Humana Aetna Likely to Lose Medicare Advantage Members

Medicare Advantage plans, offered by private insurers like Humana and Aetna, are a popular choice for seniors seeking comprehensive healthcare coverage.

However, recent developments suggest that Humana and Aetna are likely to lose Medicare Advantage members due to various challenges.

This article explores the reasons behind this trend, its impact on the companies, and what it means for consumers.

Understanding Medicare Advantage Plans

Medicare Advantage, also known as Medicare Part C, is an alternative to traditional Medicare.

Private insurers like Humana and Aetna manage these plans, offering benefits like prescription drug coverage, dental, and vision care. These plans are attractive because they often provide more comprehensive coverage than original Medicare.

Enrollment in Medicare Advantage has grown steadily, with nearly half of the 65 million Medicare beneficiaries enrolled in 2025.

However, challenges like regulatory scrutiny and provider network issues are putting pressure on insurers. Humana and Aetna, two of the largest players, face unique hurdles that could lead to membership losses.

Why Humana and Aetna Are at Risk

Several factors contribute to why Humana and Aetna are likely to lose Medicare Advantage members. These include regulatory changes, legal issues, and provider network disruptions. Let’s break down the key reasons.

Increased Regulatory Scrutiny

The Centers for Medicare & Medicaid Services (CMS) announced a more aggressive approach to auditing Medicare Advantage plans in 2025.

This heightened oversight aims to curb fraud, waste, and abuse in the program. Humana and Aetna, as major players, are under close examination, which could lead to penalties or restrictions.

Stricter audits may force these insurers to adjust their billing practices, potentially reducing revenue. This could result in less attractive plan offerings, prompting members to switch to competitors or revert to traditional Medicare.

Legal Challenges and Allegations

Both Humana and Aetna face legal troubles that could impact their Medicare Advantage membership. In May 2025, the U.S. Department of Justice filed a lawsuit against Humana, Aetna, and Elevance Health, alleging they paid illegal kickbacks to brokers to boost enrollment. The lawsuit also claims these insurers discriminated against disabled seniors by discouraging their enrollment.

Such allegations damage the companies’ reputations and could lead to financial penalties. Members may lose trust in these insurers, choosing other providers or traditional Medicare instead.

Provider Network Disruptions

Several healthcare systems have dropped Humana and Aetna’s Medicare Advantage plans from their networks in 2025. For example, UW Medicine in Seattle went out of network with Aetna on June 1, 2025, affecting members’ access to in-network care. Similarly, hospitals like Sanford Health and Baylor Scott & White have terminated contracts with Humana.

When providers go out-of-network, members face higher costs or must switch plans to maintain access to their preferred doctors. This disruption is a significant reason why Humana and Aetna are likely to lose Medicare Advantage members.

Billing Practice Reforms

Humana has signaled support for curbing billing practices tied to home visit diagnoses, which have generated billions in extra payments for insurers.

A Wall Street Journal investigation found that Humana earned an average of $1,525 per home visit between 2019 and 2021. Reforming these practices could reduce revenue, forcing Humana to cut benefits or raise premiums.

Aetna faces similar pressures, as CMS pushes for transparency in billing. Reduced benefits or higher costs could make their plans less appealing, driving members to competitors.

Impact on Humana and Aetna

The potential loss of Medicare Advantage members poses significant challenges for Humana and Aetna. Here’s how these issues affect their operations and market position.

Financial Implications

Medicare Advantage is a core revenue driver for both companies. Humana, the second-largest Medicare Advantage insurer, relies heavily on these plans for its income. Aetna, owned by CVS Health, also has a substantial stake in this market.

Membership declines could lead to reduced premiums and lower profits. For instance, Humana reported a membership decline in Q1 2025 after exiting unprofitable plans, which helped cut costs but reduced its market share.

Stock Market Reactions

The stock market has already reacted to these challenges. In May 2025, Humana’s shares dropped 6% after CMS announced stricter audits. Aetna’s parent company, CVS Health, saw a 3% decline in its stock value during the same period.

Investor confidence may wane if membership losses continue. However, some analysts remain optimistic, with Bernstein maintaining an outperform rating on Humana, citing its long-term growth strategy.

Strategic Adjustments

To counter these challenges, both companies are making strategic changes. Humana is focusing on increasing annual wellness visits to boost profitability, partnering with its CenterWell primary care brand.

Aetna is streamlining prior authorization processes and introducing programs like Aetna Clinical Collaboration to improve care transitions.

These efforts aim to retain members and improve efficiency, but their success remains uncertain amid ongoing scrutiny and network issues.

How Members Are Affected

The potential loss of members isn’t just a business problem—it directly impacts consumers. Here’s what Medicare Advantage enrollees need to know.

Higher Out-of-Pocket Costs

When providers drop Humana or Aetna’s plans, members may face higher out-of-pocket costs for out-of-network care. For example, Aetna members in Seattle lost in-network access to UW Medicine, potentially increasing their healthcare expenses.

Members may need to switch providers or plans to avoid these costs, which can be disruptive, especially for those with ongoing medical needs.

Changes in Plan Benefits

Regulatory and financial pressures may force Humana and Aetna to reduce benefits or increase premiums. For instance, Humana’s 2025 star ratings from CMS are below average at 3.63 out of 5, which could limit their ability to offer competitive benefits.

Members may find that their plans no longer cover services like dental or vision care as generously, prompting them to explore other options.

Uncertainty and Trust Issues

The DOJ lawsuit and allegations of discriminatory practices could erode trust in Humana and Aetna. Seniors may question whether these insurers prioritize their health or profits, leading some to switch to other Medicare Advantage providers or traditional Medicare.

Comparing Humana and Aetna’s Challenges

To better understand the situation, here’s a table comparing the key issues facing Humana and Aetna in their Medicare Advantage programs:

This table highlights that both insurers face similar challenges, but their responses differ slightly, with Humana emphasizing wellness visits and Aetna focusing on technology-driven solutions.

What Can Members Do?

If you’re a Humana or Aetna Medicare Advantage member, these changes may affect your coverage. Here are a few steps to consider:

• Check Your Provider Network: Confirm whether your preferred doctors and hospitals are still in-network. Contact Humana or Aetna for an updated provider list.
• Review Plan Benefits: Compare your current plan’s benefits with other Medicare Advantage options or traditional Medicare during the open enrollment period (October 15–December 7).
• Stay Informed: Monitor news about CMS regulations or lawsuits that could impact your plan’s coverage or costs.
• Consult a Medicare Advisor: A licensed Medicare advisor can help you navigate plan changes and find the best option for your needs.

The Bigger Picture for Medicare Advantage

The challenges facing Humana and Aetna reflect broader issues in the Medicare Advantage program. While these plans remain popular, growing scrutiny over billing practices and costs is prompting reforms.

Insurers must balance profitability with member satisfaction, which could reshape the industry in the coming years.

For now, Humana and Aetna are likely to lose Medicare Advantage members due to these pressures. However, their efforts to adapt—through partnerships, technology, and advocacy—may help them retain some market share.

Summary

Humana and Aetna, two leading Medicare Advantage insurers, face significant challenges that could lead to membership losses in 2025. Regulatory scrutiny, legal allegations, and provider network disruptions are key factors driving this trend.

These issues impact the companies’ finances, stock performance, and ability to offer competitive plans.

Members may face higher costs or reduced benefits, prompting some to switch providers or return to traditional Medicare. By staying informed and reviewing their options, consumers can navigate these changes effectively.

FAQ

Why are Humana and Aetna losing Medicare Advantage members?

Humana and Aetna are likely to lose Medicare Advantage members due to stricter CMS audits, legal allegations of kickbacks and discrimination, and provider network disruptions. These factors may reduce plan benefits or increase costs, prompting members to switch.

How do provider network changes affect members?

When providers go out-of-network, members face higher out-of-pocket costs for care. For example, UW Medicine dropped Aetna, and several systems dropped Humana, forcing members to switch providers or plans to maintain affordable access.

What steps are Humana and Aetna taking to address these issues?

Humana is increasing annual wellness visits and partnering with its CenterWell brand. Aetna is streamlining prior authorization and launching programs like Aetna Clinical Collaboration to improve care transitions and retain members.

Should I switch my Medicare Advantage plan?

If your providers are no longer in-network or your plan’s benefits change, consider reviewing other Medicare Advantage plans or traditional Medicare. Consult a Medicare advisor during open enrollment to find the best fit.

Sources

• Humana to back curbs to Medicare Advantage billing practices, WSJ reports | Reuters
• U.S. Prosecutors Accuse Large Insurers of Paying Kickbacks for Private Medicare Plans – The New York Times