This data brief delivers a comprehensive snapshot comparing roughly 150 smaller MA plan sponsors against the nation’s eight largest companies. The report highlights the structural, geographic, and financial realities of these smaller plan options, illustrating how current rules leave them with less flexibility than their large commercial counterparts.
- Smaller plans command about 22% of total national MA enrollment, with a heavier concentration of members located in counties that feature lower traditional Medicare spending.
- Enrollment in smaller plans leans heavily toward non-profit organizations (63% compared to just 10% among the top eight giants) and plans vertically integrated with local health systems that own hospitals.
- Smaller plan sponsors focus more on traditional HMO products and integrated Special Needs Plans for beneficiaries with Medicare and Medicaid rather than broad PPO networks or commercial employer-group retiree plans.
Data shows smaller plans operate with lower average risk scores, lower risk-adjusted payments, and higher average Medical Loss Ratios (92.5% vs. 88.7%). Despite these tighter profit margins, many excel in performance, with over 70% of their enrollees in contracts awarded 4 or more stars in the 2026 ratings.