Medicare Advantage Will See Huge Changes Again in 2027
The Trump administration is putting the best spin possible on a continuing retrenchment in the Medicare Advantage (MA) industry. The Centers for Medicare & Medicaid Services (CMS) announced that weighted average MA premiums are projected to fall more than 16% from 2026 to 2027, with MA prescription drug (MA-PD) premiums set to decrease by 38% year-over-year. Additionally, CMS said average premium for standalone Part D prescription drug plans is projected to rise by less than $1 per month in 2027.
The industry certainly has a different narrative. While it is true that MA remains broadly available, there is little doubt that benefits are being further diminished and that more plan terminations are occurring. This is evident in the landscape file release.
A Becker’s Payer article gives an overview of the retrenchment still occurring. MA choice will go down in 29 of 51 states and the District of Columbia in 2027. Florida is losing the most plans overall, from 611 in 2026 to 560 in 2027. Ohio is dropping from 212 to 180, and Illinois is falling from 157 to 136.
Tennessee will see the most plans added, rising from 132 to 155, followed by Missouri (157 to 174), Arizona (133 to 148) and Alabama (98 to 113).
Most assessments say about 2.9 million people were impacted by plan closures in 2026, or about 10%. A new study by the Alliance of Community Health Plans and consulting firm HealthScape Advisors says that number was bigger in 2026, 4.6 million or 16% of enrollees.
Humana already said that its 2027 plan exits are expected to affect about 600,000 members. Earlier 2027 estimates suggested at least 1 million could face plan terminations, but impacts were not expected to be as high in 2027. The new HealthScape number for 2026 and preliminary data we now know could push the 2027 number well higher. We will know much more as the data is analyzed.
In addition, Modern Healthcare updates on some major Special Needs Plan (SNP) changes that are happening. Starting in 2027, CMS will limit new enrollments in Dual Eligible SNPs (D-SNPs) to people enrolled in Medicaid plans from the same carrier. The limitation only exists if the D-SNP holds a state Medicaid contract in an overlapping service area. By 2030, CMS will require all D-SNP beneficiaries to enroll in an aligned Medicare-Medicaid plan. The change will for the first time lead to some changes in MA plans’ approach to SNPs moving forward, including closing enrollment in certain states. Some plans are now moving to create Chronic Care or C-SNPs, which are not subject to the same regulations. But CMS is known to want to tighten requirements on these plans over time as well.
Another new development: CMS is allowing prospective enrollment caps to encourage plans to retain marginal business propositions. It appears just a small number of plans, a bit over a dozen, are taking advantage of the new policy.
Insurers are also battling with CMS over enrollment decline predictions. One was predicted last year but MA still grew by a nominal amount.
Additional articles: https://www.cms.gov/newsroom/press-releases/medicare-advantage-medicare-prescription-drug-programs-expected-remain-stable-2027 and https://www.fiercehealthcare.com/payers/cms-projects-medicare-advantage-premiums-decline-16-2027 and https://www.modernhealthcare.com/insurance/mh-medicare-advantage-d-snp-enrollment-2027/ and https://www.beckershospitalreview.com/finance/cms-projects-lower-medicare-advantage-premiums-flat-enrollment-for-2027/ and https://www.beckerspayer.com/payer/medicare-advantage/the-states-losing-the-most-medicare-advantage-plans-in-2027/ and https://www.beckerspayer.com/payer/medicare-advantage/a-real-checkerboard-the-medicare-advantage-threats-facing-older-adults-community-plans/
#medicareadvantage #enrollment
https://www.modernhealthcare.com/insurance/mh-2027-medicare-advantage-enrollment-cms
CJR Model Saves $180M
The final evaluation for the Comprehensive Care for Joint Replacement (CJR) model says the program saved Medicare $180 million in its final three performance years without changing care quality. CJR was launched in 2016 and was the first mandatory bundled payment program, covering some hospitals for hip and knee replacement. It ended in 2024.
Among findings is that CJR hospitals sent fewer patients to inpatient rehabilitation facilities, lowering rehab facility spending by an estimated $443 per episode. Rehab facility discharges dropped 28% and home health services increased 32%.
The mandatory Comprehensive Care for Joint Replacement Expanded (CJR-X) model will be launched in 2028, with most hospitals required to be in the program. Hospitals currently in the TEAM model are exempt until that program concludes at the end of 2030.
#medicare #vbcpayments
https://www.beckershospitalreview.com/finance/cjr-saved-medicare-180m-in-final-3-years-cms
— Marc S. Ryan
