Humana May End Up with Lots of New Members It Didn’t Want
By Peter Johnson | December 5, 2025 | As seen on Health Payer Specialist
Open enrollment ends on Saturday and the payer and other Blue Cross Blue Shield affiliates are scooping up Medicare members from other insurers in an unwelcome enrollment surge in Medicare Advantage.
When the final tallies for the Medicare Advantage annual enrollment period are released, Humana and Blue Cross and Blue Shield affiliates appear poised to take on a lot of new members.
It’s an outcome that Humana desperately wanted to avoid. It’s no secret that in 2026, Medicare payers want to improve profit margin even if membership drops. Leaders of all the national Medicare plans have said they are pursuing a margin over membership strategy.
So far, according to John Selby, CEO of Medicare staffing and consulting firm the Rebellis Group, that has gone as planned for most nationals. But Humana is a notable exception, Selby said: the Medicare-focused insurer seems to be gaining membership while other nationals are losing it. That’s in spite of the fact that Humana cut commissions on about a third of its plans ahead of the enrollment period. And Humana’s CFO assured investors during a recent public appearance that the company was doing everything it could to slow enrollment growth.
Some brokers have told Health Payer Specialist that they’re enrolling some beneficiaries in plans that don’t have broker commissions. That could be one reason why Humana could be on the verge of a membership spike.
Blue affiliates are also poised to increase their MA enrollment dramatically, Selby said. A handful of Blue affiliates could have enrollment grow by 20-30%, while others are on track with their pre-AEP projections. Selby declined to say which Blue affiliates seem to be growing dramatically.
PPO Members Turn to HMOs
Meanwhile, an industrywide shift from preferred provider plan designs to health maintenance platforms seems to be working. Former members of the hundreds of PPO plans that will shut down at the end of this year seem to be heading to HMO plans, according to one large brokerage.
Broadly speaking, insurers have cut and consolidated PPO plan designs and tried to steer former PPO members into HMOs. The strategy seems to be working. Whitney Stidom, vice president of national online brokerage eHealth, said that the company has observed a significant shift to HMOs from beneficiaries who were previously enrolled in PPO plans. HMOs are signing up members whose plans were terminated, Stidom said.
Cost is “the number one factor” for beneficiaries searching for plans, Stidom said. Consequently, some new HMO enrollment is coming from members who were previously enrolled in PPO plans that weren’t canceled, Stidom said. Beneficiaries moving from still operating PPOs to HMOs probably left because of increased cost sharing and premiums, Stidom said.
With all the plan terminations, an unusually high number of beneficiaries have had to dig into different plan options during this year’s AEP, according to brokers. Stidom said that eHealth has had to field a higher volume of customer service calls this year in comparison to recent years.
Brokers Antonette Vanasek of California’s Vanasek Insurance Services and Amanda Brewton of Ohio’s Medicare Answers Now both said that they are unusually busy. They also both said that their agencies are still putting beneficiaries in plans that don’t pay out broker commissions — even though payers have tried to cut commissions on low-margin plans as part of a broader play for profitability.
“We’re not getting paid for any of this extra work,” Vanasek said during a discussion of higher-than-normal Medicare volumes.
“Most of the agents are so busy that they have anxiety about not getting to everyone in time,” Brewton said. Many brokers are handling 10 to 12 appointments a day and enrolling members in plans that won’t pay commissions, she added.
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