UnitedHealthcare and Elevance are shrinking Medicare Advantage rolls

Elevance and UnitedHealthcare are just two of the latest payers to switch from trying to increase Medicare Advantage (MA) enrollment to a “more members, more problems” attitude amid soaring medical costs and new restrictions.

As a result of slashing benefits and exiting counties, recent earnings calls suggest both companies will see their MA membership majorly shrink by the end of 2026.

“Medicare Advantage once held so much promise for insurers,” Arielle Trzcinski, principal analyst at global research and advisory firm Forrester, told us over email. “As riskier, higher-cost populations flocked to these offerings over traditional Medicare, a battle for market share among insurance companies watered down MA’s competitive advantage while eroding margins.”

Minus-ing members. UnitedHealthcare is on track to lose 1.3 million to 1.4 million Medicare Advantage members in 2026 and up to 2.8 million enrollees across all its offerings, CEO Tim Noel said in UnitedHealth Group’s Jan. 27 earnings call. United reported it had 8.4 million MA enrollees out of its 49.8 million total members at the end of 2025.

Elevance, the fourth-largest MA provider behind United, expects a “high teens percentage” decrease in MA membership in 2026, CEO and President Gail Boudreaux said in a Jan. 28 earnings call. The payer said it had 2.2 million MA members at the end of 2025 out of its total 45.2 million members.

It’s not clear whether the MA market is going to see fewer members overall. During the last annual enrollment period (AEP), MA gained 1.3 million new members despite individual companies losing hundreds of thousands of members, per a March 2025 report by consulting firm HealthScape Advisors.

Rewinding. Elevance and UnitedHealthcare’s membership losses are a change of course.

Other payers like Humana and Aetna succeeded in lowering MA membership during the last 2024–25 AEP.

But Elevance and United attracted the most new enrollees during that period, per HealthScape. UnitedHealthcare grew enrollment by 404,000 MA members and Elevance by 274,000, according to the firm’s report.

UnitedHealthcare pivoted from growing MA to shrinking it after finding itself saddled with higher-than-expected medical costs from its new MA enrollees. UnitedHealth Group’s adjusted medical care ratio—the amount spent versus earned—was 88.9% for the year compared to 85.5% in 2024, per a Jan. 27 release.

In contrast, during Elevance’s most recent earnings call, CFO and EVP Mark Kaye contended that MA costs performed “in line” with the company’s 2025 predictions.

But in previous earnings calls, Elevance pointed to higher-than-expected medical costs focused on the Affordable Care Act marketplace and Medicaid. The company’s benefit-expense ratio was 90% in 2025 compared to 88.5% in 2024.

The big picture. JPMorgan analysts viewed these membership losses as good omens.

“Given the current backdrop, we think shedding incremental lives is likely preferable to the alternative of unwanted growth,” they wrote in a Jan. 28 research note on Elevance.

United’s membership losses, which came in higher than predicted, were “not necessarily a negative.” But the big question will be which payers picked up the 1.3+ million members who left United’s plans—and whether that shifts market share away from United, the current MA leader, the JPMorgan analysts wrote in a Jan. 27 note.