Medicare Advantage

Program of All-Inclusive Care for the Elderly (PACE) is a capitated health plan that provides comprehensive Medicare and Medicaid covered services to frail, older adults in the community who are eligible for nursing home care. New research from ATI explores the latest enrollment trends and highlights latest opportunities for PACE growth.

The Medicare Advantage market is entering a period of renewed opportunity for regional and local plans. As national carriers continue to retrench from select markets amid mounting financial pressure, regional and local organizations have continued to grow, with enrollment increasing by 3.5 and 9 percent respectively in 2026.

Beginning January 1, 2030, Dual Eligible Special Needs Plan (D-SNP) enrollment must be fully aligned with Medicaid plan enrollment, and beneficiaries will no longer be able to stay in their current D-SNP. Building on a previous ATI resource, this brief outlines a transitional strategy for states subject to the impending D-SNP enrollment alignment requirements to consider.

New research from ATI shows that in 2023, Institutional Special Needs Plan (I-SNP) enrollees had lower mortality risk and fewer emergency department visits, hospitalizations, and hospital readmissions than non-I-SNP MA beneficiaries. This brief investigates the association between I-SNP enrollment and mortality, healthcare utilization, spending, and quality outcomes for long-term care residents enrolled in Medicare who had one or more nursing facility stays of 90 days or longer during the year.

ATI’s latest resource draws on analysis of CMS enrollment data to map where C-SNP growth is happening and which populations and conditions represent the highest-value opportunities. The tool provides considerations for building a high-performing plan, walking through five critical decision points and a six-phase launch roadmap while identifying common pitfalls.

The CY 2027 Final Rule continues CMS’ recent push toward a more tightly managed Medicare Advantage environment. The rule places particular emphasis on benefit appropriateness, care continuity for high-need members, integration, and streamlined marketing and quality frameworks.