Changing Dynamics in Medicare Advantage (MA): Shift From General MA to Special Needs Plans?

The number of active Medicare Advantage (MA) organizations and the number of available plans had grown consistently in the decade preceding 2023/2024. Growth in rural counties typically exceeded that of urban counties during the majority of those years. Beginning in 2023, the number of active MA organizations has fallen every year. Drops in plan growth followed in 2024 and both trends continued through 2026. While enrollment continued increasing through 2026, growth rates have fallen below 1% annually. Adding to the nuance of the shifting MA landscape are changes in availability of supplemental benefits (e.g. dental, vision) and growth of special needs plans (SNP). Chronic conditions plans (C-SNP) constituted less than 2% of MA plans historically but growth rates have taken off in the last two years. Overall growth in SNP enrollment has continued to increase even as overall MA enrollment growth has stalled. We will evaluate all aspects of MA organization and plan activity and the effects for rural Medicare beneficiaries. The analysis will include changes in overall organization and plan activity as well as accounting for shifts in the composition of plans (SNPs, e.g.) and the generosity of plans (supplemental benefits, e.g.). We will evaluate activity at the county level and aggregate to both metropolitan/nonmetropolitan and further distinguish micropolitan and noncore.