Health plan market exits and mergers are happening at a pace the industry hasn't seen in years. Major carriers pulling back from counties and states, citing rising medical costs, tightening margins, and CMS reimbursement that hasn't kept pace with acuity. The June 2026 recalculation CMS released may push more plans to the same conclusion.
When a plan exits, its members are provided prior notice and given the option to change their health plan or be automatically enrolled into Original Medicare (Part A and Part B). This adds stress to members impacted which carries over to their next health plan that they did not originally choose and do not yet understand.
Most payers will enroll these members the same way they enroll all members: a welcome kit, onboarding campaign and maybe some additional outreaches.
The problem is that these members didn't move on because they wanted to. They were forced to move. In 2026, forced disenrollment was up by 3% from 2025, with 10% of Medicare Advantage beneficiaries being pushed to a new plan. The impact on a payer will show up as a hit to CAHPS and HOS scores primarily, but also in HEDIS performance as members have either a real or perceived challenge with new plan benefits and networks.
Why displaced members are a different MA retention challenge
There's a difference between a member who chose your plan and a member who had to choose because of a market exit. The member who chose you originally arrived with at least some baseline of alignment — they compared options, they decided. First-year experience still matters enormously for retention, but they started with some goodwill.
A displaced member arrives with none of that. Their last experience with a health plan was being dropped. Their doctor may no longer be in-network. They may not know what their new benefits cover or who to call when there is an issue.
For D-SNP members, the retention risk is even more pronounced. A disproportionate share of recent market exits happened in the counties with the sickest, most complex populations — people managing chronic conditions, navigating social risk factors and trying to coordinate care that was already hard to access before their coverage changed.
Market consolidation happening alongside other revenue pressures
CMS has steadily tightened the rules for earning bonus payments and risk reimbursement. Risk adjustment methodologies have been revised to flag coding patterns that don't hold up under chart review, raising the bar for documentation and shifting more weight to actual clinical encounters and related interventions.
At the same time, administrative measures are being phased out with a greater emphasis on measures focused on health outcomes.
The result is that quality bonus payments are harder to earn, and the revenue path on a high-acuity member now runs almost entirely through clinical engagement and member experience outcomes. Star Ratings and risk revenue depend on it. Both are being measured more stringently at exactly the moment plans are absorbing a population that's disoriented, distrustful, and statistically less likely to schedule preventive care.
Plans that don't gain the trust and close that gap in year one are less likely to close the gap the following years.
How market exit churn hides inside membership data
CAHPS and HOS are the primary performance concerns for a plan receiving displaced members.
The good news: A member must be enrolled in a plan for most of the year before CMS can ask them about their experience. There’s time to positively impact member sentiment.
The bad news: Everything that happens in the first twelve months — whether they found a new PCP, whether they understood their benefits, whether the plan helped prevent or fueled the care disruption — gets baked into scores the plan won't see until it's too late to course-correct.
What a health plan member retention strategy looks like for this population
Medicare Advantage plans have an opportunity to turn friction into a trust-building experience that can establish long-term loyalty with these members. Acknowledging the potential disruption to their care is pivotal in making members feel like their new plan knows who they are and wants to support them in their care journey.
A template for how to structure a welcome campaign for re-assigned members
1. Segment inherited members from the rest of your population. Not forever, but at least until the member has re-established with in-network providers. This segmentation enables plans to easily distribute campaigns to this population. QRM® makes segmentation a breeze by taking manual distribution list management off the plates of internal teams with the Smart List feature. Easily identify members based on a variety of criteria and these lists will update in real time as your population changes and criteria is met. That means, if a plan wants to move a re-assigned member into the general outreach list after they establish with a new PCP, Smart Lists can do it in a couple clicks.
2. Create a separate welcome campaign for members who were forced into a new plan. Acknowledge they’re in a transition period and how their new plan can help. Introduce them to their benefits and how they can find new in-network care. It’s a subtle communications change that can have a huge impact. It tells the member their plan knows who they are and cares. QRM® enables health plans to target specific members within a population. And because gaining members comes with additional print mail outreach costs, QRM® leads with digital campaigns to help scale outreach without the additional financial burden.
3. Make appointment scheduling so easy that members can’t ignore it. This applies to all members, but especially this fragile population that’s unsure about their new Medicare Advantage health plan. Care continuity is where the real retention work happens. A member worried about whether their doctor still accepts their coverage isn't ready to think about HRA completion or supplemental benefits. They're stuck on a more fundamental question: Who do I call? QRM Connect™ gives members a self-service and hassle-free path to find an in-network provider and get scheduled through a two-way SMS flow or AI-assisted call. No logins, phone trees or hold times. And during a period where health systems are dropping Medicare Advantage and networks are changing rapidly, offering ways to support members in finding in-network care is critical to satisfaction and clinical outcomes.
Going quiet, for this population, usually means not getting care. Gaps don't close. HOS, HEDIS and CAHPS scores reflect unmet needs. And twelve months later the plan is looking at a member cohort it never really reached.
Healthmine partners with MA plans to navigate market consolidation
QRM® and QRM Connect™ give health plans a scalable system to identify, segment and activate members — including populations that need a different approach than standard onboarding. Medicare Advantage plans can close the gap between outreach and clinical engagement, helping facilitate care for displaced members by removing the biggest barriers between the member and receiving in-network care, without additional operational overhead.
To learn more about how QRM® and QRM Connect™ support member retention during market consolidation, get in touch.
Summary
- As Medicare Advantage plans exit markets, displaced members are forced into new health plans, most often showing up with low trust, disrupted care and a higher likelihood of disenrolling at the next AEP.
- Standard onboarding campaigns weren't design for inherited members. Plans that treat displaced enrollees like regular new members risk poor CAHPS and HOS scores.
- CMS is tightening risk adjustment requirements and phasing out administrative HEDIS measures, meaning quality bonus payments now depend almost entirely on clinical encounters and satisfaction outcomes, making early engagement with displaced, high-acuity members more financially critical.
- Health plans can reduce member churn from market consolidation by segmenting inherited members, running a dedicated welcome campaign that acknowledges the transition and using tools like QRM Connect to help members find and schedule with in-network providers before gaps in care develop.
Ana brings more than 20 years of healthcare and health plan experience to Healthmine. She most recently came from WellSense Health Plan, formerly Boston Medical Center HealthNet Plan. She had oversight of work related to Stars, HEDIS®, NCQA, Quality Rating System, External Quality Review Organization, population health programs, new product implementation, value-based care programs, policy advocacy and health equity programs.
Ana developed multiple innovative member and provider interventions that were integral in the successful improvement of key HEDIS and Consumer Assessment of Healthcare Providers and Systems (CAHPS) quality measures and meeting corporate and contractual goals. She has experience with successfully identifying and implementing new to industry initiatives, such as texting, with proven quality and financial improvement. Ana is bilingual in English and Spanish and has used this in community initiatives to help engage members and improve the quality of care for the Medicaid, Medicare, Affordable Care Act, and Commercial populations.
Ana holds a master’s degree from Simmons University in Health Administration and a bachelor’s degree from the University of New Hampshire.
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