Medicare Advantage market disruption
Key Questions
How many seniors could lose Medicare Advantage plans in 2027?
Up to 5 million may lose plans due to insurer exits and UHC's 2.9 million disenrollments. Aetna is closing about 90 plans and Centene is cutting 40,000.
What payment changes did CMS finalize for MA in 2027?
CMS set a 2.48% payment increase, effective about 4.98% with risk scores. Plans must trim dental, vision, and gym perks despite the $13.4 billion QBP raise.
Why are hospitals dropping MA plans?
Payment disputes led 23 systems including Mayo Clinic to exit in 2026. OIG data shows 65% of LTCH and 54% of IRF prior auth requests denied.
What prior authorization reforms are advancing in Congress?
House Ways & Means advanced the Seniors Timely Access to Care Act. Blumenthal and Hawley are pressing MA giants over 51-80% denial rates.
How are network disputes affecting Rhode Island seniors?
UHC and Brown Health's second-year standoff affects patients in a market with 60% MA penetration. Many lose doctors for the second consecutive year.
UHC disenrollment 2.9M; insurers exiting; up to 5M seniors could lose MA plans for 2027 (JAMA methodology). Aetna closing ~90 plans; Centene cutting 40k; Molina exiting 117k. Elevance pays $342M to CMS; sues over star ratings. KFF: MA QBP spending $13.4B, coding intensity $28B overpayment. Medigap guaranteed issue triggered. JAMA: 1 in 10 MA members forced to switch in 2026. OIG data: MA plans deny 65% of LTCH and 54% of IRF prior auth requests. 23 hospital systems including Mayo Clinic have left MA in 2026. First MA enrollment drop among new beneficiaries since 2010. Elevance sues CMS over Star Ratings. CMS released new MA-PD payment guidance on June 30, 2026. Humana pulling MA plans from 194 counties, affecting 560k members — adds granular rural concentration risk. CMS finalized 2.48% MA payment increase for 2027 (up from 0.09% proposal), effective ~4.98% with risk scores; upcoding crackdown on unlinked chart reviews; market reaction positive but AMGA warns may not cover rising costs. Adverse selection dynamic in Original Medicare pool from MA exits. CMS CY 2027 Risk Adjustment Implementation guidance released — technical but relevant to payment accuracy and upcoding. Senators Blumenthal/Hawley press MA giants over prior authorization denials; OIG findings 51-80% denial rates; naviHealth AI lawsuit trial set for 2027. House Ways & Means advances Seniors Timely Access to Care Act (prior authorization reform) — CBO cost-neutral after CMS rulemaking. AARP backs $5k out-of-pocket cap for Original Medicare, addressing coverage gap driving MA enrollment. Hospitals continue dropping MA plans; CMS proposes 2027 Special Enrollment Period for affected seniors; OIG data shows 13% wrongful denial rate and near-total overturn of SNF appeals. New: MA plans set to trim dental, vision, and gym perks in 2027 despite $13B payment increase — new compliance rules on SSBCI and prepaid debit cards squeeze margins, benefit cuts directly affect millions of seniors. Rhode Island UHC-Brown Health standoff second year in a row — 60% MA penetration, patients caught in network disputes.