Medicare Advantage 2026: How Payers Are Choosing Partners
While most providers are waiting on CMS, payers are already narrowing networks and rewriting delegation terms.
Payers are quietly narrowing networks and rewriting delegation expectations. This playbook explains how to do business with MA business for 2026.
If you’re waiting, you’re already reacting—not positioning.
In this episode, Alex Yarijanian breaks down what’s actually showing up in payer conversations right now, long before final CMS rules are published. Drawing from real contracting, network, and delegation discussions, Alex explains why waiting for regulatory clarity is already costing providers and health tech companies leverage.
You’ll hear how payer priorities have shifted from enrollment growth to margin durability, why network narrowing is accelerating quietly, how delegation has become a stress test, and what “value-based care” really means in Medicare Advantage today.
This episode also outlines who is most at risk heading into 2026, the three types of organizations positioned to win, and what provider and health tech leaders should do in the next 90 days to stay relevant.
Who should listen: Provider executives, payer leaders, value-based care operators, and health tech founders navigating Medicare Advantage.
Transcript
I foremost wanted to thank everyone who's been tuning in for tuning in. I really appreciate you. It's really encouraging to see you all benefiting from these episodes.
h that as the last episode of: Alex Yarijanian: ge, right? Medicare Advantage:Not in the final rule, not in press releases, but in peer contracting meetings and network modeling and internal margin discussions that most providers never see. I've been in enough of those conversations this year to tell you growth barely comes up anymore.
What comes up is predictability, margin protection, and who payers actually trust when things get tighter.
I want to kind of walk you through what payers are doing right now and what they're not saying out loud and how providers and startups can still position themselves to win in Medicare Advantage 26 by acting early and acting strategically. It's the first full year where payers are operating under the assumption that easy money is gone, right? Gone are Covid and other enhancements.
Okay, CMS has been clear that growth at all costs is not the model anymore, right?
I mean, I feel like we've been hearing this for some time, but of course it takes a while to change things, especially in such a massive monster industry such as healthcare. The result of these discussions have been kind of an important shift in mindset which is impacting operational plans moving forward.
So they're no longer payers are no longer optimizing for enrollment growth, they're optimizing for margin durability. The that's what's important to them. And when that changes, everything downstream changes, right?
Network changes, delegations, vendor relationships, and who gets invited into the room at all. Some of the things payers are not saying out loud is for example, network narrowing is accelerating even when it doesn't look like it.
So publicly pairs will tell you they're focused on value, quality, access, blah blah blah. Privately, the question you're asking is much simpler. Who actually controls cost and utilization when pressure hits?
Who actually controls cost and utilization when pressure hits? And what I'm seeing is not dramatic headline grabbing network cuts. It's quieter than that preferred tier.
I'm saying performance exclusions, administrative air quote changes that just happen to move volume to certain narrower network of providers.
If you're an independent group without real utilization control or hospital aligned group relying on referrals you don't manage, you're already being evaluated differently. You are, you're being looked at. 2. Delegation is not a reward, it's a stress test for you.
For a long time, delegation was positioned as the prize right. Capitation, autonomy, upside. That's starting to change.
Interestingly then, reasonably in recent payer conversations, the toner and delegation shifted from expansion to scrutiny. And on the provider side, they're looking at the cost. The question now sounds like you know, what the peers are asking now.
So like who actually performs under downside? Who survives when coding tailwinds disappear? Who needs constant exceptions?
Who's not transmitting encounter data in a way that's hitting the plans, metrics at the state and so on level. Expect fewer new delegations, more pressure on existing ones, and more downside being pushed without proportional upside.
And so I need for example to point out that I've seen recent delegation agreements where the plan is not paying the provider for these delegated functions. So that, you know, is an example of more downside risk being pushed to the provider now without proportional upside.
So proportional upside would be a downside risk would be the operational burden and you know, the need to comply with audit and so on. Otherwise the repercussions are faced. And upside, proportional upside, which doesn't exist.
There would have been some kind of reimbursement model to pay for that administrative work.
Alex Yarijanian:Otherwise the health plan would have had.
Alex Yarijanian:To done it right, performed the function that's been delegated. So delegation isn't going away, but it's going to have more accountability and more risk involved on the downstream. 3.
What I'm seeing is value based care means something narrower now. So most payers believe providers overestimated their value based maturity.
Value based care now means defensible documentation, real downside readiness, predictable utilization, not pilots, not care management without authority. If your strategy depends on retrospective bonuses to make it work, you're starting to misalign with where MA is headed.
clear. The biggest losers in:Those include primary care groups without utilization control, enablement platforms without risk or operational authority, organizations waiting for final rules before engaging payers. By the time rules are finalized, networks are already modeled decisions, mostly army, so waiting feels safe.
But the most expensive decision you can make right now is waiting. Winners will be different types. Winner number one is going to be the organization that controls decisions, not just referrals.
Winner Type 2 is going to be groups who are willing to take selective intelligent downside, not global capitation, not risk and reckless exploits exposure but targeted risk bundles, subcap, narrow performance corridors and so on.
And providers say here's where we're confident payers to listen then you gotta deliver winner type 3 is gonna be tech and service platforms with accountability. The future isn't software alone, it's not consulting alone, it's execution platforms.
If you can't stand behind outcomes financially, selling into MA next year will get harder and not easier. I have to tell you. So if I were advising a CEO or practice president right now, here's what I would say in the next 90 days.
First, audit your MA exposure honestly. Where do you lose money? Who drives variance? Who actually controls outcomes?
Then I want you to look at to changing how you talk with your health plan partners. Stop asking about incentives and start asking about where they need predictability. Third, simplify your value based story.
Fewer partners, clearer accountability, less abstraction. Complex doesn't signal sophistication anymore. It signals risk is what I'm saying. Both like simple designs and models that are effective.
It sounds cliche, but think through that mindset and you'll win. Here's some of the takeaway pairs are choosing fewer partners.
They're looking at these partners in a more rigorous fashion and the question is whether you help shape these decisions or they're made without you at the table. In Medicare Advantage, being hard to replace is the real power. So that is what I want to leave you with. Thanks for tuning in. Until next time.
