the one used in the wrong place, at the wrong time, for the wrong member.
The first 90 days of the member journey are critical. New members need fast, relevant onboarding that explains benefits, supports PCP selection, addresses transportation or access needs, and encourages timely annual wellness visits. For existing members, plans can use continuous intelligence to identify new barriers, refresh outreach strategies, and coordinate care gap and risk adjustment workflows throughout the year.
By segmenting members before engaging ranking gaps by impact, matching channels to the member’s needs, and coordinating contacts, plans can integrate data to align internal departments, protecting the member journey.
As enrollment shifts are an operational signal for health plans to move beyond reactive outreach and create a more intentional engagement model. By supporting members with greater precision, plans can improve performance in a more complex and competitive environment.
As Medicare Advantage populations evolve, reaching members with the right support at the right time is more important than ever. Learn how Eliza helps health plans create more targeted, coordinated engagement across the member journey, connecting members with outreach that reflects their individual needs.