For many years, KFF polling has found that the high cost of health care is a burden on U.S. families, and that health care costs factor into decisions about insurance coverage and care seeking. These costs and the prospect of unexpected medical bills also rank as the top financial worries for adults and their families. This data note summarizes recent KFF polling on the public’s experiences with health care costs. Main takeaways include:

• Just under half of U.S. adults say it is difficult to afford health care costs, and about three in ten say they or a family member in their household had problems paying for health care in the past 12 months. Hispanic adults, young adults, and the uninsured are particularly likely to report problems affording health care in the past year.
• The cost of health care can lead some to put off needed care. About one-third (36%) of adults say that in the past 12 months they have skipped or postponed getting health care they needed because of the cost. Notably three in four (75%) uninsured adults under age 65 say they went without needed care because of the cost.
• The cost of prescription drugs prevents some people from filling prescriptions. About one in five adults (21%) say they have not filled a prescription because of the cost while a similar share (23%) say they have instead opted for over-the-counter alternatives. About one in seven adults say they have cut pills in half or skipped doses of medicine in the last year because of the cost. A third of all adults say they have taken at least one of these cost saving measures in the past year, including larger shares of women and those with lower incomes.
• Health care debt is a burden for a large share of Americans. In 2022, about four in ten adults (41%) reported having debt due to medical or dental bills including debts owed to credit cards, collections agencies, family and friends, banks, and other lenders to pay for their health care costs, with disproportionate shares of Black and Hispanic adults, women, parents, those with low incomes, and uninsured adults saying they have health care debt.
• Those who are covered by health insurance are not immune to the burden of health care costs. Almost four in ten insured adults under the age of 65 (38%) worry about affording their monthly health insurance premium and large shares of adults with employer-sponsored insurance (ESI) and those with Marketplace coverage rate their insurance as “fair” or “poor” when it comes to their monthly premium and to out-of-pocket costs to see a doctor.
• Notable shares of adults say they are worried about affording medical costs such as the cost of health care services (including out-of-pocket costs not covered by insurance, such as co-pays and deductibles) or unexpected bills. About six in ten adults say they are either “very” or “somewhat worried” about being able to afford the cost of health care services (62%) or unexpected medical bills (61%) for themselves and their families.

Difficulty Affording Medical Costs

Many U.S. adults have trouble affording health care costs. While lower income and uninsured adults are the most likely to report this, those with health insurance and those with higher incomes are not immune to the high cost of medical care. Just under half of U.S. adults say that it is very or somewhat difficult for them to afford their health care costs (44%). Uninsured adults under age 65 are much more likely to say affording health care costs is difficult (82%) compared to those with health insurance coverage (42%). Additionally, a slight majority of Hispanic adults (55%) and half of Black adults (49%) report difficulty affording health care costs compared to about four in ten White adults (39%). Adults in households with annual incomes under $40,000 are more likely than adults in households with higher incomes to say it is difficult to afford their health care costs. (Source: KFF Health Tracking Poll: May 2025)

When asked specifically about problems paying for health care in the past year, about three in ten (28%) adults say they or a family member in their household had problems paying for care, rising to four in ten among Hispanic adults (41%) and young adults ages 18 to 29 (40%). Among those under age 65, six in ten (59%) uninsured adults report problems paying for health care in the past year, about twice the share of insured adults who say the same (30%). (Source: KFF Health Tracking Poll: November 2025)

The cost of care can also lead some adults to skip or delay seeking services, with one-third (36%) of adults saying that they have skipped or postponed getting needed health care in the past 12 months because of the cost. Women are more likely than men to say they have skipped or postponed getting health care they needed because of the cost (38% vs. 32%). Adults ages 65 and older, most of whom are eligible for health care coverage through Medicare, are much less likely than younger age groups to say they have not gotten health care they needed because of cost.

Three-quarters of uninsured adults say they have skipped or postponed getting the health care they needed due to cost. Having health insurance, however, does not offer ironclad protection as about four in ten adults with insurance (37%) still report not getting health care they needed due to cost. (Source: KFF Health Tracking Poll: May 2025)

Skipping care due to costs can have notable health impacts. Nearly two in ten adults (18%) report that their health got worse because they skipped or delayed getting care. Among adults under age 65, those who are uninsured are twice as likely as those with health coverage to say that their health worsened due to skipped or postponed care (42% vs. 20%). About four times as many adults under age 65 (23%) say their health got worse after skipping or postponing care as adults ages 65 and older (6%), most of whom have Medicare coverage. (Source: KFF Health Tracking Poll: May 2025)

A 2022 KFF report found that people who already have debt due to medical or dental care are disproportionately likely to put off or skip medical care. Half (51%) of adults currently experiencing debt due to medical or dental bills say in the past year, cost has been a probititor to getting the medical test or treatment that was recommended by a doctor. (Source: KFF Health Care Debt Survey: Feb.-Mar. 2022)

Prescription Drug Costs

The high cost of prescription drugs also leads some people to cut back on their medications in various ways. About one in four adults (23%) say in the past 12 months they have taken an over-the-counter drug instead of getting a prescription filled because of cost concerns and about one in five (21%) say they have not filled a prescription due to the cost. Additionally, about one in seven adults (15%) say that in the past 12 months they have cut pills in half or skipped doses of medicine due to cost.

One-third of the public (33%) say they have taken any of these cost saving measures in the past 12 months. Four in ten women (39%) say they have taken any of these prescription medication measures compared to one-quarter (26%) of men. Additionally, just under half of Hispanic adults (46%) say they’ve either taken an over-the-counter drug, skipped doses, or not filled prescriptions because of the cost, compared to three in ten (29%) White adults who say the same. Similarly, larger shares those with lower incomes report having taken a cost-saving measure in the last year compared to those with higher incomes (41% of those with a household income of less than $40,000 a year vs. 29% of those with an income of $40,000 or more). (Source: KFF Health Tracking Poll: May 2025)

Notably, adults with chronic conditions, who tend to have higher health care and medication needs, can often face challenges affording prescriptions. In KFF’s 2023 Survey of Consumer Experiences with Health Insurance, insured adult with a chronic condition were twice as likely as those without a chronic condition to say they had delayed or gone without prescription drugs due to the cost (18% vs. 9%).

Health Insurance Cost Ratings

Health insurance provides some financial protection, but premiums and out-of-pocket costs can still present a financial burden for many individuals. Overall, most insured adults rate their health insurance as “excellent” or “good” when it comes to the amount they have to pay out-of-pocket for their prescriptions (61%), the amount they have to pay out-of-pocket to see a doctor (53%), and the amount they pay monthly for insurance (54%). However, at least three in ten rate their insurance as “fair” or “poor” on each of these metrics, and affordability ratings vary depending on the type of coverage people have.

Adults who have private insurance through employer-sponsored insurance or Marketplace coverage are more likely than those with Medicare or Medicaid to rate their insurance negatively when it comes to their monthly premium, the amount they have to pay out of pocket to see a doctor, and their prescription co-pays. About one in four adults with Medicare give negative ratings to the amount they have to pay each month for insurance and to their out-of-pocket prescription costs, while about one in five give their insurance a negative rating when it comes to their out-of-pocket costs to see a doctor.

Medicaid enrollees are less likely than those with other coverage types to give their insurance negative ratings on these affordability measures (Medicaid does not charge monthly premiums in most states, and copays for covered services, where applied, are required to be nominal). (Source: KFF Survey of Consumer Experiences with Health Insurance)

Health Care Debt

In June 2022, KFF released an analysis of the KFF Health Care Debt Survey, a companion report to the investigative journalism project on health care debt conducted by KFF Health News and NPR, Diagnosis Debt. This project found that health care debt is a wide-reaching problem in the United States and that 41% of U.S. adults currently have some type of debt due to medical or dental bills from their own or someone else’s care, including about a quarter of adults (24%) who say they have medical or dental bills that are past due or that they are unable to pay, and one in five (21%) who have bills they are paying off over time directly to a provider. One in six (17%) report debt owed to a bank, collection agency, or other lender from loans taken out to pay for medical or dental bills, while similar shares say they have health care debt from bills they put on a credit card and are paying off over time (17%). One in ten report debt owed to a family member or friend from money they borrowed to pay off medical or dental bills.

While four in ten U.S. adults have some type of health care debt, disproportionate shares of lower income adults, the uninsured, Black and Hispanic adults, women, and parents report current debt due to medical or dental bills.

Vulnerabilities and Worries About Health Care and Long-Term Care Costs

KFF’s May 2025 Health Tracking Poll shows the cost of health care services and unexpected medical bills are at the top of the list of people’s financial worries, with about six in ten saying they are at least somewhat worried about affording the cost of health care services (62%) or unexpected medical bills (61%) for themselves and their families. These are larger than the shares who say they worry about affording housing costs (51%), transportation expenses (50%), utilities (49%), and food (48%) for their families.

Notably, eight in ten uninsured adults under age 65 say they are worried about affording the cost of health care services or unexpected medical bills (82% and 80%, respectively). About four in ten (38%) insured adults under the age of 65 say they are worried about affording their monthly health insurance premium. (Source: KFF Health Tracking Poll: May 2025)

Many U.S. adults may be one unexpected medical bill from falling into debt. About half of U.S. adults say they would not be able to pay an unexpected medical bill that came to $500 out of pocket. This includes one in five (19%) who would not be able to pay it at all, 5% who would borrow the money from a bank, payday lender, friends or family to cover the cost, and one in five (21%) who would incur credit card debt in order to pay the bill. Women, those with lower household incomes, Black and Hispanic adults are more likely than their counterparts to say they would be unable to afford this type of bill. (Source: KFF Health Care Debt Survey: Feb.-Mar. 2022)

Among older adults, the costs of long-term care and support services are also a concern. Almost six in ten (57%) adults 65 and older say they are at least “somewhat anxious” about affording the cost of a nursing home or assisted living facility if they needed it, and half say they feel anxious about being able to afford support services such as paid nurses or aides. These concerns also loom large among those between the ages of 50 and 64, with more than seven in ten saying they feel anxious about affording residential care (73%) and care from paid nurses or aides (72%) if they were to need these services. See The Affordability of Long-Term Care and Support Services: Findings from a KFF Survey for a deeper dive into concerns about the affordability of nursing homes and support services.

On January 20, 2025, the first day of his second term, President Trump issued an executive order on “gender ideology” outlining how his administration would view sex and gender and incorporate these concepts into government. This executive order has had widespread implications across government and for federal grantees. One area that has been impacted is the federal government’s data collection efforts. This includes changes to questions about sexual orientation and gender identity (SOGI) in multiple federal surveys, and retreating from plans to incorporate SOGI questions in surveys of the U.S. population by the Census Bureau. While data collection on both sexual orientation and gender has been scaled back or modified, measures relating to gender identity have been more specifically targeted for deletion.

Although several national surveys and data sets have been affected by changes to SOGI data collection and availability, this brief focuses specifically on changes in three national surveys that are representative of these efforts: the National Health Interview Survey (NHIS), the Medicare Current Beneficiary Survey (MCBS), and the National Crime Victimization Survey (NCVS). These surveys are central to the federal government’s efforts to understand the health and well-being of the U.S. population overall (NHIS) and people with Medicare (MCBS) and to understand people’s experiences with criminal victimization (NCVS), and had the potential to meaningfully expand the knowledge base in these areas as they relate to the nearly 14 million U.S. adults who identify as LGBT, and particularly the over 2 million adults who identify as transgender. Limiting SOGI data collection in these and other federal surveys moving forward will present challenges for understanding and assessing the needs and experiences of the LGBTQ population in the U.S.

Overview of Surveys Examined and Adoption of SOGI Metrics

The NHIS, MCBS, and NCVS offer unique opportunities to better understand the experiences of people’s health and well-being. While not the only federal sources that have historically collected SOGI data, these three surveys represent distinct and policy-relevant opportunities for the collection and use of LGBTQ data. The NHIS has included SOGI measures that enable analyses of broad population health measures, including insurance coverage patterns and overall health status. The MCBS could offer rare insight into LGBTQ older adults—a population that is typically difficult to sample due to its relatively small size (just 1.8% of adults over 65 identify as LGBT, but this share is likely to grow larger over time). SOGI data were only recently added to MCBS. Finally, the NCVS has provided SOGI data that is particularly valuable for examining experiences of violence and discrimination, areas where disparities between LGBTQ and non-LGBTQ people have been well documented.

The National Health Interview Survey (NHIS), administered by the National Center for Health Statistics within the U.S. Centers for Disease Control and Prevention, is the largest and oldest national health survey in the U.S. and collects information on a broad range of topics including demographics, socioeconomic factors, health status, health care access, and health coverage. NHIS data provides in depth information across the population, and its size allows for comparisons across groups, including LGBT people.

Questions about sexual orientation were added to NHIS in 2013 and questions related to gender identity were added to the survey in 2022 on an experimental basis to develop a methodology. On adding a sexual orientation variable to the survey (at the time referred to as sexual identity) HHS wrote, “The objective of asking a question on sexual identity in the NHIS is to fill the tremendous gap that exists regarding knowledge of general health behaviors, health status, and health care utilization of LGBT persons.”

The Medicare Current Beneficiary Survey (MCBS), administered by the Centers for Medicare & Medicaid Services (CMS), is the government’s long-running, comprehensive, nationally representative survey of people with Medicare. The MCBS includes questions about beneficiaries’ health care use, health status, cost and payment issues, demographic and housing characteristics, experiences with care, and other domains.

Questions about sexual orientation and gender identity were added to the survey in 2023 to provide the opportunity to gain new knowledge about LGBTQ older adults and people with disabilities covered by Medicare. According to CMS at the time, “Including sexual orientation and gender identity questions on the MCBS will provide nationally representative data on topics such as the accessibility and utilization of health care services by the Lesbian, Gay, Bisexual, and Transgender (LGBT) populations and the resulting health disparities that impact this community. … In no instance have we identified another source of data that would be an effective substitute for the MCBS.” CMS also added an item asking Medicare beneficiaries about their experiences with discrimination from health care providers based on eight demographic factors, including race, language or accent, gender or gender identity, sexual orientation, age, culture or religion, disability, and medical history. This measure, according to CMS, would allow the agency “to capture the most actionable and impactful information about health care experiences that directly influence health outcomes and will provide CMS with additional measures for assessing health equity and fair treatment for underserved populations.”

The National Crime Victimization Survey (NCVS), administered by the Bureau of Justice Statistics within the U.S. Department of Justice, provides nationally representative data on criminal victimization, including frequency, characteristics, and consequences. Data are collected on both crimes reported to the police and crimes not reported. Demographic data is also collected from respondents along with experiences with the criminal justice system.

Questions about sexual orientation and gender identity were added to the survey in 2016. The NCVS included questions asking respondents about their sexual orientation, sex assigned at birth, gender identity, and a clarifying question used when there was a conflict between a respondent’s reported sex assigned at birth and gender identity.¹ Two additional questions were asked among those who had been victimized about whether they believed it was due to “prejudice or bigotry” relating to gender identity or sexual orientation. In support of including these measures, DOJ wrote that they were “identified in other research as subgroups of interest to key stakeholders and, correlates to victimization. For example, sexual orientation and gender identity are recognized in the 2013 reauthorized Violence Against Women Act (VAWA). Additionally, the inclusion of these items will allow researchers to better understand the relationships between these variables and experiences with criminal victimization.”

Why Were SOGI Questions Added to Federal Surveys?

The inclusion of SOGI questions to federal surveys aligned with a range of efforts by the federal government to improve data collection related to sexual orientation and gender identity. Top of Form

The move to collect SOGI data within the federal government was recommended in a National Academies of Sciences Report: Understanding the Well-Being of LGBTQI+ Populations and received support from a number of researchers and advocates. Other activities that led to wider collection of this data include:

• Support in Healthy People 2010, 2020 and 2030 to increase collection of sexual orientation and gender identity data in population surveys.
• In 2016, the Office of Management and Budget (OMB) convened a Federal Interagency Working Group on Improving Measurement of Sexual Orientation and Gender Identity in Federal Surveys “to begin addressing the dearth of data for these populations and the issues surrounding methodological issues in collecting such data.”
• In 2022, pursuant to a Biden administration executive order, the OMB released a report on the best practices for sexual orientation and gender identity data collection in federal surveys.
• In 2023, the Biden administration developed a Federal Evidence Agenda on Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI+) Equity, a “roadmap for opportunities for the Federal Government to continue to build evidence and leverage data to advance equity for LGBTQI+ people.”
• Efforts within NIH to “Encourage data collection related to SGM [sexual and gender minority] populations in research and the health research workforce.” (Note the webpage for the NIH Sexual & Gender Minority Research Office hasbeen removed under the Trump Administration, likely also a part of broad efforts to align with the Executive Order discussed here).

How SOGI Data Collected in NHIS, MCBS, and NCVS Has Been Used

NHIS

The NHIS data on gender identity and sexual orientation has been used to track insurance coverage among LGBTQ people, including by KFF. Additionally, NHIS SOGI measures have allowed researchers to explore population level disparities among sexual minorities including: examining substance use and sleep problems by sexual orientation and assessing food insecurity, mental health, and health care access, as well as experiences with intersectional disparities.

MCBS

SOGI questions were added to the MCBS in 2023 and were initially released to researchers with approved data use agreements who purchased an “early release” version of the 2023 MCBS Survey File in the fall of 2024 from CMS – about 9 months before the full year of 2023 MCBS Survey File data were made available in July 2025. As such, SOGI data collected in the MCBS have not yet been widely utilized by researchers. Additionally, KFF found that the number of Medicare beneficiaries who identified as transgender in the early release file (the only file to include this data) was too small to generate a reliable estimate. Without data on gender identity in future years, researchers will be unable to pool multiple years of data to produce a more robust sample, as is sometimes done in research with LGBTQ groups in other contexts when necessitated by limited sample sizes.

NCVS

NCVS data has been used to understand the victimization experiences of teens and adults, including LGBTQ people. NCVS has been used to provide representative estimates on transgender people’s experiences specifically. Research has examined the forms of violence experienced by gender identity and sexual orientation. Experiences of victimization among LGBT people have also been examined to assess intersecting factors such as age, race/ethnicity, and relationship to the assailant, alongside comparison to non-LGBT people.

Recent Changes to SOGI Data in Federal Surveys

The Trump administration’s January 2025 Executive Order (EO) 14168 on “gender ideology” required federal agencies to “remove all statements, policies, regulations, forms, communications, or other internal and external messages that promote or otherwise inculcate gender ideology.” With these actions, the Trump administration sought to promote a view of sex as a binary biological concept and to disavow the notion of gender identity – the internal sense and experience of being male, female, transgender, non-binary or something else. Operating under this directive, the federal government undertook an effort to remove gender-identity related content from federal surveys and modify certain content related to sexual orientation and sex in early 2025.

The federal agencies responsible for administering NHIS, MCBS, and NCVS specifically cited EO 14168 in their rationale when requesting changes from the Office of Management and Budget. The changes made to these variables in NHIS, MCBS, and NCVS are as follows (see Table 1 for full question wording, changes, and sources):  

NHIS

Modifications were made to the gender identity question but not the sexual orientation question. The specific changes include:

• removing a question asking about the respondent’s gender identity
• removing the follow-up question where a respondent who selected “something else” could provide a verbatim response to describe their gender identity in their own words

MCBS

Changes were made to the series of SOGI questions, including:

• removing a question asking about the respondent’s gender identity,
• removing a question asking respondents to report their sex assigned at birth on their original birth certificate and replacing it with a question asking the respondent to report their sex (without providing additional information on how to consider the question),
• removing “something else” as a response option to a question about the respondent’s sexual orientation,
• removing the follow-up question where a respondent who selected “something else” could provide a verbatim response to describe their sexual orientation in their own words, and
• removing a question related to the respondent’s experiences with unfair or insensitive treatment from health care providers based on several demographic factors, including their sexual orientation and their gender or gender identity.

NCVS

Modifications were made to most of the gender identity questions but not the sexual orientation questions, including:

• removing a question asking about the respondent’s gender identity,
• removing a question asking respondents to report the sex assigned at birth on their original birth certificate,
• removing a question seeking clarification related to gender identity (asked when sex assigned at birth and gender identity do not align),
• temporarily pausing and then reinstating a question related to whether respondents who had been victimized believed it was due to prejudice or bigotry relating to gender identity, and
• removing training material information on the above questions.

Implications of the Survey Changes

Deleting and modifying questions related to sexual orientation and gender identity from federal surveys will leave gaps in researchers’ ability to understand and analyze the experiences of LGBTQ people, including the challenges they face and their health problems; diminish the ability of policymakers to identify and address health discrimination and equity issues for the population; and limit the information available to health care provider trying to improve care for LGBTQ people and eliminate barriers to care. Limiting data collection related to LGBTQ people and experiences with violence and victimization may also lead to challenges with addressing unmet need in that area. As LGBTQ people face persistent disparate experiences with stigma, discrimination, and victimization, as well as health (including mental health) disparities, across the lifespan, losing access to this federal data is particularly notable.

Because transgender people make up a very small share of the U.S. population overall, it may be difficult for the private and nonprofit sectors to make up for the loss of data from large federal surveys in non-governmental nationally representative surveys, which rarely have a large enough sample size to be able to pull out the experiences of this group. National surveys, with large sample sizes, had started to fill some of that gap. The challenge is especially acute when trying to understand the experiences of a segment of the transgender community. For example, given that only a small share of older adults identifies as LGBTQ and an even smaller share identify as transgender, maintaining the gender identity variable in the MCBS would have provided an opportunity to understand the experiences of a population that would otherwise be very difficult and/or very costly to sample through traditional surveys.  

The Trump administration’s rolling back of data collection related to gender identity, and to some extent sexual orientation, marks a decline in the capacity of the federal government to measure the experiences of LGBTQ people. The full implications for data users, providers, policymakers, and communities will continue to unfold, and ongoing assessment could help clarify the effects of deleted or modified SOGI measures in federal surveys.

1. Asking about both biological sex assigned at birth and gender identity provides a method for identifying people who might identify as male or female rather than as transgender, but who were assigned a different sex on their original birth certificate. This two-step approach to measuring gender identity is a recommended best practice. ↩︎

Commercial health insurance markets remain highly concentrated across coverage types. However, the individual market, which consists mostly of the ACA Marketplaces, has attracted more insurers and witnessed greater insurer competition across a variety of measures since the implementation of the enhanced premium tax credits in 2021, according to a new Healthy System Tracker analysis.

For example, from 2020 to 2023, the average market share of the largest insurer in each state’s individual market declined from 60% to 53%, corresponding with enrollment growth in the ACA Marketplaces driven by the enhanced premium tax credits. By contrast, fully insured employer-sponsored health insurance markets have become less competitive in the past decade. The analysis presents 2013-2023 enrollment and market competition data for fully insured and individual plans both nationally and on a statewide basis.

The full analysis and other data on health costs are available on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.

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 after Roe 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, 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, which operates in Massachusetts, 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. 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. Maine Family Planning has also requested a preliminary injunction to block the enforcement of Section 71113, but the district court denied their request, and their appeal of that decision is pending before the First Circuit Court of Appeals.

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.

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 and Maine Family Planning maintain 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. The district court’s order blocking enforcement for the 22 states and DC will go into effect on December 9, 2025, unless the First Circuit Court of Appeals issues a stay of the lower court’s ruling pending the appeal. 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^st 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, and Planned Parenthood Greater Northwest, have already experienced clinic closures 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 Medicaid programs. 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 Maine 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.