Market Segment Outlook : US Medicare Advantage and Medicaid Managed Care

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      <subfield code="a">Medicare Advantage: Utilization, Quality Ratings, and Reimbursement Trends Continue to Pressure Earnings -- Medicaid Managed Care: Acuity, Behavioral Health Trends, and Regulatory Changes Continue to Challenge Earnings -- Overall Profitability Expected But With Lower Margins -- Guide to Best's Market Segment Outlooks -- Rating Disclosure: Use and Limitations</subfield>
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      <subfield code="a">AM Best maintains a Negative outlook for the US Medicare Advantage and Medicaid managed care segments due to elevated utilization, rising member acuity, reimbursement and rate pressures, regulatory challenges, drug and behavioral health cost pressures, enrollment volatility, and ongoing pricing challenges. Medicare Advantage earnings remain pressured by higher medical utilization, declining CMS Star Ratings, and lower-than-needed rate adjustments, with further risk adjustment model changes set for 2027. Medicaid managed care faces higher-than-expected acuity and behavioral health utilization, plus policy shifts such as work requirements and more frequent eligibility checks that may disrupt enrollment and strain margins. While overall profitability is expected to persist, margins will likely be lower, requiring pricing, benefit design, and market participation adjustments.</subfield>
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