What payer experts, leaders are thinking about 2026

Payers had a wild year, and 2026 is shaping up to be just as dramatic, particularly for those offering government plans within Medicare, Medicaid, and the health insurance marketplace.

Marketplace insurers hiked up 2026 premiums an average of 26%, per KFF, and are expecting a huge drop in enrollees. Meanwhile, already-high medical costs could rise further, and AI is majorly changing patient, provider, and payer relationships.

Healthcare Brew asked executives at leading insurance companies and other industry experts about what they’re expecting in 2026.

These answers have been lightly edited for length and clarity.

Michael Carson, CEO, Centene WellCare Health Plans

One trend we’re not just watching but actively engaging in is the growth of the dual-eligible population. This group—which includes people with multiple chronic conditions and physical, mental, developmental, and cognitive disabilities—is expected to grow by more than 6% every year through 2028. While they make up only about 20% of Medicare members, they account for over one-third of Medicare spending, which underscores the financial and systemic impact.

Their needs go beyond medical care; they often face social and financial challenges, too. That’s why we’re focused on delivering coordinated, high-quality care and identifying the right partnerships that address the whole person. Because when we remove barriers and simplify access, we improve health outcomes and quality of life for those who need it most. This isn’t passive observation; it’s the proactive engagement that this growing population deserves.

Dan Delaney, managing partner, HealthScape Advisors

Given the myriad headwinds payers faced in 2025, I’d expect a notable acceleration in payer consolidation in 2026.

Executives are facing tough decisions, and I’d anticipate many will evaluate and ultimately pursue partnerships or formal affiliations that help address the scale, capability, and affordability concerns. If you’re a smaller to midsize health plan, the risk of going it alone might be too high. If you’re a larger health plan, this is an opportunity to grow and further strengthen your market position.

Oliver Kharraz, founder and CEO, Zocdoc

The collapse of ghost networks will accelerate. After years of patient frustration and policy inertia, regulators are increasing pressure and enforcement. Payers will be forced to abandon static, error-prone directories in favor of modern infrastructure with real-time data, dynamic scheduling, and feedback loops.

Sandhya Rao, chief medical officer, Blue Cross Blue Shield of Massachusetts

The cost of cancer care is expected to surpass $240 billion by 2030, and the financial burden continues to be felt by patients and employers. While breakthroughs in cancer treatment will offer more hope than ever, the associated costs will become increasingly difficult to manage. Health plans, providers, and the pharmaceutical industry will need to deepen their focus and collaboration to address the high cost of cancer care to ensure patients can access treatments and medications that are affordable and effective.