286: A Medicare Advantage reset — and what comes next

Once a high growth, high margin line of business for health plans, Medicare Advantage (MA) is now in the middle of a financial reset. Growth has slowed, margins have turned negative, and federal financial support is eroding — with CMS proposing a near flat reimbursement increase for 2027. As a result, plans are exiting markets, tightening benefit designs, and shifting their focus toward Special Needs Plans (SNPs). At the same time, seniors are facing rising costs, fewer perks, and more frequent plan changes. To cut through the noise and understand what’s really happening beneath the headlines, host Rachel (Rae) Woods speaks with Advisory Board experts Sally Kim and Aaron Hill about the new divide emerging in MA: between plans equipped to manage the intensive needs of high cost seniors and execute on SNP strategies — and those that will be forced to exit markets or rethink their MA ambitions entirely. Listen as they break down how MA’s financial and clinical headwinds are reshaping payer–provider relationships — and why future success depends on disciplined focus, deeper provider partnerships, and new investments in technology and cross benefit management. We’re here to help: Tool | Medicare Market Explorer Webinar | Medicare Advantage: Insights on today’s more competitive market Webinar | Medicare Advantage: The latest on product design and growth Podcast | Ep. 227: The changing tide of Medicare Advantage Expert Insight | 3 data-driven insights on Medicare Advantage Star Ratings Ready-to-Use Slides | Medicare Advantage market outlook 2026 Advisory Board Summit Washington, D.C. A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.