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For plan year 2026, Medicare Advantage has experienced significant disruption as plan offerings have shrunk and enrollment shifts have accelerated. About 13% of MA-PD enrollees (2.6 million individuals) found themselves in plans that were terminated for 2026, and up to 1.3 million more were in plans affected by consolidations, creating widespread member movement and onboarding complexity for remaining plans. Overall, the industry had 32 Medicare Advantage prescription drug plans to choose from per beneficiary in 2026, down from 34 in 2025. This reduction in optionality signals a meaningful pullback that is leaving remaining plans to absorb an influx of new members with limited historical visibility into medication use, adherence risk and emerging care needs.
This level of member transition is more than an operational challenge. It introduces a critical data gap at the exact moment plans are being held accountable by CMS for medication adherence, patient safety and outcomes-based performance.
The question for remaining Medicare Advantage organizations is clear: How do you support new members effectively when you do not yet know their medication history, risk profile or likelihood of falling out of adherence?
The answer lies in acting earlier, not later, by leveraging external prescription data and other outside sources of member information before internal claims begin to accumulate.
The 2026 MA Landscape: Plan Terminations and Member Influx
The Medicare Advantage marketplace is in the midst of a major reshaping. As plans exit certain markets, reduce offerings or consolidate products, millions of beneficiaries are moving into new coverage arrangements.
For the plans that remain, this phenomenon creates immediate pressure:
- Membership growth happens suddenly, often without time to scale care management resources
- New enrollees arrive with complex chronic needs, but little accessible historical context
- Plans must meet quality and safety expectations without the baseline data typically used to guide early interventions
This disruption affects far more than enrollment operations. It impacts Star Ratings strategy, adherence program performance and the ability to prioritize outreach effectively in the first months of the measurement year.
Without early insight, plans risk falling behind on the measures that require consistent medication, access and sustained behavior over time.
The Data Gap: Why Traditional Member Onboarding Isn’t Enough
Most Medicare Advantage plans rely on internal claims, data and utilization patterns to understand member needs. But those signals take time.
For newly enrolled members, the early part of the year often looks like a blank slate:
- No internal prescription fill history
- No clinical utilization data from previous plans
- Limited visibility into prior medication behaviors or safety concerns
- Delayed understanding of chronic condition complexity
The consequences are significant. Plans may miss the window for early adherence support, allowing members to fall behind on Part D measures before outreach even begins.
This is especially critical for measures tied to Proportion of Days Covered (PDC), SUPD and new patient safety measures, where early medication gaps can be difficult to recover from later in the year.
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Early Visibility Through External Prescription Data and Other Outside Insights
For Medicare Advantage plans absorbing large numbers of new members in 2026, the challenge is not enrollment alone, but what comes next: understanding member needs quickly enough to protect adherence and quality performance.
Medication adherence and safety measures do not allow for delayed insight. Plans cannot afford to wait months for internal claims data to build before identifying members who may already be at risk. Many newly enrolled beneficiaries arrive with chronic conditions and complex regimens, with established refill patterns that remain invisible to their new plan early in the year.
This is where external prescription data becomes a strategic advantage. Historical pharmacy fill data from PBMs, retail pharmacy partners or national prescription databases can provide immediate context into a member’s medication journey, revealing recent gaps in therapy, prior nonadherence or early safety concerns before the plan has generated its own utilization history. Additionally, plans can illuminate many blind spots about a member’s specific needs using variables like geographical location as a proxy for resource availability.
With this visibility, plans can identify high-risk members sooner, intervene earlier and deliver targeted support when it can have the greatest impact. In a year defined by disruption and member movement, early insight is foundational to improving outcomes and sustaining Star Ratings success.
Early Outreach and Intervention: What Success Looks Like
When plans gain early visibility into risk profiles, they can engage sooner, smarter and with greater impact.
Improve quality outcomes
By identifying at-risk members before internal data accumulates, plans can initiate targeted interventions earlier in the measurement year. For example, outreach to members who are likely to fall below PDC thresholds for antihypertensives or diabetes medications can begin immediately, rather than months into coverage.
This early action becomes a competitive advantage for Star Ratings performance, adherence improvement and clinical stability.
Enhance member experience
New members want reassurance that their plan understands their needs.
Personalized, data-informed outreach builds trust early and positions the plan as a source of guidance and support, not just coverage. Rather than generic onboarding messages, plans can connect members with relevant help from day one.
Optimize resource allocation
External prescription insights allow care teams to focus efforts where they are needed most. Instead of broad, inefficient outreach across an entire new population, plans can prioritize members with validated adherence risk or safety exposure.
This reduces wasted effort, improves care team efficiency and supports smarter operational planning.
Support long-term impact
Medication adherence is not a one-time intervention. It is a sustained behavior that drives year-round outcomes.
Setting new members up for adherence success and safety as early as possible improves the likelihood of sustained performance throughout the measurement year, while also boosting satisfaction and retention.
Practical Steps Plans Can Take Now
To respond effectively to the 2026 environment, plans should act quickly to close the new member visibility gap.
Step 1: Evaluate current data ingestion practices
How quickly does your plan obtain prescription history and adherence signals for newly enrolled members?
Step 2: Identify external data partners
Explore services available through PBMs, pharmacy retail partners or healthcare technology organizations that can enable real-time prescription history exchange.
Step 3: Integrate external data into risk models
Enhance predictive analytics to stratify new members early, prioritize outreach and align interventions with adherence and safety performance goals.
Plans that take these steps now will be better positioned to protect quality outcomes, improve member experience and reduce avoidable risk across the year.
Conclusion
The Medicare Advantage disruption heading into 2026 has created an urgent challenge for remaining plans: an influx of newly enrolled members with limited historical data and immediate quality risk. Plans that can gain early visibility into prescription, clinical and social histories will be better equipped to identify adherence gaps, patient safety concerns and high-risk members before performance declines. This proactive approach enables earlier intervention, stronger member engagement, smarter resource allocation and a faster path to sustained adherence and Star Ratings success in a volatile enrollment environment.
Plans do not have to navigate this transition alone. With the right data partnership, Medicare Advantage organizations can gain early visibility into new member risk, intervene sooner and protect adherence, safety and Star Ratings performance throughout the year.
Looking to make strides in your medication adherence strategy in 2026? Contact AdhereHealth today to learn more!
Authored by:
Kempton Presley
AdhereHealth Chief Executive Officer
