Three key Medicare Advantage strategies for small to mid-sized healthcare payers

With benefits that go beyond traditional Medicare (e.g., vision, dental, hearing, drug coverage) and an aging “boomer” population, Medicare Advantage programs are seeing record enrollment growth. 

The MA market has been dominated by a handful of large healthcare plans, but as demand for these plans grows, more and more regional plans and startups are seeing opportunities to enter the market.

What can smaller health plans do to ensure they’re part of the mix competing for the Medicare-aged population?

1. Reassess in-house capabilities amid rising complexity 

   With over-35 million enrollees in Medicare Advantage-as of 2025, small and mid-sized payers face mounting pressure to scale operations while managing costs. Many are reevaluating whether their internal systems can keep pace with: 
   

   • Regulatory demands-(CMS interoperability and health equity rules)
   • Member expectations-for digital-first experiences
   • Operational efficiency-in claims, enrollment, and provider management 

   For organizations seeking agility without overextending internal teams,-modular SaaS platforms-and-end-to-end BPO partnerships-offer a path to modernization without the burden and significant investment of a full in-house transformation. 

   Tip: Look for platforms that integrate seamlessly with existing systems and offer real-time analytics to support compliance and member engagement. 

2. Choose a flexible program delivery model 

   CMS’s 2025 guidance emphasizes-value-based care,-network adequacy and-member outcomes. To stay competitive, payers are moving away from rigid models and toward-flexible delivery ecosystems-that allow them to: 

   • Scale operations seasonally or regionally
   • Reduce member and provider abrasion.
   • Accelerate time-to-market for new plan designs 

   Whether through-co-sourced models-or-fully managed services, the ability to pivot quickly and reduce costs is becoming a strategic differentiator. 

   Hint: A delivery model that combines technology with operational support can help smaller payers punch above their weight. 

3. Prioritize member-centric innovation and regulatory readiness 

   CMS continues to raise the bar on-Star Ratings,-health equity, and-digital engagement. In 2025, successful payers are those that: 

   • Use-real-time data-to personalize member journeys
   • Address-social determinants of health (SDOH)-through targeted outreach
   • Ensure-regulatory readiness-with built-in compliance tools 

   Platforms that embed-member engagement tools,-multilingual support and-automated compliance workflows-can help payers meet these goals without adding administrative overhead. 
   

   Forward-thinking payers are embedding innovation into their core operations — not just layering it on top. 

   Curious how other payers are adapting to the 2026 rule changes? Explore how our flexible platforms and operational support can help.  

With the Medicare Advantage market booming and poised for steady growth over the coming years. Small to mid-sized plans who follow the steps above will strengthen their ability to offer a high-quality program, attract new business and prosper in this expanding market. 

About Conduent Healthcare Payer Solutions
As a partner to the entire healthcare ecosystem, Conduent helps increase access to care, optimize the cost of care, and improve health outcomes. We work with 17 of the 20 largest health plans serving over 25 million members — driven by our HSP Payer Suite technology supporting core administration and member engagement. Learn more on our website about Conduent’s Healthcare Business Solutions.