Major health systems are increasingly dropping MA plans due to high denial rates and administrative burdens, citing concerns for long-term financial sustainability. Regulatory and Policy Developments Congressman Greg Murphy, MD - Facebook

Concerns have been raised regarding inaccurate provider directories that list specialists who are not actually in-network or accepting new patients.

The Medicare Advantage (MA) market represents a significant and growing portion of the healthcare landscape, with private insurance companies now serving 54% of all Medicare beneficiaries. While these plans are marketed as cost-effective alternatives to Traditional Medicare (TM), they face intense scrutiny regarding provider network limitations, high rates of care denials, and substantial overbilling of the federal government.

This report provides a comprehensive overview of the Medicare Advantage (MA) sector as of early 2026, focusing on its market structure, operational challenges, and the evolving regulatory landscape.

In 2025, MA plans saved the Centers for Medicare & Medicaid Services (CMS) roughly $13.9 billion in administrative costs by managing 54% of eligible beneficiaries, compared to the $11.8 billion spent on the remaining 46% in Traditional Medicare.