Medicare Advantage 2026 changes for medical practices are shaping up to be some of the most consequential shifts in recent years. With enrollment projected to dip from 50% to 48% of all Medicare eligibles, or roughly 34 million people, the Centers for Medicare & Medicaid Services (CMS) expects a cooling period after years of rapid growth.
These changes aren’t just numbers—they’re a roadmap for how patient care, reimbursement, and network access may evolve in the coming year. And for practice owners and managers, that means it’s time to pay close attention to how major payers are adjusting their 2026 plans.
(Source: CMS 2026 Medicare Advantage announcements)
UnitedHealthcare: Primary Care Takes the Spotlight
UnitedHealthcare remains the largest Medicare Advantage insurer, and its 2026 strategy shows it’s trimming—not retreating. Despite exiting 16 markets and dropping 100 plans, it will still reach 94% of Medicare eligibles.
The insurer’s focus? Primary care–driven HMO plans. Most members will enjoy $0 copays for preventive and primary care, plus $0 Tier 1 prescriptions. Even as it narrows its portfolio, UHC is preserving dental, vision, and hearing benefits—a relief for providers managing continuity of care.
For practices, this means deeper coordination expectations and a continued push toward value-based care models.
Humana: Stability and Simplicity Rule the Day
Humana’s response to the Medicare Advantage 2026 changes for medical practices centers on consistency. The insurer says 80% of members will see no benefit changes, and every plan will continue to include dental, vision, and hearing coverage.
The focus is on preventive care and patient engagement, with $0 copays for screenings and primary visits, plus Go365 wellness rewards for preventive participation.
Providers can expect fewer patient benefit surprises and steadier utilization patterns—music to any practice manager’s ears.
Aetna: Accessibility Meets CVS Integration
Aetna (a CVS Health company) is leaning into access and affordability. Its $0 premium plans will be available in every county, and its Extra Benefits Card—usable at CVS and 70,000+ other retailers—makes supplemental benefits easier to manage.
With expanded Special Needs Plans (SNPs) across 16 new states and a focus on preventive screenings at no cost, Aetna’s approach signals a continued investment in patient convenience and home-based care.
For practices, this means more coordination with in-home care teams like Signify Health—a sign of where payer-supported care delivery is headed.
Centene (WellCare): Stretching the Supplemental Dollar
Centene’s WellCare brand is expanding into 51 new counties and offering $0 copays for primary care, key screenings, and vaccines. Members can also leverage the Spendables Card, which combines OTC, dental, and wellness funds in one tool.
Expect more proactive patients coming in for covered preventive visits—a small but welcome ripple effect for medical practices.
How Medicare Advantage 2026 Changes Affect Your Practice
Here’s the big picture:
- Fewer plans and narrower networks.
- More focus on primary and preventive care.
- A heavier tilt toward value-based coordination.
For practices, these Medicare Advantage 2026 changes mean it’s time to:
- Review your payer contracts — UHC and Aetna’s exits could shift patient volumes.
- Educate your Medicare patients — ensure they understand coverage updates before open enrollment ends Dec. 7.
- Track utilization and wellness incentives — Humana’s and Centene’s wellness programs could increase preventive visits.
For a deeper dive into related topics, explore Claims Med’s Knowledge Base.
The Bottom Line
Medicare Advantage may be entering a “reset” year—but it’s still where half of Medicare patients call home. The 2026 changes for medical practices are less about contraction and more about recalibration.
Think of it as a detox year for insurers and an adaptation year for providers. Those who plan early, educate patients, and align with payer incentives will be best positioned when growth returns.