Enrollment opens for Medicare Advantage plans on October 15, and large-scale market research suggests that trust is eroding, confusion is growing and many offerings fall short of expectations. The result? A growing number of potential Medicare Advantage plan members are actively considering alternatives. In fact, nearly 1 million fewer people could enroll in the privatized Medicare plans next year, according to the Centers for Medicare & Medicaid Services (CMS), marking the first time in years Medicare Advantage enrollment could decline. Furthermore, with so many plans experiencing greater member dissatisfaction, we may see more shopping and plan switching than ever before.
As health plan members grapple with the still unknown effects of the government shutdown at the precise moment when many have the most questions about different plan options, it begs the question: Can private sector plan leaders turn the tide?
An uncertain landscape
Medicare Advantage plans have major vulnerabilities heading into this year’s open enrollment season. According to the J.D. Power 2025 U.S. Medicare Advantage Study, just 38% of first-year members say their insurer fulfills their service expectations. Common challenges for new members include understanding explanation of benefits, locating in-network doctors, navigating deductibles and prior authorizations and how to use their Health Savings Account (HSA)/Health Reimbursement Account (HRA).
To some degree, that may be expected. Member onboarding for newly eligible Medicare patients can be confusing. Many are transitioning from employer-sponsored plans they’ve known for years, which adds to the challenge. But it’s not just new members feeling the strain. Even among established members who’ve been with the same plan for more than a year, just 45% say they’re satisfied with their service.
In fact, overall satisfaction across all Medicare Advantage plans – regardless of the tenure of members – has been trending down steadily as members report lower levels of trust in their plans, dissatisfaction with coverage offerings and challenges working with their plan administrators. It’s a call to action that many plans need to identify where they are falling short of customer expectations and to create action plans to differentiate and create more member value.
Beating the market factors with tech
As some plans wrestle to confront this reality, there is a temptation to ascribe the drop in satisfaction with market factors. After all, 2025 brought about increased government oversight, policy changes and profitability challenges confronting Medicare Advantage plans. Some patients lost over-the-counter benefits, while other plans reduced meal and transportation benefits. Yet top-performing plans are mitigating these challenges by investing in increased transparency, new digital tools, broader networks and social support services.
Take, for example, digital tools. Digital engagement is a major driver of member satisfaction. Plans that excel in digital tools see significantly higher scores: members of the highest-performing plans report satisfaction that is, on average, 98 points higher (on a 1,000-point scale) than those in the lowest-performing plans. Usage reinforces this trend — 85% of members in top-performing plans have accessed their member portal, compared with 76% in lower-performing plans. And ease of use matters: 52% of members in high-performing plans say their plan’s website features are very easy to use, versus just 40% in low-performing plans. High-performing plans are finding ways to use technology to increase personalization, automate onboarding and increase transparency with real-time updates that members need.
The technology does not have to be revolutionary either. An easily accessible digital tool that explains coverage status or benefits utilization in a manner that is clearer and easier to understand, coupled with ease of navigation, can make all the difference. That personal touch not only helps members feel like their coverage fits their needs, it also mitigates plans’ exposure to the ebbs and flows in the market.
Gaining deeper insights
As enrollment begins for 2026, Medicare Advantage plan leaders need to find ways to streamline their onboarding for new members and foster a better relationship with their existing ones. The only way to do that is evaluate the experience as a whole and pinpoint exactly where disconnects exist between plans and their members’ expectations. Plans that understand and act upon these meaningful insights can build a strategy to stand out in the marketplace. And in a health care environment as volatile as this one, differentiation can make a big difference, especially with laser focus on the member.
Christopher Lis, PhD, MPH, is managing director of global health care intelligence at J.D. Power.
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