Market Access: Navigate shifting networks

Q. Several major insurers are scaling back their Medicare Advantage footprints in 2026. How will this geographic “recalibration” affect HME providers and patients? 

 A. The Medicare Advantage (MA) market is shrinking for the first time in 20 years. Driven by rising health care utilization and shifting federal reimbursement, payers have adjusted their geographic participation, streamlined their MA offerings, or exited the market entirely.   

While total MA enrollment is projected to decrease to 34 million this year – roughly a 900,000 decline from 2025, these programs remain a steadfast choice for patients, continuing to offer a robust selection of plan options and the enhanced benefits beneficiaries have come to expect. This trend creates a significant shift for the home medical equipment (HME) sector – however, through strategic planning and strong collaborations, we can safeguard patient access to essential, covered supplies. 

In areas where MA plans are reducing their presence, many beneficiaries may transition back to traditional Medicare. Providers must be ready to navigate Medicare’s billing, documentation and compliance requirements, which can differ significantly from private plans.  

 The implications for patients are also important to consider. When an insurer exits a region, beneficiaries must find a new plan or return to the federal program. If a new plan does not contract with their current HME provider, it can disrupt access to critical medical supplies and equipment. In this shifting environment, it is increasingly important for patients and providers to work with HME companies that have a longstanding experience, broad coverage capabilities, and strong familiarity with varied coverage requirements. Established HME suppliers possess the operational stability and deep regulatory expertise necessary to navigate such complex market shifts without compromising patient care. 

 Ultimately, 2026 is a year of geographic agility. HME suppliers need to navigate shifting networks and engage providers to ensure that, despite market volatility, patient care remains uninterrupted. 

Yelena Brusilovsky is vice president, commercial sales, for ADSG | Edgepark.