Medicare Advantage plans are in flux: What providers need to watch

WASHINGTON – Medicare Advantage (MA) plans will face new restrictions in 2026 that could force insurers to rethink their business models, according to payer relations experts. While these changes don’t directly impact home medical equipment (HME) providers today, they could influence future plan design and reimbursement strategies. 

Key changes for 2026 

• MA plans can no longer offer supplemental benefits unrelated to health, such as life insurance or funeral planning. 
• Plans must follow traditional Medicare rules more closely. 
• Prior authorizations cannot be used to deny services that have already been approved. 

“With more restrictions and requirements put on the MA plans, they may make different business decisions about what is sustainable for them,” says Melanie Ewald, vice president of payer relations and reimbursement for VGM & Associates. “We’re seeing this as a recalibration of the industry. I expect we’ll see that in some instances they have a better model for servicing the beneficiary population going forward.” 

Insurers scale back on plan offerings 

A report from the Kaiser Family Foundation (KFF) shows that in 2026, Medicare beneficiaries will have an average of 39 plans to choose from, down slightly from 42 in 2025. The bigger question, says Cadie McGonagill, senior director of payer relations for AAHomecare, is whether enrollment continues to grow. In 2025, enrollment slowed, but 54% of eligible beneficiaries still chose MA plans. 

“Do (beneficiaries) still like the choices that are available to them,” she said. “I suspect that we’re going to continue to see that increase of enrollees selecting a Medicare Advantage plan simply because they offer those additional benefits like vision and dental.” 

Spike in C-SNPs 

Almost half (48%) of the total increase in MA enrollment between 2024 and 2025 came from Chronic Special Needs Plans (C-SNPs), with 476,300 new enrollees, according to KFF. These plans serve individuals with severe or disabling chronic conditions, offering tailored benefits and coordinated care. 

“What is it about those plans that it seems like payers are offering more of them, and enrollees are choosing more of them,” said McGonagill. “There’s a huge spike, so it’s an interesting trend we need to watch and see how it impacts our patient populations.” 

Trickle-down effect? 

Whether these changes will affect HME providers remains unclear, says Ewald. 

“The market is always going to be fluid,” she said. “I don’t know how granular these changes will get into the HME experience. We’ll continue to advocate on our side, and we will do that across the industry with our partners.”