By Megan R. Wilson

In today’s issue:

• Insurers are shifting toward tighter provider networks in Medicare Advantage as they manage rising costs
• A new coalition called the Specialty Access Alliance wants lawmakers to consider the practical challenges patients face in accessing complex treatments
• Watch: What health policy changes are in store after the midterms? The latest WP Intelligence health briefing outlines a post-midterm landscape.

Welcome back to the Health Brief newsletter! I’m your health policy host, Megan Wilson, back from a brief hiatus.

There are exactly 14 days until Election Day, and I’m trying to dial in to all things midterms. If you’re working with any campaigns or post-election legislative strategy, I want to hear from you.

Send tips, scoops and health campaign intel to megan.wilson@washpost.com, or send a secure message on Signal to megan.434.

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Many insurers, including UnitedHealthcare, are shifting Medicare Advantage plan options. (Elise Amendola/AP)

As Medicare’s open enrollment begins, insurance companies offering Medicare Advantage are making a trade-off of fewer plans offering out-of-network flexibility, alongside continued growth in specialized coverage that could raise costs for taxpayers.

That’s the subject of the latest report from my colleague Rebecca Adams, WP Intelligence’s lead health care analyst.

The number of Medicare Advantage preferred provider organization (PPO) options has fallen nearly 21 percent since 2025, according to a WP Intelligence analysis of federal data. Insurers are increasingly favoring health maintenance organizations (HMOs), which typically offer tighter provider networks and more tools to manage costs.

Why it matters: That could leave beneficiaries with fewer choices of doctors and hospitals if they want their plans to cover the care. It’s one of the moves being employed by insurance companies to help manage rising costs.

HMOs that facilitate “care management and care coordination are really critical as we work around affordability and bend the cost curve in health care, which is obviously one of the key charges that we have as an organization,” Bobby Hunter, president of UnitedHealthcare, told reporters in a call last month.

UnitedHealthcare is the largest insurer in the country, including covering an estimated 7.3 million people in Medicare Advantage — or roughly 20 percent of the program’s enrollees.

Another finding from Rebecca’s report: Special needs plans represent another growth area for the industry. Nearly 1 in 4 Medicare Advantage enrollees is now in one of these plans, which target people with specific chronic conditions, those eligible for both Medicare and Medicaid, or people who are institutionalized.

While that’s an opportunity for insurers, it also raises questions about the value taxpayers are getting. Some analysts say special needs plans can improve care coordination, but it’s unclear whether they produce better health outcomes than other Medicare Advantage plans.

“It’s not necessarily clear that they have better health outcomes than regular [Medicare Advantage] plans, but they are able to garner higher margins than other MA plans, which is concerning,” said Anna Bonelli, the director of health policy for the nonpartisan Committee for a Responsible Federal Budget. The plans “use their specialized networks … to earn even higher margins than other MA plans, but the federal budget doesn’t benefit from that efficiency.”

The timeline element: Open enrollment runs through Dec. 7. Older Americans on the privately run version of Medicare will have to weigh changing provider networks and coverage options as insurers rethink where and how they compete.

→ The changes are coming as insurers are also pulling back from some markets. One estimate projects that nearly 11 percent of Medicare Advantage enrollees — about 3.2 million people — are expected to have to find new coverage for 2027 because their current plans will no longer be offered in their area.

Most affected consumers will still have other Medicare Advantage options, but switching plans can mean changes to provider networks, benefits, and out-of-pocket costs.

Read the full report: “Medicare enrollment season reveals shift in insurers’ coverage strategies.”

A new coalition wants a seat at the table as Congress debates health care policy, pressing lawmakers to account for the needs of patients who depend on specialty pharmacies to access and manage complex treatments.

• The Specialty Access Alliance aims to give patients with rare, chronic and difficult-to-treat conditions a stronger voice in policy discussions that often overlook the complexities of getting treatment to the people who need it.
• “Is there anybody that’s really thinking through the logistics behind getting the actual human the actual care?” Machalagh Carr, executive director of the new coalition, told me in an exclusive interview. Even lawmakers with deep health care expertise may have limited exposure to specialty pharmacies and the patients who depend on their services, she said.
• The initial members include the National Health Council, the Immune Deficiency Foundation, sickle cell patient group Sick Cells and the Academy of Managed Care Pharmacy — and Carr tells me she wants to bring more organizations into the effort. The group will be announcing new members “in the coming months,” according to a release.

“The phrase ‘specialty pharmacy’ almost sounds as though it’s a really distinct and small group, but it’s a lot of people in this country from a variety of different backgrounds,” Carr adds. “Millions of patients with complex needs rely on this care, and what we find is when there are specialty pharmacies in place, it improves patient outcomes.”

Why it matters: The Specialty Access Alliance is meant to emphasize that specialty pharmacies do more than just dispense medications. The alliance says millions of Americans with complex conditions rely on that infrastructure, and these pharmacies can help some patients move from hospital-based treatments to receiving infusions at home.

• Along with the launch, the coalition is releasing a report that hopes to drive home these points. The alliance’s first priority is to meet with lawmakers and their staff to explain the role specialty pharmacies play in patient care — and the potential consequences of policies that fail to account for that role.

“When there are discussions happening — whether it’s end-of-year deals, whether it’s funding deals … as we’re looking toward the end of this particular Congress and the beginning of a new Congress — whatever the focus of the lawmakers is, we want to make sure that patients and the logistics behind their care are not an afterthought,” said Carr, who previously served in senior roles for Republicans on Capitol Hill.

Affordability is often a central concern in legislative discussions, alongside the needs of government programs, insurers and providers. But the practical challenges patients face in accessing and managing treatment can get lost in those conversations, Carr said.

ICYMI: The latest WP Intelligence health briefing Friday focused on how the midterm elections could impact health policy on Capitol Hill.

I was joined by top lobbyists Libby Greer, of advocacy firm FTP and Monica Popp, a founding partner of Marshall & Popp.

It’s clear that there’s groundwork being laid for several 2027 priorities should Democrats take back one or both chambers: digging into the Trump administration’s drug-pricing deals with pharma companies, reviving enhanced Obamacare premium subsidies, and trying to fix the way providers and insurance companies resolve unexpected out-of-network medical bills.

“U.S. cancer patients need lifesaving drugs. Some have to get them in China.,” Arthur Allen reports for KFF Health News.

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