The Medicare Advantage Shake-Up: UnitedHealth and Elevance Shed Millions as Humana Surges

The week of February 2 through February 8 produced the clearest evidence yet that the Medicare Advantage market is undergoing the most significant reordering of its modern era. Member counts disclosed in earnings calls and confirmed in industry reporting on Thursday, February 5, and Friday, February 6, show UnitedHealthcare on track to lose between 1.3 million and 1.4 million MA members in 2026, while Elevance Health expects a "high teens percentage" decline. Humana, by contrast, added roughly one million individual MA members during open enrollment and now projects more than 25% growth, a trajectory that could allow it to overtake UnitedHealthcare as the largest Medicare Advantage carrier in the country before the year ends. That is not a marginal market-share shift. It is a wholesale repositioning of who serves America's seniors, and it happened in plain view across a single week of disclosures.

That story did not arrive in isolation. The same week saw President Trump launch the TrumpRx direct-to-consumer drug pricing website on February 5, the House pass an appropriations package on February 3 that ended a four-day partial government shutdown without extending enhanced ACA subsidies, the Department of Health and Human Services announce on February 5 that it would scrap its current 340B rebate model pilot program, and Cigna report fourth-quarter earnings on February 5 alongside Centene's full-year results on February 6. Taken together, these moves point in the same direction: insurer balance sheets are being rebuilt on a more conservative footing, drug-pricing politics are entering a new direct-to-consumer phase, and the federal scaffolding around exchange affordability has continued to weaken even as enrollment numbers have come in surprisingly resilient.

How the MA Pullback Actually Happened

The retreat from Medicare Advantage is not a story of carriers losing a competition. It is a story of carriers choosing, for the first time in a decade, to stop competing for unprofitable members. UnitedHealthcare's MA enrollment slid to just under 9.4 million as of February, down 9% from the 10.3 million it carried in October before open enrollment began, according to figures cited by Healthcare Brew on February 6. Elevance's MA book contracted from 2.2 million to 1.9 million. Both carriers used their late-January earnings calls and follow-on commentary the first week of February to frame the pullback as deliberate. Elevance CEO Gail Boudreaux signaled the strategic retreat on a January 28 earnings call when she described the high-teens membership decline; the same posture surfaced in UnitedHealth's commentary as the company digested higher-than-expected medical costs from MA members it added in 2024 and 2025. As one industry summary put it, the largest plans have moved from a "more members" growth posture to a "more members, more problems" defensive crouch.

Humana's path runs in the other direction. During open enrollment for 2026 plans, the carrier added approximately one million individual MA members and is now guiding to 25%-plus growth. With UnitedHealth shedding more than a million members and Humana adding nearly that many, the two companies are converging on a crossover point that would make Humana the largest MA insurer in the United States. That said, Humana's own 2026 earnings guidance came in below Wall Street expectations, mirroring the muted outlooks issued by UnitedHealth, CVS Health, and Elevance, a reminder that growing into a high-cost senior population is no easy victory lap. The MA market in 2026 will be larger in aggregate, but each member is more expensive to serve, and every carrier in the program is being forced to price that reality in.

For employer benefits leaders, this matters more than it might appear at first glance. Many plan sponsors offer Medicare Advantage retiree group plans, and the active-life PPO and HMO networks built around MA economics shape what is available to active employees in the same geography. Brokers handling Medicare-eligible workforces will see plan-design churn, network changes, and benefit-feature pruning during 2026 as carriers adjust to the new economic reality. Retirees who were comfortably enrolled in a UnitedHealthcare or Elevance plan in 2025 may discover, midway through 2026, that the plan they relied on for years has been redrawn, repriced, or shut down in their county. The 180,000 seniors that UnitedHealth Group disclosed would face plan changes is only the visible top of a deeper recalibration.

TrumpRx Lands on a Drug-Pricing Stage Already in Motion

On February 5, the Trump administration launched TrumpRx.gov, a federal website that does not sell drugs directly to patients but instead acts as a referral hub pointing consumers to manufacturer direct-to-consumer storefronts that have agreed to discount certain products. At launch the site featured 43 drugs from five manufacturers: AstraZeneca, Eli Lilly, EMD Serono, Novo Nordisk, and Pfizer. Among the most-watched listings, Novo Nordisk's GLP-1 diabetes drug Ozempic appears at $350 per month against a list price near $1,000, the migraine drug Zavzpret is offered at $549 against a $1,189 list, and Wegovy oral weight-loss pills are available for as little as $149 a month, down from $1,349. The discounts are restricted to consumers who agree to pay outside their insurance.

That last detail is the load-bearing one. TrumpRx is not an insurance program. It is a market-pricing experiment that runs parallel to commercial coverage, and it deliberately steps around the rebate-and-formulary economics of pharmacy benefit managers. STAT, CBS News, and CNBC each noted in their February 5 coverage that the program's actual savings reach is uncertain because most insured patients with rich employer or Medicare drug benefits already pay less out of pocket than the TrumpRx cash price. Where TrumpRx is most likely to bite is among the uninsured, the high-deductible commercially insured early in the plan year, and people facing prior authorization barriers. For employers, the launch raises a strategic question that did not exist a week ago: should plans permit members to use TrumpRx pricing without applying it to deductible accumulators, and how should specialty drug carve-outs treat a manufacturer-direct channel that may genuinely undercut PBM-negotiated net pricing for select products?

The launch also reframes the political environment around the just-implemented Medicare Part D negotiated prices, which took effect January 1 for ten high-cost drugs. The administration is, in effect, layering a parallel price-discovery mechanism on top of the IRA negotiation framework, betting that competitive transparency on a public federal site will pull list prices down faster than statute alone. Whether that bet pays off will determine whether TrumpRx becomes a durable feature of the U.S. drug-pricing landscape or a 2026 footnote.

A Shutdown Ends, but the Subsidy Cliff Does Not

The four-day partial government shutdown that began when six appropriations bills lapsed on January 30 ended on February 3, when the House cleared the comprehensive package the Senate had passed days earlier. According to the American Hospital Association's February 3 update and Advisory Board's February 4 policy roundup, the Labor, HHS, and Education portion of the deal provided $116.8 billion for HHS, lifted NIH funding above fiscal 2025 levels, and extended several expiring health programs, including Medicare telehealth flexibilities, Medicaid disproportionate share hospital payment protections, and the low-volume hospital payment adjustment. Those extensions matter operationally; without them, telehealth reimbursement and rural-hospital margins would have begun unraveling within weeks.

What the deal conspicuously did not do is restore the enhanced ACA premium tax credits that expired at the end of 2025. The political fight that originally drove the standoff in late October 2025 has now produced a funding outcome that locks the subsidy cliff in place for at least the rest of 2026. KFF's running enrollment tracker and CBS News reporting during the week showed final 2026 marketplace enrollment landing at roughly 23.1 million, a 4.9% drop from the 24.3 million record set in 2025. The share of enrollees receiving any subsidy fell from 92% in 2024 and 2025 to 87% in 2026. The average net monthly premium across the marketplaces climbed from $113 in 2025 to $178 in 2026.

State-level damage is uneven. North Carolina, Ohio, West Virginia, Indiana, Arizona, and Delaware each saw double-digit enrollment declines, ranging from 15.6% to 21.9%. New Mexico, which deployed state tax dollars to backfill the lost federal subsidies, ran in the opposite direction. CMS attributed a meaningful share of the decline to its anti-fraud enforcement, citing 1.5 million enrollments deemed ineligible or improperly placed. For brokers serving individuals and small groups, the practical takeaway from the shutdown's resolution is that the 2026 affordability environment is now baked. Anyone hoping the appropriations fight would deliver a reprieve has to plan around the absence of one.

HHS Scraps the 340B Rebate Pilot

On February 5, the Department of Health and Human Services announced it would scrap its current 340B Rebate Model Pilot Program, the controversial pilot that would have required covered hospitals and clinics to pay full wholesale acquisition cost for nine of the ten Medicare-negotiated drugs upfront and then chase a rebate from manufacturers. The pilot had been blocked in late 2025 by U.S. District Judge Lance Walker on the grounds that it likely violated the Administrative Procedure Act's arbitrary-and-capricious standard, and it faced active litigation from major hospital groups. HHS's February 5 retreat, reported by AHA News and Becker's, ended the immediate threat to safety-net providers' upfront cash flow.

The announcement does not, however, bury the rebate concept. HHS signaled it could pursue a restructured rebate model in the future, and just days later HRSA began work on a request for information published February 13 to gather industry input on alternative approaches. For self-funded employers and benefits consultants tracking pharmacy spend, this is consequential because 340B economics propagate through the commercial pharmacy supply chain. Restructuring rebate flows for safety-net providers reshapes hospital pricing leverage, pharmacy-channel margins, and ultimately the rates that show up in employer plans. The story is paused, not resolved.

Insurer Earnings Confirm a Repricing Cycle

Cigna's Q4 2025 results, released February 5, framed 2026 as a margin-reset year. Total fourth-quarter revenue rose 10% and full-year revenue rose 11%, with Evernorth specialty pharmacy continuing to drive top-line growth as utilization of complex therapies climbed. Cigna repriced its stop-loss product early in the year after seeing fourth-quarter 2024 stop-loss costs spike on specialty drug utilization and high-acuity surgeries among employer-sponsored plan members; the company expects stop-loss margins to improve through 2026 as those repriced contracts incept. Cigna's 2026 adjusted-revenue outlook landed at approximately $280 billion, a number Wall Street read as cautious but disciplined.

Centene reported full-year 2025 results on February 6 alongside its 2026 guidance of greater-than-$3.00 adjusted diluted EPS. The company also acknowledged that exchange membership had collapsed from 5.6 million at the end of 2025 to 3.6 million in the first quarter of 2026, a roughly two-million-member contraction tied to the subsidy expiration. Centene CEO Sarah London told investors the loss tracked with the company's pricing assumptions, an unusually candid concession that the largest ACA exchange insurer had baked the cliff into its plans. Read alongside Cigna's stop-loss repricing and the Medicare Advantage retreats at UnitedHealth and Elevance, the picture is consistent: the major commercial and government carriers are using 2026 to rebuild margin discipline after a multi-year cost surge, and they are doing so by surrendering or repricing books of business they consider structurally unprofitable.

What Brokers and Employers Are Watching Next

The week's developments left three live questions for benefits professionals. The first is what happens to Medicare Advantage retiree group plans during 2026 if Humana's growth trajectory continues and UnitedHealth's contraction deepens; group sponsors with carrier-specific arrangements will need to monitor network and benefit changes more closely than they have in prior years. The second is whether TrumpRx becomes a meaningful pricing reference point for high-deductible plan members and whether plan documents need to address the program's interaction with deductibles and out-of-pocket maximums. The third is whether the absence of an enhanced-subsidy extension in the shutdown deal pushes more individual-market shoppers toward employer coverage, association health plans, or alternative arrangements like ICHRAs during 2026 mid-year and renewal cycles.

For now, the through line of February 2 through February 8 is straightforward. The carriers that drove a decade of MA expansion are pulling back; the federal government has launched a parallel drug-pricing channel that bypasses traditional pharmacy benefits; the brief shutdown left the ACA affordability picture untouched; and the 340B rebate fight has paused without resolving. Each of those threads will be pulled harder in the weeks ahead, and the employers, brokers, and plan members navigating 2026 will feel the tension in renewals, drug formularies, network letters, and quarterly enrollment reports for the rest of the year.