Competitive pressure intensifying in Medicare Advantage. Medicare advantage growth in the 2022 annual enrollment period was not uniformly strong as in recent years. Humana's enrollment grew only approximately 3%, well below initial forecasts, and Centene and Cigna expect membership growth to slow in 2022. Humana cited increased outreach to beneficiaries from competitors and aggregators that encourage people to call the number on their TV screen to get the best deal. It seems clear that competition is forcing more of a trade-off between growth and margin.