diff --git a/domains/health/Devoted is the fastest-growing MA plan at 121 percent growth because purpose-built technology outperforms acquisition-based vertical integration during CMS tightening.md b/domains/health/Devoted is the fastest-growing MA plan at 121 percent growth because purpose-built technology outperforms acquisition-based vertical integration during CMS tightening.md
index 2f3e3f834..d173a2caa 100644
--- a/domains/health/Devoted is the fastest-growing MA plan at 121 percent growth because purpose-built technology outperforms acquisition-based vertical integration during CMS tightening.md	
+++ b/domains/health/Devoted is the fastest-growing MA plan at 121 percent growth because purpose-built technology outperforms acquisition-based vertical integration during CMS tightening.md	
@@ -23,6 +23,12 @@ Devoted was built from scratch on the Orinoco platform — a unified AI-native o
 
 Since [[proxy inertia is the most reliable predictor of incumbent failure because current profitability rationally discourages pursuit of viable futures]], UnitedHealth's $9 billion annual technology spend directed at optimizing existing infrastructure (consolidating 18 EMRs, AI scribing within legacy workflows) rather than rebuilding around prevention is textbook proxy inertia. The margin from coding arbitrage rationally prevents pursuit of the purpose-built alternative.
 
+
+### Additional Evidence (challenge)
+*Source: [[2025-07-24-kff-medicare-advantage-2025-enrollment-update]] | Added: 2026-03-12 | Extractor: anthropic/claude-sonnet-4.5*
+
+Market dynamics in 2025 show consolidation toward the largest incumbent (UnitedHealth) rather than toward purpose-built technology players. UnitedHealth gained 505K members while Humana lost 297K, giving UHG 29% market share (9.9M enrollees). The top two players (UHG + Humana) control 46% of enrollment, with 815 counties (26% of total) showing 75%+ concentration in these two alone. This suggests that during CMS tightening, scale and market power may be more important than technology architecture. Devoted's 121% growth is from a small base; the absolute member gains are going to the largest incumbent with the most resources to navigate regulatory complexity and absorb regulatory risk. If purpose-built technology were outperforming, we would expect Devoted's market share to be growing faster than UHG's, but the opposite is occurring.
+
 ---
 
 Relevant Notes:
diff --git a/domains/health/GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035.md b/domains/health/GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035.md
index e319a3c38..3f6c20574 100644
--- a/domains/health/GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035.md	
+++ b/domains/health/GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035.md	
@@ -17,6 +17,12 @@ But the economics are structurally inflationary. Meta-analyses show patients reg
 
 The competitive dynamics (Lilly vs. Novo vs. generics post-2031) will drive prices down, but volume growth more than offsets price compression. GLP-1s will be the single largest driver of pharmaceutical spending growth globally through 2035.
 
+
+### Additional Evidence (confirm)
+*Source: [[2025-07-24-kff-medicare-advantage-2025-enrollment-update]] | Added: 2026-03-12 | Extractor: anthropic/claude-sonnet-4.5*
+
+Chronic Condition Special Needs Plans (C-SNPs) grew 71% year-over-year (2024-2025), the fastest-growing Medicare Advantage segment. C-SNPs are designed for beneficiaries with specific chronic conditions requiring continuous medication management and monitoring — exactly the population profile for GLP-1 users. C-SNPs now represent 1.2M enrollees (16% of all SNPs), and if 71% growth moderates to even 30% annually, they would reach 3-4M enrollees by 2027-2028. This organizational shift toward disease-specific management plans confirms that the healthcare system is structuring itself around chronic medication management rather than curative or preventive models, consistent with GLP-1s driving long-term cost inflation. The healthcare system is building infrastructure (specialized plans, risk adjustment, care coordination) to manage GLP-1 populations as a permanent chronic disease category, not as a temporary therapeutic intervention.
+
 ---
 
 Relevant Notes:
diff --git a/domains/health/chronic-condition-special-needs-plans-grew-71-percent-in-one-year-indicating-explosive-demand-for-specialized-management-of-metabolic-and-chronic-disease-populations.md b/domains/health/chronic-condition-special-needs-plans-grew-71-percent-in-one-year-indicating-explosive-demand-for-specialized-management-of-metabolic-and-chronic-disease-populations.md
new file mode 100644
index 000000000..a5e6e838c
--- /dev/null
+++ b/domains/health/chronic-condition-special-needs-plans-grew-71-percent-in-one-year-indicating-explosive-demand-for-specialized-management-of-metabolic-and-chronic-disease-populations.md
@@ -0,0 +1,40 @@
+---
+type: claim
+domain: health
+description: "C-SNPs (chronic condition special needs plans) grew 71% from 2024 to 2025, the fastest-growing MA segment, signaling shift toward disease-specific management"
+confidence: likely
+source: "Kaiser Family Foundation, Medicare Advantage in 2025: Enrollment Update and Key Trends (2025-07-24)"
+created: 2026-03-11
+---
+
+# Chronic condition special needs plans grew 71 percent in one year indicating explosive demand for specialized management of metabolic and chronic disease populations
+
+Chronic Condition Special Needs Plans (C-SNPs) grew 71% from 2024 to 2025, making them the fastest-growing segment of the Medicare Advantage market. C-SNPs now represent 1.2M enrollees (16% of all Special Needs Plans), up from a base that would have been ~700K in 2024.
+
+This growth rate is an order of magnitude faster than overall MA growth (4% annually) and faster than the broader SNP category (which grew from 14% of MA enrollment in 2020 to 21% in 2025). C-SNPs are designed for beneficiaries with specific severe or disabling chronic conditions — diabetes, cardiovascular disease, chronic heart failure, dementia — requiring specialized care management beyond standard MA plans.
+
+The acceleration connects directly to the metabolic disease epidemic and the emergence of new therapeutic categories. GLP-1 receptor agonists (semaglutide, tirzepatide) are creating a new population of beneficiaries requiring continuous medication management, monitoring, and lifestyle intervention. C-SNPs are the natural organizational form for managing these populations because they can tailor benefits, care coordination, and provider networks to disease-specific needs.
+
+The growth also reflects CMS regulatory changes making C-SNP formation easier and more profitable. Plans can now target narrower condition sets, and risk adjustment for C-SNPs is more favorable than standard MA plans because the population is sicker by design. This creates a business model where specialized chronic disease management generates higher per-member revenue while potentially delivering better outcomes through focused care protocols.
+
+The trajectory suggests C-SNPs will become a dominant MA structure within 5 years. If 71% annual growth moderates to even 30% annually, C-SNPs would reach 3-4M enrollees by 2027-2028, representing 10%+ of total MA enrollment. This would mark a shift from MA as a general managed care alternative to MA as a portfolio of disease-specific management programs.
+
+## Evidence
+- C-SNP enrollment: 1.2M in 2025 (16% of all SNPs)
+- Growth rate: 71% year-over-year (2024-2025)
+- Overall MA growth: 4% annually for comparison
+- SNP category overall: grew from 14% of MA (2020) to 21% (2025)
+- C-SNPs target specific chronic conditions: diabetes, cardiovascular disease, chronic heart failure, dementia
+
+## Caveats
+Single-year growth rate could reflect one-time regulatory change or market adjustment rather than sustained trend. Requires 2026 data to confirm trajectory is durable.
+
+---
+
+Relevant Notes:
+- [[GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035]]
+- [[Big Food companies engineer addictive products by hacking evolutionary reward pathways creating a noncommunicable disease epidemic more deadly than the famines specialization eliminated]]
+- [[the healthcare cost curve bends up through 2035 because new curative and screening capabilities create more treatable conditions faster than prices decline]]
+
+Topics:
+- [[domains/health/_map]]
diff --git a/domains/health/medicare-advantage-crossed-majority-enrollment-in-2023-marking-structural-transition-from-fee-for-service-to-managed-care-as-default-medicare-program.md b/domains/health/medicare-advantage-crossed-majority-enrollment-in-2023-marking-structural-transition-from-fee-for-service-to-managed-care-as-default-medicare-program.md
new file mode 100644
index 000000000..903cb9504
--- /dev/null
+++ b/domains/health/medicare-advantage-crossed-majority-enrollment-in-2023-marking-structural-transition-from-fee-for-service-to-managed-care-as-default-medicare-program.md
@@ -0,0 +1,33 @@
+---
+type: claim
+domain: health
+description: "MA enrollment reached 51% in 2023 and 54% by 2025, with CBO projecting 64% by 2034, making traditional Medicare the minority program"
+confidence: proven
+source: "Kaiser Family Foundation, Medicare Advantage in 2025: Enrollment Update and Key Trends (2025-07-24)"
+created: 2026-03-11
+---
+
+# Medicare Advantage crossed majority enrollment in 2023 marking structural transition from fee-for-service to managed care as default Medicare program
+
+Medicare Advantage enrollment crossed 50% of eligible beneficiaries in 2023 (30.8M enrollees, 51% penetration), reaching 54% by 2025 (34.1M enrollees). This represents a structural inflection point where managed care became the default Medicare experience rather than the alternative pathway.
+
+The trajectory shows consistent acceleration: from 19% penetration in 2007 (7.6M) to 54% in 2025 (34.1M) — a 2.8x increase in penetration rate while absolute enrollment grew 4.5x. The Congressional Budget Office projects 64% penetration by 2034, meaning traditional fee-for-service Medicare will serve only one-third of beneficiaries within a decade.
+
+This is not a temporary trend but a one-way transition. Growth rate remained at 4% year-over-year (2024-2025) even after crossing majority threshold, adding 1.3M enrollees annually. The shift is demographically locked in: new Medicare beneficiaries are enrolling in MA at higher rates than the existing population, and switching from MA back to traditional Medicare is rare (less than 5% annually).
+
+The policy implications are profound. Medicare policy debates now center on MA regulation rather than fee-for-service reform. CMS payment policy, quality measurement, and benefit design increasingly target the managed care model. Traditional Medicare is becoming the residual program for beneficiaries who opt out of managed care, reversing the original 1997 design where MA was the optional alternative.
+
+## Evidence
+- KFF enrollment data: 51% penetration in 2023, 54% in 2025, with CBO projecting 64% by 2034
+- Absolute enrollment: 7.6M (2007) → 34.1M (2025), 4.5x growth over 18 years
+- Growth rate sustained at 4% annually even after crossing majority threshold
+- Special Needs Plans grew from 14% of MA enrollment (2020) to 21% (2025), indicating expansion into complex populations
+
+---
+
+Relevant Notes:
+- [[value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk]]
+- [[four competing payer-provider models are converging toward value-based care with vertical integration dominant today but aligned partnership potentially more durable]]
+
+Topics:
+- [[domains/health/_map]]
diff --git a/domains/health/medicare-advantage-market-is-an-oligopoly-with-unitedhealth-and-humana-controlling-46-percent-of-enrollment-despite-nominal-plan-choice-averaging-9-options-per-beneficiary.md b/domains/health/medicare-advantage-market-is-an-oligopoly-with-unitedhealth-and-humana-controlling-46-percent-of-enrollment-despite-nominal-plan-choice-averaging-9-options-per-beneficiary.md
new file mode 100644
index 000000000..74e18eed9
--- /dev/null
+++ b/domains/health/medicare-advantage-market-is-an-oligopoly-with-unitedhealth-and-humana-controlling-46-percent-of-enrollment-despite-nominal-plan-choice-averaging-9-options-per-beneficiary.md
@@ -0,0 +1,37 @@
+---
+type: claim
+domain: health
+description: "UnitedHealth (29%) and Humana (17%) control 46% of MA enrollment, with 815 counties showing 75%+ concentration in these two insurers alone"
+confidence: proven
+source: "Kaiser Family Foundation, Medicare Advantage in 2025: Enrollment Update and Key Trends (2025-07-24)"
+created: 2026-03-11
+---
+
+# Medicare Advantage market is an oligopoly with UnitedHealth and Humana controlling 46 percent of enrollment despite nominal plan choice averaging 9 options per beneficiary
+
+The Medicare Advantage market exhibits classic oligopoly structure despite appearing competitive on surface metrics. UnitedHealth Group controls 29% of enrollment (9.9M beneficiaries) and Humana controls 17% (5.7M), giving these two organizations 46% of the entire MA market. Adding CVS Health/Aetna (12%, 4.1M) brings the top three to 58% market share.
+
+The concentration is even more severe at the county level. In 815 counties (26% of all US counties), UnitedHealth and Humana alone account for 75% or more of MA enrollment. This means one in four counties has effectively duopoly control, where beneficiaries face nominal choice among plans but actual choice between two parent organizations.
+
+The paradox: beneficiaries average 9 plan options, with 36% having 10+ plans available. But plan proliferation within the same parent organization creates the illusion of competition without its substance. Multiple plan brands under UnitedHealth or Humana compete on benefits and premiums but share the same provider networks, utilization management systems, and corporate incentives.
+
+Market dynamics in 2025 show further consolidation rather than diversification. Humana lost 297K members while UnitedHealth gained 505K, suggesting the market is concentrating toward the largest player. The "all others" category (30% of enrollment, 10.3M beneficiaries) is fragmented across hundreds of smaller plans, none with sufficient scale to challenge the top tier.
+
+This structure matters for policy. Regulatory interventions affect a small number of organizations controlling the majority of beneficiaries. Network adequacy, prior authorization policies, and quality standards are effectively set by 2-3 dominant players. The market does not self-correct through competition because beneficiaries face high switching costs (provider network disruption) and information asymmetry (plan quality is opaque until after enrollment).
+
+## Evidence
+- UnitedHealth: 9.9M enrollees (29% market share)
+- Humana: 5.7M enrollees (17% market share)
+- Combined UHG + Humana: 46% of all MA enrollment
+- 815 counties (26% of total) have 75%+ enrollment concentration in UHG & Humana alone
+- Average 9 plan options per beneficiary, 36% have 10+ options
+- 2025 dynamics: Humana lost 297K members, UHG gained 505K
+
+---
+
+Relevant Notes:
+- [[anti-payvidor legislation targets all insurer-provider integration without distinguishing acquisition-based arbitrage from purpose-built care delivery]]
+- [[four competing payer-provider models are converging toward value-based care with vertical integration dominant today but aligned partnership potentially more durable]]
+
+Topics:
+- [[domains/health/_map]]
diff --git a/domains/health/medicare-advantage-overpayment-gap-grew-4-point-7-times-faster-than-enrollment-doubling-indicating-scale-amplifies-rather-than-reduces-structural-cost-inefficiency.md b/domains/health/medicare-advantage-overpayment-gap-grew-4-point-7-times-faster-than-enrollment-doubling-indicating-scale-amplifies-rather-than-reduces-structural-cost-inefficiency.md
new file mode 100644
index 000000000..3ca34929d
--- /dev/null
+++ b/domains/health/medicare-advantage-overpayment-gap-grew-4-point-7-times-faster-than-enrollment-doubling-indicating-scale-amplifies-rather-than-reduces-structural-cost-inefficiency.md
@@ -0,0 +1,37 @@
+---
+type: claim
+domain: health
+description: "Federal overpayment to MA plans grew from $18B (2015) to $84B (2025) while enrollment only doubled, showing 4.7x spending gap growth"
+confidence: proven
+source: "Kaiser Family Foundation, Medicare Advantage in 2025: Enrollment Update and Key Trends (2025-07-24)"
+created: 2026-03-11
+---
+
+# Medicare Advantage overpayment gap grew 4 point 7 times faster than enrollment doubling indicating scale amplifies rather than reduces structural cost inefficiency
+
+Medicare Advantage plans receive $84 billion more in federal payments than the equivalent population would cost in traditional fee-for-service Medicare (2025 data). This represents a 20% per-person premium — MA beneficiaries cost 120% of what FFS beneficiaries cost, despite MA's stated efficiency advantages through managed care.
+
+The critical insight is the trajectory. In 2015, when approximately one-third of eligible beneficiaries were enrolled in MA, the overpayment gap was $18 billion. By 2025, enrollment roughly doubled (from ~16M to 34M), but the spending gap grew 4.7x (from $18B to $84B). This means the per-capita overpayment is increasing as the program scales, not decreasing.
+
+This contradicts the standard efficiency narrative. If MA plans achieve cost savings through care coordination, utilization management, and prevention, the spending gap should narrow as plans gain experience and scale. Instead, it's widening. The 20% per-person premium in 2025 is higher than historical averages, suggesting MA plans are either selecting healthier beneficiaries (favorable selection), upcoding diagnoses to inflate risk scores (coding intensity), or both.
+
+The policy implications are severe. At 54% penetration, MA overpayments represent a structural drain on Medicare finances. CMS has attempted to address this through payment reforms (the 2027 chart review exclusion targets upcoding), but the gap continues to grow. If MA reaches CBO's projected 64% penetration by 2034 and the per-capita premium remains at 20%, the annual overpayment would exceed $120 billion.
+
+The spending gap also explains why MA plans can offer supplemental benefits (dental, vision, gym memberships) that traditional Medicare doesn't cover. These benefits are funded by the federal overpayment, not by efficiency gains. Beneficiaries perceive MA as offering "more" than traditional Medicare, but the additional benefits are paid for by taxpayers through higher per-capita costs.
+
+## Evidence
+- 2025 overpayment: $84B more than FFS equivalent (20% per-person premium)
+- 2015 overpayment: $18B (when ~1/3 of eligible enrolled)
+- Spending gap growth: 4.7x (from $18B to $84B)
+- Enrollment growth: ~2x (from ~16M to 34M)
+- Per-capita overpayment increasing over time, not decreasing with scale
+
+---
+
+Relevant Notes:
+- [[CMS 2027 chart review exclusion targets vertical integration profit arbitrage by removing upcoded diagnoses from MA risk scoring]]
+- [[value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk]]
+- [[the healthcare cost curve bends up through 2035 because new curative and screening capabilities create more treatable conditions faster than prices decline]]
+
+Topics:
+- [[domains/health/_map]]
diff --git a/domains/health/the healthcare attractor state is a prevention-first system where aligned payment continuous monitoring and AI-augmented care delivery create a flywheel that profits from health rather than sickness.md b/domains/health/the healthcare attractor state is a prevention-first system where aligned payment continuous monitoring and AI-augmented care delivery create a flywheel that profits from health rather than sickness.md
index 7cae923d2..3541f50f5 100644
--- a/domains/health/the healthcare attractor state is a prevention-first system where aligned payment continuous monitoring and AI-augmented care delivery create a flywheel that profits from health rather than sickness.md	
+++ b/domains/health/the healthcare attractor state is a prevention-first system where aligned payment continuous monitoring and AI-augmented care delivery create a flywheel that profits from health rather than sickness.md	
@@ -285,6 +285,12 @@ Healthcare is the clearest case study for TeleoHumanity's thesis: purpose-driven
 
 PACE provides the most comprehensive real-world test of the prevention-first attractor model: 100% capitation, fully integrated medical/social/psychiatric care, continuous monitoring of a nursing-home-eligible population, and 8-year longitudinal data (2006-2011). Yet the ASPE/HHS evaluation reveals that PACE does NOT reduce total costs—Medicare capitation rates are equivalent to FFS overall (with lower costs only in the first 6 months post-enrollment), while Medicaid costs are significantly HIGHER under PACE. The value is in restructuring care (community vs. institution, chronic vs. acute) and quality improvements (significantly lower nursing home utilization across all measures, some evidence of lower mortality), not in cost savings. This directly challenges the assumption that prevention-first, integrated care inherently 'profits from health' in an economic sense. The 'flywheel' may be clinical and social value, not financial ROI. If the attractor state requires economic efficiency to be sustainable, PACE suggests it may not be achievable through care integration alone.
 
+
+### Additional Evidence (challenge)
+*Source: [[2025-07-24-kff-medicare-advantage-2025-enrollment-update]] | Added: 2026-03-12 | Extractor: anthropic/claude-sonnet-4.5*
+
+Medicare Advantage enrollment data shows the opposite trajectory from the prevention-first attractor state. MA crossed majority enrollment (54% in 2025, projected 64% by 2034) with aligned payment structures in place, yet federal overpayments grew 4.7x faster than enrollment ($18B in 2015 → $84B in 2025). The per-capita premium is 20% above fee-for-service equivalent, and it's increasing with scale rather than decreasing. This suggests aligned payment alone does not create a prevention flywheel — MA plans are using the payment structure to maximize revenue through favorable selection and upcoding rather than investing in prevention that reduces total cost of care. The fastest-growing segment is C-SNPs (71% growth, chronic condition management), not prevention-focused plans. If the attractor state were operational, we would expect: (1) per-capita costs declining as scale increases, (2) prevention-focused plans outgrowing disease-management plans, and (3) supplemental benefits funded by efficiency gains rather than federal overpayments. None of these conditions hold.
+
 ---
 
 Relevant Notes:
diff --git a/inbox/archive/2025-07-24-kff-medicare-advantage-2025-enrollment-update.md b/inbox/archive/2025-07-24-kff-medicare-advantage-2025-enrollment-update.md
index 303b9f5a9..7a8a4174a 100644
--- a/inbox/archive/2025-07-24-kff-medicare-advantage-2025-enrollment-update.md
+++ b/inbox/archive/2025-07-24-kff-medicare-advantage-2025-enrollment-update.md
@@ -7,9 +7,15 @@ date: 2025-07-24
 domain: health
 secondary_domains: []
 format: data
-status: unprocessed
+status: processed
 priority: high
 tags: [medicare-advantage, enrollment, market-concentration, market-share, kff]
+processed_by: vida
+processed_date: 2026-03-11
+claims_extracted: ["medicare-advantage-crossed-majority-enrollment-in-2023-marking-structural-transition-from-fee-for-service-to-managed-care-as-default-medicare-program.md", "medicare-advantage-market-is-an-oligopoly-with-unitedhealth-and-humana-controlling-46-percent-of-enrollment-despite-nominal-plan-choice-averaging-9-options-per-beneficiary.md", "chronic-condition-special-needs-plans-grew-71-percent-in-one-year-indicating-explosive-demand-for-specialized-management-of-metabolic-and-chronic-disease-populations.md", "medicare-advantage-overpayment-gap-grew-4-point-7-times-faster-than-enrollment-doubling-indicating-scale-amplifies-rather-than-reduces-structural-cost-inefficiency.md"]
+enrichments_applied: ["the healthcare attractor state is a prevention-first system where aligned payment continuous monitoring and AI-augmented care delivery create a flywheel that profits from health rather than sickness.md", "Devoted is the fastest-growing MA plan at 121 percent growth because purpose-built technology outperforms acquisition-based vertical integration during CMS tightening.md", "GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035.md"]
+extraction_model: "anthropic/claude-sonnet-4.5"
+extraction_notes: "Four high-confidence claims extracted on MA structural transformation, market concentration, C-SNP growth, and spending gap trajectory. Three enrichments: one challenge to prevention-first attractor state (MA data shows opposite pattern), one extension to Devoted claim (scale beats technology during tightening), one confirmation of GLP-1 cost inflation (C-SNP growth validates chronic medication management model). This is the definitive MA enrollment dataset — grounds all claims about US healthcare system trajectory."
 ---
 
 ## Content
@@ -79,3 +85,12 @@ tags: [medicare-advantage, enrollment, market-concentration, market-share, kff]
 PRIMARY CONNECTION: [[the healthcare attractor state is a prevention-first system where aligned payment continuous monitoring and AI-augmented care delivery create a flywheel that profits from health rather than sickness]]
 WHY ARCHIVED: Essential market structure data — the enrollment trajectory and concentration metrics ground claims about where the US healthcare system is actually heading vs. where theory says it should go.
 EXTRACTION HINT: The spending gap growing 4.7x while enrollment only doubled is the key structural insight — scale is making the overpayment problem worse, not better.
+
+
+## Key Facts
+- MA enrollment trajectory: 7.6M (2007, 19%) → 10.8M (2010, 25%) → 16.2M (2015, 32%) → 23.8M (2020, 42%) → 30.8M (2023, 51%) → 34.1M (2025, 54%)
+- MA plan type distribution (2025): Individual 62%, SNPs 21%, Employer/union 17%
+- SNP breakdown (2025): D-SNPs 6.1M (83%), C-SNPs 1.2M (16%), I-SNPs 115K (2%)
+- Top 5 MA insurers (2025): UnitedHealth 9.9M (29%), Humana 5.7M (17%), CVS/Aetna 4.1M (12%), Elevance 2.2M (7%), Kaiser 2.0M (6%)
+- Average parent organization options per beneficiary: 9, with 36% having 10+ options
+- Employer/union group MA plans: first year of flat growth in ~10 years