Rob Lourenco, VP of Client Services –

In the summer of last year, I shared in one of our Industry Insights articles that we expected another disruptive AEP heading into 2026. Turns out market volatility didn’t only mirror what we saw the previous year, but surpassed it. 2.7 million plan terms represented a 50% increase in MA consumers losing their coverage. Not to mention the widespread disruption in the form of benefit degradation. Carriers have pivoted away from their acquisition focused strategy of previous years and adopted a more nuanced approach – one that shifts the attention to utilization, risk, and Star in order to bolster financial stability.

This is one of the reasons we decided to publish the National Medicare Health Segmentation Study earlier this year. In it, we ask survey participants several questions: from prescription usage, to doctor appointments and hospital visits among others, to segment the Medicare senior population into six distinct groups. These segments don’t only differ from each other in terms of health, but they also differ in terms of utilization and attitude towards their healthcare. This report, along with the member scoring service, is meant to provide carriers with an actionable roadmap for member engagement, care management, benefit design and operations. But leveraging this framework in our other studies has also produced interesting insights.

We took this segmentation work and leveraged it in our most popular syndicated study – the Medicare Shopping and Switching Study. This report is focused entirely on what happened in the AEP. And though disruption was widespread in the market, there was one particular health segment that saw more switching and meaningfully more plan terminations than any other; a segment we call “Episodically Engaged”.

The Episodically Engaged have several chronic conditions; over five on average. This means they have real health needs. The problem though is they are not consistently engaged in their healthcare. They are not great about doing the preventative work to stay healthy in the long run. They only become engaged when a health episode forces them to be. Hence their name. This leads unnecessarily to more costly services that may have been prevented. Given this reality, should it surprise us that carriers focused on financial stability would disproportionately target these difficult to manage members with terminations? I don’t think it should.

Plans that are no longer financially viable, are so for a reason. And one of the interesting developments this last AEP was that those who were forced to switch were disproportionately more likely to be bad risk. Which means the plans that have picked up members, may have disproportionately picked up this bad risk in 2026.