Medicare Advantage plans, which enrolled more than 34 million Medicare beneficiaries or 54% of the eligible Medicare population in 2025, typically offer extra benefits, such as dental, vision, and hearing, often for no additional premium, as well as lower cost sharing compared to traditional Medicare without supplemental insurance. These additional benefits usually come with the trade-off of more restrictive provider networks and greater use of cost management tools, such as prior authorization.

This brief provides an overview of premiums and benefits in Medicare Advantage plans that are available for 2026 and key trends over time. This brief uses data from the CMS Landscape and Benefit files. See methods for more details. In general, this brief refers to individual Medicare plans available for general enrollment, which excludes Special Needs Plans (SNPs), except where noted, and excludes employer plans. A companion analysis describes trends in plan offerings.

Medicare Advantage Highlights for 2026

• Two-thirds of all Medicare Advantage plans with Part D prescription drug coverage (MA-PDs) (67%) will charge no premium (other than the Medicare Part B premium) in 2026, the same as 2025.
• While nearly all individual Medicare Advantage plans (98% or more) are offering vision, dental and hearing benefits, as they have in previous years, the share offering certain other supplemental benefits has declined, such as an allowance for over-the-counter items (66% in 2026 vs. 73% in 2025), a meal benefit (57% in 2026 vs. 65% in 2025), remote access technologies (48% in 2026 vs. 53% in 2025), and transportation (24% in 2026 vs. 30% in 2025).
• The share of Special Needs Plans (SNPs) offering certain supplemental benefits has also declined, such as transportation (67% in 2026 vs 81% in 2025), a meal benefit (66% in 2026 vs 73% in 2025), bathroom safety devices (47% in 2026 vs 54% in 2025), and remote access technologies (44% in 2026 vs 50% in 2025), while the share offering in-home support services (25% in 2026 vs 17% in 2025) and support for caregivers (16% in 2026 vs 5% in 2025) has increased.
• In 2026, a larger share of SNPs than Medicare Advantage plans for individual enrollment offer transportation benefits for medical needs (67% for SNPs vs 24% for individual plans), an allowance for over-the-counter items (94% vs 66%), bathroom safety devices (47% vs 21%), in-home support services (25% vs 7%), and caregiver support (16% vs 5%). A smaller share of SNPs than individual plans offer acupuncture (28% vs 34%) and fitness benefits (86% vs 93%).
• Nearly one-third (32%) of individual Medicare Advantage plans will offer some reduction in the Medicare Part B premium in 2026 as a supplemental benefit, the same as in 2025. Among plans offering a reduction in the Part B premium, more than a third (36%) are offering a reduction of more than $100 a month, while 28% of plans are offering a reduction of $10 or less per month.
• A larger share of SNPs than other Medicare Advantage plans are offering Special Supplemental Benefits for the Chronically Ill, which are extra benefits available to a subset of a plan’s enrollees, particularly food and produce (85% in SNPs vs 11% in individual plans) and general supports for living, such as housing and utilities (72% in SNPs vs 8% in individual plans).

Premiums

The vast majority of Medicare Advantage plans for individual enrollment (89%) will include prescription drug coverage (MA-PDs), similar to 2025 (88%), and the share of MA-PDs where enrollees are responsible for the Medicare Part B premium ($202.90 per month) but no additional premium is 67% in 2026, the same as in 2025 (Figure 1). Nearly all Medicare beneficiaries (98%) have access to a MA-PD with no additional monthly premium in 2026, similar to 2025 (99%).

In 2025, more than three-quarters (76%) of enrollees in MA-PD plans pay no premium other than the Medicare Part B premium. Based on enrollment in March 2025, 9% of enrollees pay at least $50 a month, including 3% who pay $100 or more. CMS estimates that the average monthly plan premium among all Medicare Advantage enrollees in 2026, including those who pay no premium for their Medicare Advantage plan, will be $14.00 a month.

While many employers and unions also offer Medicare Advantage plans to their retirees, complete information about these 2026 plan benefits is not made available. Employer and union plans are administered separately and may have enrollment periods that do not align with the Medicare open enrollment period.

Extra Benefits

Medicare Advantage plans may offer extra benefits that are not available in traditional Medicare and are considered “primarily health related.” Plans are required by law to use rebate dollars (which may be higher for plans that qualify for the quality bonus program) to help cover the cost of extra benefits, reduce cost sharing, or reduce the Part B and/or Part D premium. Beginning in 2019, CMS expanded the definition of “primarily health related” to allow Medicare Advantage plans to offer additional supplemental benefits. Medicare Advantage plans may also restrict the availability of these extra benefits to certain subgroups of beneficiaries, such as those with diabetes or congestive heart failure, making different benefits available to different enrollees.

Availability of Extra Benefits in Individual Plans for General Enrollment

In 2026, 98% or more individual plans offer some vision (99%), dental (98%) or hearing benefits (98%), similar to 2025 (97% or more) (Figure 2). Though these benefits are widely available, the scope of coverage for these services varies. For example, a dental benefit may include cleanings and preventive care or more comprehensive coverage, and often is subject to an annual dollar cap on the amount covered by the plan. From year to year, plans may change the parameters of this coverage, such as increasing or decreasing annual maximums the plan will pay toward the benefit or adjusting cost sharing for services. There is not yet data available about utilization of these benefits or associated costs, so it is not clear the extent to which supplemental benefits are used by enrollees.

Some benefits are being offered by a smaller share of plans in 2026 than in 2025. For example, 66% of plans are offering an allowance for over-the-counter items (vs. 73% in 2025), while 57% are offering a meal benefit (vs. 65% in 2025), and 24% are offering transportation benefits for medical needs (vs. 30% in 2025). A similar share of plans is offering fitness benefits, acupuncture, bathroom safety devices, in-home support services, and support for caregivers of enrollees in 2026 compared with 2025 (Figure 2). This is not an exhaustive list of extra benefits that plans offer, and plans may offer other services such as home-based palliative care, therapeutic massage, and adult day health services, among others.

As of 2020, Medicare Advantage plans have been allowed to include telehealth benefits as part of the basic benefit package – beyond what was allowed under traditional Medicare prior to the COVID-19 public health emergency – which was extended to January 2026. Therefore, these benefits are not included in the figure above because their cost is not covered by either rebates or supplemental premiums. Medicare Advantage plans may also offer supplemental telehealth benefits via remote access technologies and/or telemonitoring services, which can be used for those services that do not meet the requirements for coverage under traditional Medicare or the requirements for the telehealth benefits as part of the basic benefit package (such as the requirement of being covered by Medicare Part B when provided in-person). In 2026, 48% of plans are offering remote access technologies, a decline from 53% in 2025. The same share of plans is offering telemonitoring services (2% in 2026 and 2025).

Availability of Extra Benefits in Special Needs Plans

SNPs are designed to serve a higher-need population and an increasing number of beneficiaries are enrolling in SNPs. A similar share of SNPs in 2026 compared with 2025 are offering dental, vision, hearing, fitness, an allowance for over-the-counter items, and telemonitoring services (Figure 3). However, a smaller share of SNPs is offering transportation benefits for medical needs (67% in 2026 vs 81% in 2025), a meal benefit (66% in 2026 vs 73% in 2025), bathroom safety devices (47% in 2026 vs 54% in 2025), and remote access technologies (44% in 2026 vs 50% in 2025). A larger share of SNPs is offering their enrollees in-home support services (25% in 2026 vs 17% in 2025) and support for caregivers (16% in 2026 vs 5% in 2025) (Figure 3).

In 2026, a larger share of SNPs than plans for other Medicare beneficiaries offer their enrollees transportation benefits for medical needs (67% for SNPs vs 24% for individual plans), an allowance for over-the-counter items (94% for SNPs vs 66% for individual plans), bathroom safety devices (47% for SNPs vs 21% for individual plans), in-home support services (25% for SNPs vs 7% for individual plans), and caregiver support (16% for SNPs vs 5% for individual plans). A smaller share of SNPs than individual plans offer their enrollees acupuncture (28% vs 34%) and fitness benefits (86% vs 93%).

Availability of a Part B Rebate

Both Medicare Advantage enrollees and traditional Medicare beneficiaries pay a monthly Part B premium, which will be $202.90 per month in 2026. Medicare Advantage plans may use the rebate portion of their payments from CMS to reduce the Part B and/or Part D premium. In 2026, nearly one-third (32%) of individual Medicare Advantage plans available for general enrollment will offer some reduction in the Part B premium (or a “Part B Rebate”), the same as the share in 2025, while more than two-thirds (68%) will not offer this benefit (Figure 4).

Among plans that are offering a monthly reduction in the Part B premium, more than a third (36%) are offering a monthly reduction of $100 or more (vs 28% in 2025), 23% are offering a reduction of $50.01 to $100 (vs 25% in 2025), 13% are offering a reduction of $10.01 to $50 (vs 17% in 2025), and 28% are offering a monthly reduction of $10 or less (vs 30% in 2025).

A smaller share of SNPs than individual plans offer a Part B rebate (19% vs 32%). The share of SNPs offering the Part B rebate has declined in 2026 compared with 2025 (19% vs 28%) (Figure 3). In 2026, about half (51%) of SNPs offering the Part B rebate are plans for people who are dually eligible for Medicare and Medicaid (D-SNPs), 39% are plans for people with certain chronic conditions (C-SNPs), and 10% are institutional-SNPs. Although SNPs may offer a Part B rebate, for dual-eligible individuals enrolled in the Medicare Savings Programs, which comprise most enrollment in SNPs, the rebate is paid to the state rather than to the individual because the state Medicaid program pays the Part B premium for these beneficiaries. (Note that the Medicare Savings Programs are not available in Puerto Rico.)

Availability of Special Supplemental Benefits for the Chronically Ill (SSBCI)

Beginning in 2020, Medicare Advantage plans have also been able to offer extra benefits to a subset of a plan’s enrollees, that are not primarily health related and are specifically for chronically ill beneficiaries, known as Special Supplemental Benefits for the Chronically Ill (SSBCI). In prior years, Medicare Advantage plans could also participate in the Value-Based Insurance Design Model, which allowed plans to offer these non-primarily health related supplemental benefits to their enrollees using different eligibility criteria than required for SSBCI, including offering them based on an enrollee’s socioeconomic status. However, this model was terminated at the end of the 2025 plan year.

Most individual and SNP Medicare Advantage plans still do not offer these benefits, though more SNP plans generally offer these benefits, particularly food and produce. SSBCI benefits offered in 2026 include food and produce (11% for individual plans and 85% for SNPs), general supports for living (e.g., housing, utilities) (8% for individual plans and 72% for SNPs), transportation for non-medical needs (5% for individual plans and 37% for SNPs), and pest control (3% for individual plans and 23% for SNPs) (Figure 5).

Like for other types of supplemental benefits, the scope of services for SSBCI benefits varies. For example, many plans offer a specified dollar amount that enrollees can use toward a variety of benefits, such as food and produce, utility bills, rent assistance, and transportation for non-medical needs, among others. This dollar amount is often loaded onto a flex card or spending card that can be used at participating stores and retailers, which can vary depending on the vendor administering the benefit. Depending on the plan, this may be a monthly allowance that expires at the end of each month or rolls over month to month until the end of the year, when any unused amount expires.

Over the last decade, Medicare Advantage, the private plan alternative to traditional Medicare, has taken on a prominent role in the Medicare program. In 2025, more than 34 million Medicare beneficiaries are enrolled in a Medicare Advantage plan – more than half, or 54%, of the eligible Medicare population.

In 2026, the average Medicare beneficiary has a choice of 32 Medicare Advantage prescription drug (MA-PD) plans, two fewer than the 34 in 2025. Virtually all Medicare Advantage plans for 2026 provide multiple extra benefits like vision, hearing, and dental benefits, similar to last year. While Medicare Advantage plan choices are relatively stable for a large share of beneficiaries, the number of enrollees facing plan terminations is increasing in 2026, which could lead to some beneficiaries experiencing disruptions in their coverage.

This brief provides an overview of the Medicare Advantage plans that are available for 2026 and key trends over time. This analysis uses data from the CMS Landscape files. In general, this brief refers to individual Medicare plans available for general enrollment, excludes Special Needs Plans (SNPs), except where noted, and excludes employer plans. (See methods for more details.) A second, companion analysis, describes premiums and benefits that are available for 2026 Medicare Advantage plans and over time.

Medicare Advantage Highlights for 2026

• The average Medicare beneficiary has the option of 32 Medicare Advantage prescription drug (MA-PD) plans in 2026, two fewer than the 34 options available in 2025. Across all plans for individual enrollment, including those with and without prescription drug coverage, the average beneficiary has 39 options in 2026, compared to 42 options in 2025.
• The number of plans with prescription drug coverage available to the average beneficiary varies across states in 2026, as does the change in the number of plans compared to 2025. In 35 states, DC and Puerto Rico, the average beneficiary has a choice of fewer plans on average in 2026 than in 2025, while in six states, the average beneficiary has a choice of more plans, and in eight states the number of plans available, on average, stayed the same.
• In total, 3,373 Medicare Advantage plans, including those without prescription drug coverage, are available nationwide for individual enrollment in 2026 – a 9% decrease from 2025. HMOs account for more than half (57%) of all Medicare Advantage plans offered in 2026 but have declined as a share of all Medicare Advantage plans since 2017 (71% of plans). During this period local PPOs have risen as a share of all plans, increasing from 24% to 42%.
• More than a quarter of all Medicare beneficiaries (28%) live in a county with more than 50 Medicare Advantage plans available in 2026, up from seven percent in 2020, but down from 32% in 2025.
• Less than 1% of Medicare beneficiaries live in a county with no plans available. These beneficiaries live in 122 counties across 13 states (Alaska, California, Colorado, Idaho, Kansas, Minnesota, Montana, Nebraska, Nevada, Oregon, South Dakota, Utah, and Vermont) and territories other than Puerto Rico.
• The average Medicare beneficiary can choose from among plans offered by eight firms in 2026, the same as in 2025 and 2024.
• The two largest Medicare Advantage insurers – UnitedHealthcare and Humana – are exiting more counties – meaning they are no longer offering any plans in those counties – than they are entering in 2026. For example, UnitedHealthcare is exiting 225 counties, while entering 14 new counties and Humana is exiting 198 counties, while entering five new counties. Each insurer is offering plans in roughly 80% of all U.S. counties, a decline from 2025, when each insurer was offering plans in nearly 90% of counties.
• Across all Medicare Advantage insurers that are exiting any markets, the set of counties that each Medicare Advantage insurer is exiting do not completely, or in many cases, largely overlap. The different decisions of insurers to exit some counties suggest a combination of factors are at play, including local market characteristics, cost pressures, shifts in firm-level strategies, and ultimately the insurers’ assessment of potential profits.
• About 13% of beneficiaries enrolled in individual MA-PDs this year (or about 2.6 million people) are in a plan that has been terminated for 2026, an increase from 2025 when nearly 1.3 million Medicare Advantage enrollees faced a termination. Additionally, up to 6% of enrollees in MA-PDs (or as many as 1.3 million people) are in a plan affected by a consolidation, meaning some portion of this 1.3 million people will be moved into another plan under the same insurer automatically.
• In 2026, ten firms entered the market for the first time (nearly all offering D-SNPs), four firms exited the market, and nine had contracts taken over by other insurers.

Plan Offerings in 2026

Number of Plans Available to Beneficiaries

For 2026, the average Medicare beneficiary has access to 32 Medicare Advantage prescription drug (MA-PD) plans, two fewer than the 34 in 2025 (Figure 1). The number of MA-PD options has grown steadily since 2010, peaking in 2024 when the average Medicare beneficiary had 36 options. Despite the decline in offerings over the last two years, the number of options available for 2026 is higher than the number available in 2022 (31) and every year before.

Across all plans for individual enrollment, including those with and without prescription drug coverage, the average beneficiary has 39 options in 2026, compared to 42 options in 2025. These numbers exclude employer- or union-sponsored group plans, Special Needs Plans (SNPs), PACE plans, cost plans, and Medicare-Medicaid plans (MMPs) that are only available to select populations.

Number of Plans Available to Beneficiaries, by State

The number of Medicare Advantage plans with prescription drug coverage available to the average beneficiary varies across states, as does the change in the number of plans compared to 2026 (Figure 3). In 35 states, DC and Puerto Rico, the average beneficiary has a choice of fewer plans on average in 2026 than in 2025.

The states with the largest drop in the number of plans available were New Hampshire (13 fewer plans) and Minnesota (11 fewer plans). In Minnesota, UCare, the second largest Medicare Advantage insurer in the state, exited the market altogether (excluding one D-SNP plan), while UnitedHealthcare and Humana decreased their offerings, especially in more rural counties with lower Medicare Advantage enrollment. Additionally, several more rural states have four or fewer options on average, including South Dakota (4 MA-PDs), Wyoming (3 MA-PDs), Vermont (1 MA-PD) and Alaska (0). Alaska had no plans available in 2026, as in 2025 (Alaska has historically had few or no Medicare Advantage plans available for general enrollment).

In six states (AL, HI, KS, MO, UT, and WV), the average beneficiary has access to more plans in 2026 than in 2025, on average. In the remaining eight states, the number of plans available to the average beneficiary stayed the same (including Alaska, with no MA-PDs in either year). Connecticut is not included in this calculation because of differences in how counties are reported across CMS enrollment and plan files.

Total Number of Plans

Individual plans. In total, 3,373 Medicare Advantage plans, including those without prescription drug coverage, are available nationwide for individual enrollment in 2026 – a 9% decrease from the number of plans (346 fewer plans) offered in 2025 (Figure 3).

HMOs account for more than half (57%) of all Medicare Advantage plans offered in 2026 but have declined as a share of all Medicare Advantage plans since 2017 (71% of plans) (Figure 3). During this period local PPOs have risen as a share of all plans, increasing from 24% to 42%. The share of plans that are regional PPOs has declined from around 3% of plans offered in 2017 to 1% in 2026 (Appendix Figure 1).

The number of plans offered by plan type mostly mirrors Medicare Advantage enrollment in HMOs (59%) and PPOs (40%) in 2025. The increasing availability of PPOs may reflect interest in plans with some out-of-network coverage, as physician availability is an important component when Medicare Advantage enrollees select their plan.

While many employers and unions also offer Medicare Advantage plans to their retirees, no information about these 2026 plan offerings is made available by CMS to the public during the Medicare open enrollment period. Employer and union plans are administered separately and may have enrollment periods that do not align with the Medicare open enrollment period.

Special Needs Plans (SNPs). In 2026, 1,721 SNPs will be offered nationwide, a 19 percent increase between 2025 and 2026 (Figure 4).

D-SNPs. Nearly six in ten SNPs (59%) are designed for people dually eligible for Medicare and Medicaid (D-SNPs). The number of D-SNPs has nearly doubled since 2020, increasing from 540 D-SNPs in 2020 to 1,019 D-SNPs in 2026 (up from 909 D-SNPs in 2025), suggesting insurers continue to be drawn to this high-need population. In 2025, 6 million Medicare beneficiaries are enrolled in D-SNPs.

C-SNPs. The number of SNPs offered for people with chronic conditions (C-SNPs) has substantially increased, more than tripling since 2020, from 165 plans that year to 548 plans in 2026 (up from 376 plans in 2025). Enrollment in C-SNPs has also increased sharply, rising to 1.2 million Medicare beneficiaries in 2025, comprising 75% of total SNP enrollment growth between 2024 and 2025. The acceleration of C-SNP enrollment and C-SNP offerings coincided with implementation of new rules for D-SNPs requiring greater integration between Medicare and Medicaid, and stricter rules about enrolling a large number of dually-eligible individuals in plans generally available for enrollment, which are not required of C-SNPs.

I-SNPs. The number of SNPs for people who require an institutional-level of care (I-SNPs) increased from 150 plans in 2020 to 189 plans in 2023, before dropping back down to 154 in 2026 (down from 160 plans in 2025). In 2025, about 115,000 Medicare beneficiaries are enrolled in I-SNPs.

Medicare Advantage Plans by County

In 2026, more than a quarter of Medicare beneficiaries (28%) (in 6 percent of counties) can choose from more than 50 Medicare Advantage plans (including plans without prescription drug coverage; Figure 5).

The 28% of Medicare beneficiaries who have more than 50 plan options is a decrease from 2025 when 32% of beneficiaries in 9 percent of counties had a choice of more than 50 plans. Similar to the last three years, the counties with the most plan options are predominantly in Pennsylvania and Ohio. Beneficiaries in Lancaster, Pennsylvania can choose from 82 Medicare Advantage plans – the most offerings of any county in the U.S.

In 2026, about 8 million people have a choice of 61 or more plans (including plans without prescription drug coverage) in 84 counties (Figure 6).

An additional 9 million beneficiaries have a choice of 51 to 60 plans in 125 counties. In contrast, in 2026, 1.4% of beneficiaries live in a county with one to four Medicare Advantage plans available, while less than 1% of beneficiaries live in a county without any plans available. In 122 counties across 13 states (Alaska, California, Colorado, Idaho, Kansas, Minnesota, Montana, Nebraska, Nevada, Oregon, South Dakota, Utah, and Vermont) and territories other than Puerto Rico, about 391,000 Medicare beneficiaries will not have access to a Medicare Advantage plan (an increase from 81 counties and about 250,000 Medicare beneficiaries in 2025). Similar to 2025, there are no Medicare Advantage plans for individual enrollment being offered in any county in Alaska in 2026, which includes about 106,000 beneficiaries.

Medicare Advantage Plans by Geographic Status. As in recent years, virtually all Medicare beneficiaries (99.4%) have access to a Medicare Advantage plan as an alternative to traditional Medicare, but the number of options varies by rurality.

Medicare beneficiaries living in urban areas can choose from 42 Medicare Advantage plans in 2026 on average, including 34 with Part D coverage, substantially more than beneficiaries living in rural areas – both areas adjacent and non-adjacent to urban areas. Beneficiaries in rural counties adjacent to urban areas can choose from an average of 29 plans, including 22 with Part D coverage.

Beneficiaries in the most rural areas – counties not adjacent to rural areas – can choose from an average of 20 plans, including 15 with Part D coverage.

Medicare Advantage Plan Offerings by Firm

The average Medicare beneficiary is able to choose from plans offered by eight firms in 2026 (Figure 7), the same as in 2024 and 2025. Despite most beneficiaries having access to plans operated by several different firms, enrollment is concentrated in plans operated by UnitedHealthcare and Humana, and together UnitedHealthcare and Humana account for nearly half (46%) of Medicare Advantage enrollment in 2025.

In 2026, nearly three in ten beneficiaries (29%), in 132 counties, are able to choose from plans offered by 10 or more firms or other sponsors (a decline from 31% in 2025). In contrast, 8% of beneficiaries live in a county where one to three firms offer Medicare Advantage plans (714 counties, an increase from 501 counties in 2025).

Further, in 171 counties, only one firm will offer Medicare Advantage plans in 2026. These are mostly rural counties with relatively few Medicare beneficiaries (less than 1.5% of the Medicare population). In some of these counties, there were no firms offering Medicare Advantage in 2025, e.g., two counties in Idaho (Clatsop and Tillamook). In contrast, Medicare beneficiaries in some counties had access to three firms in 2026 but only one firm in 2025, such as people living in five counties in Vermont (Caledonia, Essex, Orange, Windham, and Windsor). In Vermont, Vermont Blue Advantage (Blue Cross Blue Shield of Vermont), the largest Medicare Advantage insurer in the state in 2025, ended its Medicare Advantage coverage, as did UnitedHealthcare. Humana is offering plans in five of Vermont’s 14 counties. The remaining counties in Vermont have no Medicare Advantage options for 2026.

Availability of Plans by Firm and County

UnitedHealthcare and Humana, the two firms with the most Medicare Advantage enrollees in 2025, have large footprints across the country, offering plans in the majority of counties, though their footprints have slightly shrunk compared to 2025 (Figure 8).

For example, in 2026, Humana will be in 82% of counties, down from 89% of counties in 2025, and United Healthcare will be in 80% of counties in 2026, down from 87% of counties in 2025. Neither insurer will offer plans in 11% of counties, up from 5% of counties in 2025.

Some major insurers are expanding into new counties, while leaving others – meaning they are no longer offering any plans in those counties – though on the whole, the largest insurers are exiting more counties than they are entering in 2026 (Figure 9).

UnitedHealthcare is exiting the greatest number of counties – 225 counties in 2026 – while entering 14 new counties. In total, UnitedHealthcare is offering plans in 2,597 counties in 2026, a decrease of 211 counties from 2025. Humana is exiting the second greatest number of counties – 198 counties in 2026 – while entering 5 new counties. Humana is offering plans in more counties than any other large Medicare Advantage insurer – 2,655 counties in 2026 – though that represents a decrease of 193 counties from 2025.

Elevance is exiting 181 counties and entering 45 new counties in 2026, a decrease of 136 counties from 2025. CVS is exiting 160 counties, while entering 17 new counties in 2026, a decrease of 143 counties from 2025. Centene is exiting 104 counties, but is entering 63 new counties, the most new counties of any of the largest insurers. Kaiser Foundation Health Plans is neither exiting nor entering new counties in 2026.

The set of counties that each Medicare Advantage insurer is exiting do not completely, or in many cases, largely overlap. In some cases, such as many counties in Vermont and New Hampshire, multiple insurers are leaving rural areas with relatively low Medicare Advantage penetration. In other cases, such as in Monroe, NY (Rochester) and in Hennepin, MN (Minneapolis), insurers are leaving counties with higher Medicare Advantage penetration in an urban area. The different decisions of insurers to exit some counties suggest a combination of factors are at play, including local market characteristics, cost pressures, shifts in firm-level strategies, and ultimately the insurers’ assessment of potential profits.

Plan Renewals and Terminations

In 2026, 13% of Medicare Advantage enrollees in MA-PDs or about 2.6 million people, are in a plan that has been terminated for the coming year and will not be automatically assigned to another plan. (This number excludes people enrolled in SNPs, plans without prescription drug coverage, and people with employer coverage). This is an increase compared to 2025, when 6% of Medicare Advantage enrollees in MA-PDs or nearly 1.3 million people, were in a plan that was terminated.

People who have had their plan terminated will be able to enroll in another Medicare Advantage plan if one is available in their area or choose traditional Medicare. If they choose traditional Medicare, they will qualify for a special enrollment period for Medigap with guaranteed issue rights, meaning they can switch to traditional Medicare and will not be denied a Medigap policy due to a pre-existing condition. It is beyond the scope of this analysis how many beneficiaries in terminated plans have the option to enroll in another plan from the same insurer or the number of plans from which they can choose.

Another 6% of Medicare Advantage enrollees in MA-PDs, or about 1.3 million people, are in plans that have been affected by a consolidation. This is similar to 2025 when about 1.3 million people were also impacted by a consolidation. In this situation, some portion of this 1.3 million people will be moved into another plan under the same insurer automatically if the contract includes another plan of the same type (i.e., HMO or PPO) in the same county. (Some enrollees in consolidated renewal plans will not see changes in their plan because they were already in the plan that other enrollees are now being assigned to.) They may still enroll in another Medicare Advantage plan if one is available or choose traditional Medicare. However, they do not qualify for a special enrollment period for Medigap.

One of the features of the Medicare Advantage market is that plans can change from year to year, including in which counties insurers choose to offer plans for Medicare beneficiaries. When deciding on their health coverage, Medicare beneficiaries weigh factors such as out-of-pocket costs, provider networks, access to extra benefits offered by Medicare Advantage plans, drug formularies, among other plan benefits. Plan terminations and consolidations in the Medicare Advantage market add to the complexity that beneficiaries face when selecting their Medicare coverage.

New Market Entrants and Exits 

In 2026, ten firms are entering the market for the first time, four firms are exiting the market, and nine have had contracts taken over by other insurers (Figure 10). All of the new market entrants are only offering plans in California, including nine that are only offering a D-SNP plan, and a tenth firm that is offering two HMO plans.

In the last few years, some firms have introduced plans that are either co-branded or are in partnership with another company. For example, Alignment Health is offering plans co-branded with Instacart in California and Nevada in 2026, as they did in 2025. These plans will offer groceries to qualifying beneficiaries with chronic conditions. Alignment Health also continues to partner with Walgreens. As they did in 2025, other companies with a partnership that are offering plans in 2026 include Select Health and Kroger and Humana and USAA, though this is not an exhaustive list.

Four firms that participated in the Medicare Advantage market in 2025 are not offering plans in 2026. Two of the firms cited financial challenges, while another (Ochsner) did not specify why it was leaving the market. Avian Health Holdings, marketed as Sonder Health Plans, was placed in receivership and ceased operations.

Another nine firms left the market but had most of their contracts taken over by other insurers. Seven firms that are no longer in the Medicare Advantage market had contracts taken over by other parent organizations that were already offering plans in the Medicare Advantage market (Capital District Physicians’ Health Plan, Centers Plan for Healthy Living, Commonwealth Care Alliance, HTA Holdings, Indiana University Health, RiverSpring Living Holding Corp, and the Cigna Group). Cigna, the largest of these insurers, had its Medicare line of business acquired by Health Care Service Corporation. Additionally, Blue Cross Blue Shield of North Carolina plans are now part of the newly formed CuraCor Solutions holding company and SA Plan LLC is now part of BrightSpring Health Services, which is new to the Medicare Advantage market.

Appendix

Introduction

One of the immediate impacts of the 2025 Federal Budget Reconciliation Law is a provision, Section 71113, that blocks certain reproductive health care providers (who also provide abortions) from receiving federal Medicaid reimbursement for one year. The law impacts three organizations: (1) Planned Parenthood; (2) Maine Family Planning, a network of clinics in Maine, (3) and Health Imperatives, a network of specialized reproductive health clinics based in Massachusetts. Shortly after President Trump signed the law, Planned Parenthood, Maine Family Planning (legally known as the Family Planning Association of Maine), and 22 states and the District of Columbia filed separate legal challenges to prevent the implementation of Section 71113. One of the key issues in the litigation is whether Congress acted rationally to reach its policy goal of reducing the number of abortions across the country or whether they unlawfully targeted Planned Parenthood. This brief provides an overview of these legal challenges and summarizes the key positions of the plaintiffs and the defendants, Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS). 

Background

The 2025 Federal Budget Reconciliation Law is not the first instance of federal policy targeting funding for abortion and abortion providers. Blocking coverage of abortion under Medicaid and limiting abortion access has been a priority for abortion opponents since soon afterRoe v. Wade granted individuals the right to an abortion. Since 1977, Congress has included the Hyde Amendment every year as a rider to the federal appropriations budget prohibiting federal funds for abortion except in situations where the pregnancy is the result of rape or incest, or the pregnant person’s life is at risk. Federal Medicaid dollars may only reimburse abortion providers in these very limited situations. Some states make their own funds available to pay for abortion in other circumstances for their Medicaid enrollees. Yet, despite this longstanding provision, abortion opponents at the state and federal level have advocated going further in restricting federal funding. They argue that by allowing providers that also offer abortion services to remain in the Medicaid program, federal funds that go to these providers for other services indirectly subsidize abortion services with federal Medicaid dollars. While federal policy blocks funding for abortions under most circumstances, federal law mandates the coverage of family planning services, including contraception. Unique among covered benefits, federal Medicaid law classifies family planning services and supplies as a “mandatory” benefit category that states must cover and established a 90% federal matching rate (FMAP) for the costs of services categorized as family planning, a higher proportion than for other services. States pay the remaining 10% of costs. Many abortion providers also offer family planning services to their patients. 

Over the years, anti-abortion policy makers and advocates have utilized many different strategies to block Planned Parenthood from participating in Medicaid. In 2017, Congress attempted to block Medicaid reimbursement to entities (including Planned Parenthood affiliates) that provide abortions outside of the Hyde Amendment exceptions as part of efforts to repeal and replace the Affordable Care Act. That year, the House of Representatives passed a Reconciliation bill that would have blocked federal Medicaid funds to Planned Parenthood; however, the bill failed in the Senate and did not become law. In addition to federal attempts to block Planned Parenthood from Medicaid reimbursement, in the past decade at least 14 states (AL, AR, AZ, FL, IA, ID, IN, KS, LA, MO, MS, OK, SC, TN, TX) have used state-level policies or sought federal permission to block the provider from participating in their state Medicaid programs. Though most of these provisions were blocked by court action, the Supreme Court’s June 2025 decision in a case challenging South Carolina’s exclusion of Planned Parenthood from their Medicaid program changed this precedent. In Medina v. Planned Parenthood South Atlantic the Court allowed states to exclude providers from their Medicaid programs if they provide abortions or other services the state does not condone. Since Medina, a few states (Indiana, Nebraska, Oklahoma) have taken new actions to exclude Planned Parenthood from their state Medicaid programs.

Who is Challenging Section 71113 of the 2025 Federal Budget Reconciliation Law?

Planned Parenthood, Maine Family Planning, and 22 states and the District of Columbia (CA, NY, CT, CO, DE, HI, IL ME, MD, MA, MI, MN, NV, NJ, NM, NC, OR, the Governor of PA, RI, VT, WA, WI and the District of Columbia) have filed separate legal challenges claiming that Section 71113 violates the United States Constitution. Health Imperatives has not filed a lawsuit challenging this provision, but Massachusetts is one of the states challenging the law. 

The plaintiffs in these lawsuits say that restricting Medicaid funding to entities under Section 71113 would harm affected organizations and lead to increased costs to states. Further, they say this provision would decrease access to millions of Medicaid enrollees who receive reproductive health care including contraception, sexually transmitted infection testing and treatment, pregnancy testing, cancer screening, and other preventive services from affected providers. Section 71113 blocks federal Medicaid funding from certain entities for one year starting the date the law was signed, July 4, 2025; however, the provision states that entities are only designated as a “prohibited entity” if they meet certain criteria on October 1, 2025. 

Status of Cases Challenging Section 71113

Section 71113 is currently in effect for all three entities, and they are blocked from receiving federal Medicaid reimbursement for services provided to patients; however, throughout the course of the ongoing litigation the enforceability of Section 71113 has varied. A district court initially granted a preliminary injunction for ten Planned Parenthood affiliates that do not individually meet the criteria of Section 71113 on July 21, 2025. On July 28, 2025, the district court extended the preliminary injunction to all Planned Parenthood affiliates. On September 11, 2025, the First Circuit Court of Appeals reversed the district court ruling by pausing the preliminary injunction, therefore blocking Planned Parenthood sites across the country from receiving federal Medicaid funds for any service they provide to Medicaid enrollees while the case is ongoing. On December 12, 2025, the First Circuit permanently blocked the district court’s preliminary injunction. The First Circuit held that Section 71113 does not impose punishment on Planned Parenthood and instead is a lawful exercise of Congress’ taxing and spending power. The district court is continuing to consider this case in accordance with the First Circuit’s ruling.

Maine Family Planning also requested a preliminary injunction to block the enforcement of Section 71113, but the district court denied their request, and Maine Family Planning appealed. However, on December 29, 2025, Maine Family Planning filed a motion to voluntarily dismiss their case.

On December 2, 2025, a district court granted a motion for a preliminary injunction blocking enforcement of Section 71113 for the 22 states and DC. However, the judge stayed her order for seven days, and HHS has appealed. The court held that text of Section 71113 does not provide clear notice to states of how a Medicaid provider is determined to be a “prohibited entity.” The court reasoned that Section 71113 does not sufficiently give states: (1) the criteria to determine whether an entity is “primarily engaged in family planning”; (2) guidance on calculating Medicaid expenditures (for the purpose of Section 71113’s $800,000 threshold) of entities in their state that are members of multistate organizations; and (3) how to identify “affiliates” when those organizations operate outside the state’s boarders. Further, the court asserted that the plaintiff states would be harmed by enforcement of Section 71113 including retroactive enforcement because the retroactive nature of the provision conflicts with states obligation to make payments on providers claim within 30 days of receipt.

 After initially blocking the law from being implemented, the First Circuit subsequently granted the Government’s request on December 30, 2025, allowing the provision to be enforced in the 22 Plaintiff States and DC. The First Circuit held that the asserted ambiguities in Section 71113, including the definition of “affiliate” are unlikely to support the granting of a preliminary injunction. Currently states may reimburse Planned Parenthood and other affected providers with non-federal dollars, but only a handful of states have indicated their willingness to provide this support.

On What Grounds are the Plaintiffs Suing the Federal Government?

The heart of the litigation is the constitutionality of Congress’ action of prohibiting payments to certain entities that provide services to Medicaid patients. 

While all plaintiffs concede that Congress has the power to dictate spending guidelines for Medicaid funds, the constitutionality of Congress’ actions in enacting Section 71113, and the resulting burden on states is at the heart of this litigation. The Spending Clause in the United States Constitution grants Congress the power to, “lay and collect taxes…and provide for the common defense and general welfare of the United States,”— but this power is not unlimited. All exercises of Congress’ Spending Clause authority are subject to constitutional limitations. These limitations include the requirement that Congress must give clear notice of what actions are required in exchange for federal funds. Further, Congress cannot attach discriminatory conditions to federal funds that would violate other constitutional rights. At issue in this litigation is whether Section 71113 provides clear notice of state’s enforcement obligations, and whether the provision violates Maine Family Planning and Planned Parenthood’s constitutional rights.

First Amendment Claims 

The First Amendment of the United States Constitution states that, “Congress shall make no law… abridging the freedom of speech…or the right of the people to assemble.” The First Amendment has been interpreted not only to guarantee freedom of speech, but also the right to associate with others. Planned Parenthood and the states contend that Section 71113 unconstitutionally burdens Planned Parenthood’s First Amendment right to freedom of association. The text of Section 71113 includes affiliates of an entity that meet the criteria of a prohibited entity. They argue that penalizing Planned Parenthood affiliates that do not independently meet the criteria of Section 71113 because they are associated with other Planned Parenthood affiliates that are prohibited entities, hinders the affiliates’ ability to freely associate.

Plaintiffs further allege that Section 71113 violates Planned Parenthood’s First Amendment rights because Section 71113 could be considered unconstitutional retaliation. The First Amendment prevents the government from restricting speech or retaliating against protected speech. Retaliation is an adverse action a plaintiff experiences where the motivating factor behind the action was the plaintiff’s protected speech. In their complaints, Plaintiffs, Planned Parenthood, and the states allege that the motivation for enacting Section 71113 is to stop Planned Parenthood’s advocacy for sexual and reproductive health care. The states and Planned Parenthood claim that due to the narrow criteria of abortion providers affected by Section 71113, the provision was specifically written to target Planned Parenthood and its affiliates.                                                                                                

Bill of Attainder Claims 

In addition to the First Amendment claims, Planned Parenthood Federation of America and the states contend that Section 71113 is a violation of the US Constitution because it is an unlawful “bill of attainder.” A bill of attainder is a law that imposes a penalty without trial and circumvents due process of law. In their complaint, plaintiffs draw on the legislative history of Section 71113, and statements made by lawmakers to support their claim that Section 71113 was enacted specifically to exclude Planned Parenthood from receiving federal Medicaid funds. Planned Parenthood and the states also cite a 2017 attempt by Congress to block Medicaid payments from entities that provide abortions outside of the Hyde Amendment exceptions. During the 2017 attempt, the enacted provision would have solely excluded Planned Parenthood. Planned Parenthood argues that the text of the 2017 and 2025 provisions that block payments to prohibited entities are similar, demonstrating Congress’ intent to specifically penalize Planned Parenthood.

Fifth Amendment Claims 

In all three cases, the plaintiffs allege some violation of the Fifth Amendment Equal Protection Principle. All Plaintiffs allege that Section 71113 violates the equal protection component of the Due Process Clause of the Fifth Amendment because it only applies to “prohibited entities.” The Fifth Amendment prevents arbitrary discrimination and generally requires that similarly situated entities are treated alike. If an entity believes they have been unfairly discriminated against by a government entity, they can file a claim alleging a violation of their Fifth Amendment rights. The courts will then analyze the government’s purpose for enacting the law, and whether the government has violated the entities’ guaranteed rights such as freedom of speech and equal protection under the law. Planned Parenthood maintains they are being treated differently than other abortion providers who provide abortions outside of the Hyde Amendment exceptions. They argue that there is not a legitimate government interest in drawing this distinction, and thus the provision violates the Fifth Amendment.

Planned Parenthood also asserts a separate Fifth Amendment claim, maintaining that Section 71113 is invalid because it is vague. The Fifth Amendment Due Process Clause states that a person cannot be deprived of their life, liberty, or property without due process of law. This has been interpreted to mean that statutes that lack specificity or definiteness can be invalidated because they do not give clear warning of a prohibited action (void for vagueness). Planned Parenthood alleges that Section 71113 does not define essential terms in the statutory text, thus making it void. Planned Parenthood maintains that the words “affiliates, subsidiaries, successors, and clinics,” in the statute are undefined leaving it unclear whether Section 71113 applies to Planned Parenthood affiliates who do not independently meet the provisions criteria. In a November 21, 2025, letter to State Medicaid Directors CMS provided guidance defining the statutory term “affiliate “as “a corporation that is related to another corporation by shareholdings or other means of control; a subsidiary, parent, or sibling corporation.” In the guidance CMS defines “control” as: “the direct or indirect power to govern the management and policies of a person or entity, whether through ownership of voting securities, by contract, or otherwise; the power or authority to manage, direct or oversee.” Planned Parenthood filed a response to this guidance in the district court contending that CMS’ definition of affiliate still leaves ambiguity on who is considered an “affiliate,” because of the overbroad terms used in the CMS guidance. Therefore, Planned Parenthood continues to allege that Section 71113 is “void for vagueness.”

The Trump Administration Contends Section 71113 is Constitutional 

The Trump administration maintains similar legal arguments in all the lawsuits challenging the constitutionality of Section 71113. The government contends that Section 71113 is a component of duly enacted legislation, and plaintiffs’ attempts to block implementation of this provision seek to override the intentions of Congress. The Trump administration also argues that Congress has broad discretion to tax and spend for the general welfare, which includes the ability to alter federal Medicaid expenditures. The government also states that the parameters for designating entities to be removed from Medicaid reimbursement are not arbitrary and serve a legitimate government purpose. Further, the government rejects plaintiffs’ argument that Section 71113 was enacted due to animus toward plaintiffs. Instead, the government offers the alternative explanation that Section 71113 was enacted to reduce the number of abortions performed in the United States, a legitimate government interest.

What are the Next Steps? 

Currently, Section 71113 in effect, and Planned Parenthood affiliates, Maine Family Planning, and Health Imperatives are blocked from receiving federal reimbursement for services provided to Medicaid patients. Litigation challenging Section 71113 has the potential to directly impact the over 2.1 million people who receive health care from these organizations. To continue to qualify for federal Medicaid funding it was reported that Planned Parenthood of Wisconsin responded by first stopping abortion care before the October 1, 2025, deadline and then when they resumed abortion care, they relinquished their Essential Community Provider status, to avoid meeting the criteria set forth in Section 71113. However, it is unclear whether this will be enough for them and other affiliates which do not meet the criteria of Section 71113 on their own to not land on HHS’s prohibited entity list based on CMS’ guidance released on November 21, 2025. If Section 71113 remains in effect, Planned Parenthood and Maine Family Planning may close clinics, reduce services, or be unable to serve Medicaid patients. While some states have announced plans to fill in gaps created by the loss of Medicaid funding, this is not likely enough to make up for lost federal funds. Planned Parenthood Mar Monte, Planned Parenthood North Central, Planned Parenthood Northern New England, Planned Parenthood of Greater New York, Planned Parenthood of Michigan, Planned Parenthood of Western Pennsylvania, and Planned Parenthood Greater Northwest, have already experienced clinic closures or service interruptions in the face of financial uncertainty, and Maine Family Planning has announced that they will no longer offer primary care services to Medicaid enrollees at three of their 18 sites. 

Even if the Plaintiffs ultimately prevail on their challenges to Section 71113, the Supreme Court’s decision in Medina v. Planned Parenthood South Atlantic, opens the door for states to block providers from their Medicaid program. Without a federal law preventing Planned Parenthood from being blocked from Medicaid, more states may choose to exclude Planned Parenthood from their state’s Medicaid program. Ultimately, the constitutionality of Section 71113 may be decided by the Supreme Court; however, because Section 71113 only prohibits funding from July 4, 2025, to July 3, 2026, the year may be up before there is a final decision. Some states, such as Colorado and California, have provided temporary financial support to Planned Parenthood and other affected providers to fill the gap from the loss in federal funding. Yet, many anticipate that this provision could be inserted into a similar reconciliation bill in future years. It is not clear whether states will be able to continue to provide this support if there is a future reconciliation bill blocking federal Medicaid payments to these providers, especially in the face of future fiscal challenges and competing programmatic demands. 

Summary

Stark racial disparities in maternal and infant health in the U.S. have persisted for decades despite continued advancements in medical care. Compared to other high-income countries, the U.S. remains the country with the highest rate of maternal deaths. The disproportionate impact of the COVID-19 pandemic on people of color brought increased attention to health disparities, including the longstanding inequities in maternal and infant health. Subsequently, the overturning of Roe v. Wade, growing barriers to abortion, cuts to staff and programs within the U.S Department of Health and Human Services (HHS), and the passage of the 2025 tax and budget law all have the potential to further widen existing disparities in maternal health.

This brief provides an overview of racial disparities for selected measures of maternal and infant health, discusses the factors that drive these disparities, and provides an overview of policy changes that may impact them. It is based on KFF analysis of publicly available data from CDC WONDER online database, the National Center for Health Statistics (NCHS) National Vital Statistics Reports, and the CDC Pregnancy Mortality Surveillance System.

While this brief focuses on racial and ethnic disparities in maternal and infant health, wide disparities also exist across other dimensions, including income, education, age, and other characteristics. For example, there is significant variation in some of these measures across states and disparities between rural and urban communities. Data and research often assume cisgender identities and may not systematically account for people who are transgender and non-binary. In some cases, the data cited in this brief use cisgender labels to align with how measures have been defined in underlying data sources. Key takeaways include:

Large racial disparities in maternal and infant health outcomes persist. Pregnancy-related mortality rates among Black women are over three times higher than the rate for White women (49.4 vs. 14.9 per 100,000). Black, American Indian or Alaska Native (AIAN), and Native Hawaiian or Pacific Islander (NHPI) women also have higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to White women. Infants born to Black, AIAN, and NHPI people have markedly higher mortality rates than those born to White people.

Maternal and infant health disparities reflect broader underlying social and economic inequities that are rooted in racism and discrimination. Differences in health insurance coverage and access to care play a role in driving worse maternal and infant health outcomes for people of color. However, inequities in broader social and economic factors, including income, are primary drivers for maternal and infant health disparities. Moreover, the persistence of disparities in maternal health across income and education levels, points to the importance of addressing the roles of racism and discrimination as part of efforts to improve health and advance equity.

Recent actions by the Trump administration and Congress reflect a shift away from prioritizing maternal and infant health equity and may contribute to widening disparities. Several key programs that historically supported expanding access to care and services and efforts to address racial disparities, such as diversifying the health care workforce and enhancing data collection and reporting, now face funding cuts or elimination. Other recent federal program and budget cutbacks, including the reduction or elimination of diversity, equity, and inclusion (DEI) initiatives, may undermine efforts to improve disparities in maternal and infant health outcomes. Moreover, the 2025 tax and budget law is anticipated to lead to large coverage losses, particularly in Medicaid, which is a primary source of care for people of color. Coverage losses will likely contribute to access barriers, including for maternal care. Additionally, state variation in access to abortion in the wake of the overturning of Roe v. Wade may exacerbate existing racial disparities in maternal health.

Racial Disparities in Maternal and Infant Health

Pregnancy-Related Mortality Rates

In 2023, approximately 676 women died in the U.S. from causes related to or worsened by pregnancy. This is a decrease from 793 maternal deaths in 2022. Pregnancy-related deaths are deaths that occur within one year of pregnancy. The pregnancy-related mortality rate decreased among White and Hispanic women, will there were no significant changes for Asian or Black women. Approximately one in five (20%) deaths occur during pregnancy, nearly one quarter (23%) occur during labor or within the first week postpartum, and more than half (57%) occur one week to one year postpartum, underscoring the importance of access to health care beyond the period of pregnancy. Recent data show that more than eight out of ten (87%) pregnancy-related deaths are preventable.

As of 2023, Black people are more than three times as likely as White people to experience a pregnancy-related death (49.4 vs. 14.9 per 100,000 live births) in 2023 (Figure 1). The rate for Hispanic and Asian people is lower compared to that of White people (12.3 and 10.7 vs. 14.9 deaths per 100,000 live births). Data from 2023 were insufficient to identify mortality among AIAN and NHPI women. However, earlier data from 2021 show that AIAN and NHPI people (118.7 and 111.7 per 100,000, respectively) had the highest rates of pregnancy-related mortality across racial and ethnic groups.

Research shows that this disparity for Black women increases by age and persists across education and income levels. Data show higher pregnancy-related mortality rates among Black women who completed college education than among White women with the same educational attainment and White women with less than a high school diploma. Other research also shows that Black women are at significantly higher risk for severe maternal morbidity, including conditions such as preeclampsia, which is significantly more common than maternal death. Further, AIAN, Black, NHPI, Asian, and Hispanic women have higher rates of admission to the intensive care unit during delivery compared to White women, which is considered a marker for severe maternal morbidity.

Birth Risks and Outcomes

Black, AIAN, and NHPI women are more likely than White women to have certain birth risk factors that contribute to infant mortality and can have long-term consequences for the physical and cognitive health of children. Preterm birth (birth before 37 weeks gestation) and low birthweight (defined as a baby born less than 5.5 pounds) are some of the leading causes for infant mortality. Receiving pregnancy-related care late in a pregnancy (defined as starting in the third trimester) or not receiving any pregnancy-related care at all can also increase the risk of pregnancy complications. Black, AIAN, and NHPI women have higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to White women (Figure 2). Notably, NHPI women are four times more likely than White women to begin receiving prenatal care in the third trimester or to receive no prenatal care at all (22.4% vs. 4.7%). Black women also are nearly twice as likely compared to White women to have a birth with late or no prenatal care compared to White women (10.4% vs. 4.7%).

While teen birth rates overall have declined over time, they are higher among Black, Hispanic, AIAN, and NHPI teens compared to their White counterparts (Figure 3). In contrast, the birth rate among Asian teens is lower than the rate for White teens. Many teen pregnancies are unplanned, and pregnant teens may be less likely to receive early and regular prenatal care. Teen pregnancy also is associated with increased risk of complications during pregnancy and delivery, including preterm birth. Teen pregnancy and childbirth can also have social and economic impacts on teen parents and their children, including disrupting educational completion for the parents and lower school achievement for the children. Research studies have found that increased use of contraception as well declines in teen sexual activity have helped lower the rate of teen births nationally.

Reflecting these increased risk factors, infants born to AIAN, Hispanic, Black, and NHPI women are at higher risk for mortality compared to those born to White women. Infant mortality is defined as the death of an infant within the first year of life, but most cases occur within the first month after birth. The primary causes of infant mortality are birth defects, preterm birth and low birthweight, sudden infant death syndrome, injuries, and maternal pregnancy complications. Infant mortality rates have declined over time, although the 2023 rate is unchanged from the 2022 rate (5.6 per 1,000 births, respectively). However, disparities in infant mortality have persisted and sometimes widened for over a century, particularly between Black and White infants. As of 2023, infants born to Black women are over twice as likely to die relative to those born to White women (10.9 vs. 4.5 per 1,000), and the mortality rate for infants born to AIAN and NHPI women (9.2 and 8.2 per 1,000) is nearly twice as high (Figure 4). The mortality rate for infants born to Hispanic mothers is similar to the rate for those born to White women (5.0 vs. 4.5 per 1,000), while infants born to Asian women have a lower mortality rate (3.4 per 1,000).

Data also show that fetal death or stillbirths—that is, pregnancy loss after 20-week gestation—are more common among NHPI, Black and AIAN women compared to White and Hispanic women. Moreover, causes of stillbirth vary by race and ethnicity, with higher rates of stillbirth attributed to diabetes and maternal complications among Black women compared to White women. 

Based on the most recently available federally published estimates from 2018, about one in five AIAN, Asian or Pacific Islander, and Black women reported symptoms of pregnancy-related depression compared to about one in ten White women (Figure 5). Hispanic women (12%) had similar rates of depression during and after childbirth compared to their White counterparts (11%). A recent study among women in Southern California suggests that the prevalence of PPD) has grown over the past decade , driven by increases among Black and Asian and Pacific Islander women. Women of color experience increased barriers to mental health care and resources, along with racism, trauma and cultural barriers. Research suggests that perinatal mental health conditions are a leading underlying cause of pregnancy-related deaths and that individuals with perinatal depression are also at increased risk of chronic health complications such as hypertension and diabetes. Infants of mothers with depression are more likely to be hospitalized and die within the first year of life. 

Factors Driving Disparities in Maternal and Infant Health

The factors driving disparities in maternal and infant health are complex and multifactorial. They include differences in health insurance coverage and access to care. However, broader social and economic factors and structural and systemic racism and discrimination also play a major role (Figure 7). In maternal and infant health specifically, the intersection of race, gender, poverty, and other social factors shapes individuals’ experiences and outcomes. Recently there has been broader recognition of the principles of reproductive justice, which emphasize the role that the social determinants of health and other factors play in reproductive health for communities of color. Notably, Hispanic women and infants fare similarly to their White counterparts on many measures of maternal and infant health despite experiencing increased access barriers and social and economic challenges typically associated with poorer health outcomes. Research suggests that this finding, sometimes referred to as the Hispanic or Latino health paradox, in part, stems from variation in outcomes among subgroups of Hispanic people by origin, nativity, and race, with better outcomes for some groups, particularly recent immigrants to the U.S. However, the findings still are not fully understood.

Disparities in maternal and infant health, in part, reflect increased barriers to care for people of color. Research shows that coverage before, during, and after pregnancy facilitates access to care that supports healthy pregnancies, as well as positive maternal and infant outcomes after childbirth. Overall, people of color are more likely to be uninsured and face other barriers to care. Medicaid helps to fill these coverage gaps during pregnancy and for children, covering more than two-thirds of births to women who are Black or AIAN. Given its significant role as a payor of maternity care for women of color, several health care professionals and state Medicaid programs have developed initiatives to improve maternal health and decrease maternal mortality and morbidity, such as broader inclusion of doulas as Medicaid providers. However, AIAN, Hispanic, and Black people are at increased risk of being uninsured prior to their pregnancy, which can affect access to care before pregnancy and timely entry to prenatal care. Beyond health coverage, people of color face other increased barriers to care, including limited access to providers and hospitals and lack of access to culturally and linguistically appropriate care.

Several areas of the country, particularly in the South, which is home to a large share of the Black population, have gaps in obstetrics providers. AIAN women also are more likely to live in communities with lower access to obstetric care. These challenges may be particularly pronounced in rural and medically underserved areas. For example, research suggests that the steep closures of hospitals and obstetric units over the past decade in rural areas has a disproportionate negative impact on Black infant health. Suggested approaches for stemming shortages include more training programs for perinatal nurses and midwives, raising Medicaid payment rates, and expansion of midwifery and birth centers services.

Research also highlights the role racism and discrimination play in driving racial disparities in maternal and infant health. Research has documented that social and economic factors, racism, and chronic stress contribute to poor maternal and infant health outcomes, including higher rates of pregnancy-related depression and preterm birth among Black women and higher rates of mortality among Black infants. In recent years, research and news reports have raised attention to the effects of provider discrimination during pregnancy and delivery. News reporting and maternal mortality case reviews have called attention to a number of maternal and infant deaths and near misses among women of color where providers did not or were slow to listen to patients. A recent report determined that discrimination, defined as treating someone differently based on the class, group, or category they belong to due to biases, stereotypes, and prejudices, contributed to 30% of pregnancy-related deaths in 2020. In one study, Black and Hispanic women reported the highest rates of mistreatment (such as shouting and scolding, ignoring or refusing requests for help during the course of their pregnancy). Even after controlling for insurance status, income, age, and severity of conditions, people of color are less likely to receive routine medical procedures and experience a lower quality of care. Another study found that Black women are more likely to receive a cesarian section compared to White women while controlling for health status, suggesting that differences in provider judgement and structural inequalities may be contributing to the disparity. A 2023 KFF survey found that about one in five (21%) Black women say they have been treated unfairly by a health care provider or staff because of their racial or ethnic background. A similar share (22%) of Black women who have been pregnant or gave birth in the past ten years say they were refused pain medication they thought they needed.

Current Policies Impacting Maternal and Infant Health Disparities

Since President Trump took office in January 2025, the Administration and Congress have made significant health policy changes. While in some cases pregnant and postpartum people have been specifically exempted or protected from changes, many changes may have significant impacts on maternal and infant health that could exacerbate existing disparities.

President Trump’s executive orders rolling back federal diversity efforts could exacerbate longstanding disparities in maternal health. As one of his first actions in office, President Trump signed executive orders revoking federal DEI related programs and actions in the federal government and among federal contractors and grantees. In implementing President Trump’s executive orders, the administration has taken significantly broader actions beyond eliminating DEI programs to include eliminating priorities, actions, information, data, and funding related to concepts of diversity or disparities among federal agencies as well as federal contractors and grantees. The broad nature of these actions risks reversing progress on health equity and may lead to widening disparities in maternal health.

Recent federal restructuring may reverse progress on maternal and infant health, particularly for communities already facing persistent disparities. On March 27, 2025, the Trump administration announced an Executive Order reorganizing HHS, which has disrupted key programs affecting maternal health. This impacts included laying off most staff in the CDC’s Division of Reproductive Health, halting community-based maternal health grants, erasing the prior White House Blueprint for Addressing the Maternal Health Crisis, and closing several federal offices that supported state and local efforts to address racial disparities in maternal care. The restructuring has also eliminated key initiatives, including the Pregnancy Risk Assessment Monitoring System (PRAMS), which for decades provided data to track maternal experiences and inform evidence-based policies, and the Safe to Sleep Campaign, a national effort to reduce sudden infant death syndrome (SIDS). These rollbacks come at a time when sleep-related infant deaths have risen nearly 12% between 2020 and 2022, with SIDS among Black infants increasing by 15% in 2020.

The 2025 tax and spending legislation makes large cutbacks in federal Medicaid spending that are expected to lead to large coverage losses, which will likely reduce access to care, including maternal care. According to the Congressional Budget Office (CBO), the law will reduce federal Medicaid spending over the next decade by an estimated $911 billion and increase the number of uninsured people by 10 million. Given the disproportionate role Medicaid plays in covering women of color, they are at increased risk for being affected by program cutbacks. In 2023, Medicaid covered 37% of AIAN 30% of Black and 26% of Hispanic reproductive age women, compared to 20% of reproductive age women overall. Moreover, among women of reproductive age enrolled in Medicaid, nearly four in ten are covered through the Medicaid expansion and could be at risk of losing coverage due to new work and eligibility requirements under the law. While the law provides exemptions from new work requirements for pregnant and postpartum women and for adults with children under age 14, many may still be at risk for losing coverage if they face challenges documenting information necessary to quality for the exemption. The requirements may also limit access to coverage before pregnancy, a particularly important time for addressing preventive care and managing chronic conditions, which are associated with healthier pregnancy outcomes.

The law also imposes a one-year ban on federal Medicaid payments to certain family planning providers, including all Planned Parenthood clinics, which could weaken resources and care that support maternal and infant health. This policy prohibits some family planning clinics that also offer abortion services from receiving any Medicaid payments for contraceptive and other preventive services. Because Medicaid covers 90% of the cost of family planning services, losing this funding would be a major financial blow. While Planned Parenthood clinics represent a small share of the reproductive health safety net overall, they serve many patients of color, provide a significant portion of contraceptive care and are often the only provider in rural or underserved areas. Excluding them from Medicaid could result in clinic closures, reduced services, and fewer reproductive care options for low-income women. 

In addition, President Trump’s policies and budget proposals are threatening to dismantle the Title X family planning program, disproportionately affecting communities already facing higher barriers to care. Title X, a federal program established in 1970, provides funding to clinics that offer contraceptive services, STI testing, and cancer screenings to low-income and uninsured patients. These clinics provide care to a diverse population, with nearly a quarter (23%) of the patient population identifying as Black, more than a third (36%) as Hispanic or Latino, and about a fifth (19%) reporting limited proficiency in English. In recent years, the program has faced mounting restrictions. During President Trump’s first term, his administration implemented rules that barred clinics from participating in Title X if they offered or referred for abortion services, resulting in roughly 1,000 clinics losing Title X funding. While the Biden administration later reversed these restrictions, the second Trump administration has resumed efforts to limit the program by withholding funds from some grantees and proposing to eliminate all funding for the program. If enacted, these policies would dismantle the program, leaving many rural and underserved communities with fewer resources for affordable reproductive health care.

State abortion bans and restrictions may exacerbate poor maternal and infant health outcomes and access to care. Since the Dobbs ruling in June 2022, about half of states have banned abortion or restricted it to early in pregnancy. People of color are disproportionately affected by these bans and restrictions as they are at higher risk for pregnancy-related mortality and morbidity, are more likely to obtain abortions, and more likely to face structural barriers that make it more difficult to travel out of state for an abortion. While the number of abortions has slightly increased nationally since the ruling, ongoing and impending legal challenges, state legislative efforts, and federal executive actions could further alter the reproductive care landscape and have impacts beyond abortion counts. A recent JAMA study, for instance, found that fertility rates have increased in states with complete or 6 week abortion bans, particularly among Black and Hispanic populations compared to White populations. A concurrent study showed infant mortality rates have also risen in these states and the increases were larger among Black infants. Abortion bans are exacerbating maternity workforce shortages, as some clinicians do not want to work in areas that criminalize their practice and restrict their ability to provide evidence-based care.

Summary

As routine and seasonal vaccination rates continue to decline among children, racial disparities in vaccination rates persist. Declining vaccination rates leave children at increased risk for preventable illnesses, while disparities leave some children at greater risk relative to others. Research shows that many childhood diseases require a high level of vaccination within the population to achieve community-wide protection. As vaccination rates decline, risk for disease outbreaks increases. For example, as of November 2025, there have been 44 measles outbreaks (3 or more related cases) in the U.S. during 2025, and the number of measles cases reported for 2025 is the highest level reported in decades, a consequence of declining measles vaccination rates in many areas.

This analysis examines recent childhood vaccination rates by race and ethnicity for children’s recommended vaccines overall and for the measles, mumps, rubella (MMR) and seasonal flu vaccines specifically, based on KFF analysis of data from the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) and the CDC Flu Vaccination Coverage Report (see Methods). It also discusses potential factors contributing to the ongoing disparities in vaccination rates and recent declines in levels of vaccination coverage.

Overall, the data show that children’s vaccination rates, including receipt of recommended childhood vaccinations as well as for MMR and seasonal flu vaccine specifically, have declined in recent years largely due to decreases in vaccinations among White and Asian children. At the same time, and despite the declines among White and Asian children, Black and AIAN children remain least likely to have received recommended childhood vaccinations and the MMR vaccine specifically. In contrast, for the seasonal flu vaccine, White children along with Black and AIAN children are less likely to have received the vaccination compared to their Asian and Hispanic peers.

Ongoing racial disparities in vaccination rates likely reflect a combination of factors including differences in access to care as well as varying levels of trust in vaccines.For example, the 2025 KFF/Washington Post Survey of Parents shows lower levels of confidence in the safety of some vaccines among Black parents compared to White parents. The recent declines in vaccination rates may reflect spread of vaccine misinformation, growing public skepticism about the safety and effectiveness of vaccines, and increasingly partisan views on vaccination. The KFF/Washington Post Survey of Parents shows Republican parents are nearly three times as likely to report skipping vaccinations for their children compared to parents who are Democrats. Most recently, the Centers for Disease Control and Prevention (CDC) posted information to its website indicating that “studies have not ruled out the possibility that infant vaccines cause autism” despite longstanding scientific evidence disputing this connection. Going forward, these declines could be exacerbated by changes in federal vaccine policy.

Children’s Vaccination Rates by Race and Ethnicity

Largely driven by decreases among Asian and White children, rates of receipt of recommended childhood vaccinations for children ages 24 months or younger have declined. The U.S. Advisory Committee on Immunization Practices (ACIP) has established a recommended immunization schedule for children, which outlines the vaccines they should receive from birth through age two. Examination of vaccination rates by birth cohorts, which group children by the year they were born to allow for comparisons across groups and years, shows that vaccination coverage rates among Asian and White children up to age 24 months have declined, falling from 77% among Asian children in the 2017-2018 birth cohort to 70% in the 2020-2021 birth cohort and from 74% to 69% among White children across these cohorts (Figure 1). The rate for Hispanic children rose from 66% to 69% between the 2017-2018 and 2018-2019 cohorts but then declined again to 65% among the 2020–2021 birth cohort. Rates for Black children remained relatively stable over this period. Both Hispanic and Black children continue to have lower vaccination rates than Asian and White children, with only about two-thirds of each group receiving recommended childhood vaccinations. The rate for AIAN children has increased but is still lower than other groups at 59% among the 2020-2021 birth cohort. In addition to lower routine childhood vaccination rates among children ages 24 months and younger, the rate of school vaccine exemptions increased following the COVID-19 pandemic. Recent survey data suggest that parents who had a White child were less likely to agree that school and daycare vaccination requirements are important or necessary compared to parents of children of other racial and ethnic groups.

For the MMR vaccination specifically, Asian and White children have the highest rates of receiving at least one dose by age 24 months but their rates have been declining in recent years; rates for Black and AIAN children remain lower and below the Healthy People 2030 goal of 90.8% children receiving at least one MMR dose by their second birthday. Asian children have the highest MMR vaccination rate across racial and ethnic groups, although it fell from 95% among those born in 2017-2018 to 92% among those born in 2020-2021 (Figure 2). Similarly, the rate for White children fell from 93% to 90% across these birth cohorts. Rates for other groups remained largely stable across these cohorts, but rates for Black (89%) and AIAN (88%) children born in 2020-2021 remain lower and below the Healthy People 2030 vaccination goal.

Flu vaccination rates among children ages 6 months to 17 years have fallen to their lowest level in over a decade, with a steady decline among White children since the pandemic. Prior to the COVID-19 pandemic, flu vaccination rates had been increasing, with rates highest among Asian and Hispanic children and lower levels among White, Black, and AIAN children. Vaccination rates fell among all groups moving into the 2020-2021 season following the onset of the COVID-19 pandemic. The rate for AIAN children dropped by nearly 20 percentage points and there were larger declines in vaccination rates for Black, Asian, and Hispanic children compared to their White counterparts. Rates rebounded slightly after 2020-2021 season for most groups although they remain below pre-pandemic levels and continued to decline for White children. As of the 2023-2024 flu season, Asian children (70%) had the highest flu vaccination rate, followed by Hispanic children (61%). In contrast, just over half of AIAN (54%), Black (52%), and White (52%) children received the flu vaccine (Figure 3). Preliminary data for the 2024-2025 season that are available for selected groups also show that only about half of White (46%) Black (48%), and Hispanic (53%) children received the vaccine.

Factors Affecting Vaccination Rates

Racial differences in vaccination rates may reflect a variety of factors including differences in social and economic factors that impact access to care as well as differing levels of trust in vaccines. For example, Black, Hispanic, and AIAN people fare worse compared to their White and Asian counterparts on some measures of access to care and across social and economic factors that may impact access to and use of care, including education and income. In a July 2025 KFF Health Tracking Poll, Black and Hispanic adults were among the most concerned about the availability and insurance coverage of the COVID-19 vaccine. The long legacy of the medical system’s abuse and mistreatment of people of color may also contribute to distrust of vaccines. For example, KFF/Washington Post survey data from October 2025 show that just over half (55%) of Black parents say they are confident the flu vaccines are safe for children compared to about two-thirds of White parents (64%), and Black parents are at least 10 percentage points less likely than White parents to express confidence in the safety of the Polio and MMR vaccines.

A growing partisan divide in attitudes toward childhood vaccinations may be contributing to declining vaccination rates among White children. KFF polling data show that the share of parents who say they keep their child up to date with recommended childhood vaccines like the MMR has been declining over time. For example, KFF Tracking Poll data show that the share of parents who report skipping or delaying some vaccines for their children increased between 2023 and 2025, driven largely by Republican-leaning parents. KFF/Washington Post survey data from October 2025 show that Republican parents are nearly three times as likely to report skipping vaccinations other than flu or COVID for their children compared to parents who are Democrats (22% vs. 8%). Other data show that White voters make up the nearly eight in ten of Republicans and Republican leaders.

Changing attitudes towards vaccines may reflect the spread of vaccine misinformation. Some public health leaders have noted that vaccine hesitancy related to COVID-19 may have had spillover effects on routine child immunizations. More recently, HHS Secretary Robert F. Kennedy Jr. has amplified claims about vaccines that have been rejected by scientists and public health officials. Kennedy has suggested without evidence that the number of recommended childhood vaccines has led to a rise in chronic disease in the U.S. Kennedy has also repeated false claims that vaccines, including MMR, can cause autism and that the measles vaccine causes the illness it prevents. Most recently, the CDC posted information to its website indicating that “studies have not ruled out the possibility that infant vaccines cause autism” despite longstanding scientific evidence disputing this connection. KFF/Washington Post survey shows that many parents are uncertain whether false or misleading claims about vaccines and measles are true, and the share who say these false claims are true is higher among Republican parents, particularly those who identify as supporters of the Make America Great Again (MAGA) movement.

Shifts in federal policy on vaccines may contribute to continued declines in childhood vaccinations. Since his appointment as Secretary of Health and Human Services, Robert F. Kennedy Jr. has made several changes to U.S. vaccine policy, including replacing ACIP, removing COVID-19 vaccine recommendations for healthy children and pregnant women, and cancelling funding for mRNA vaccine research. Secretary Kennedy pledged to examine and revise the recommended vaccine schedule to reduce the number of vaccines given to children and perhaps remove vaccines from the recommended schedule altogether. President Trump has echoed many of Secretary Kennedy’s criticisms of the vaccine schedule, saying that children in the U.S. receive too many vaccines and that parents should disregard current federal recommended childhood vaccine schedule and instead space out shots. In response to changes in federal policies and statements from Trump Administration officials, many states have taken steps to maintain access to vaccines and de-link state vaccine policies from federal recommendations. In contrast, other states have expanded exemptions from school vaccine requirements. This variation in state policies may result in uneven levels of vaccine protection across the country, which could leave some areas at increased risk for disease outbreaks and weaken the nation’s overall community-level protection.