Medicare Advantage members hit hard by rising costs

With the rising cost of healthcare proving a key financial concern for retirees, Medicare Advantage plan members are facing a mounting financial squeeze, and their health insurers are largely failing to help them navigate it.

According to the J.D. Power 2026 U.S. Medicare Advantage Study released Tuesday, overall member satisfaction fell 12 points this year to 611 on a 1,000-point scale; the second consecutive annual decline and a 41-point drop since 2024.

Behind that slide is retirees feeling the pinch of rising prescription drug costs, higher outpatient expenses, and narrower provider networks, and they don't feel their health plans are helping them manage any of it.

The steepest declines over two years were in the areas members feel most in their wallets including saving time and money, trust, and whether their coverage actually meets their needs, suggesting many feel they are paying for a plan that no longer delivers value.

"Healthcare has grown increasingly complex and exceedingly costly, and Medicare Advantage plans are juggling these challenging market dynamics while trying to guide their members to the best outcomes," said Meaghan Hafner, senior director of healthcare solutions at J.D. Power. "While some stand-out performers are driving improvements in member satisfaction despite the challenges, the majority of plans are struggling to build a strong sense of patient advocacy and trust among their members."

Fewer than half of plan members (43%) say they strongly agree that their plan is a trusted partner in their health and wellness. That erosion of trust, combined with tangible cost increases, suggests that clients may be paying more out-of-pocket than they anticipated when they enrolled.

The understanding gap

The study highlights a significant gap between members who understand their coverage and those who don't.

Among new plan members who say they understand their coverage very well, 34% report that their insurer helps prepare them for unexpected healthcare costs, and 29% say the insurer anticipates their needs. For members who lack that understanding, those figures fall to just 17% and 16% respectively.

That gap points to an opportunity for financial advisors: helping clients understand Medicare Advantage plan structures, cost-sharing mechanisms, and network limitations before enrollment could prevent costly surprises down the line.

Special needs plans outperform

One bright spot in the data is the performance of special needs plans (SNPs), which are designed for individuals with severe or disabling chronic conditions, those in institutional settings, or dual Medicare-Medicaid eligibles.

These plans delivered significantly higher overall satisfaction and trust scores; a result the study attributes to higher-touch support models, stronger care coordination, and more personalized guidance.

This suggests that clients with complex health needs may find better financial value in a specialized plan than a standard Medicare Advantage option, even if premiums appear higher at first glance.

The study was based on responses from 14,559 Medicare Advantage plan members across 12 US markets, fielded between January and June 2026.