CMS released initial insights on the 2027 Medicare Advantage landscape Sept. 28, along with data breaking down plans.
One wrinkle gaining attention: enrollment capacity limits. In April, CMS said insurers could include enrollment caps for specific plans in their 2027 MA bids, relying on existing regulatory authority. With these caps, plans cannot disenroll current members. Once a plan hits its cap, it must stay closed to new enrollees until space opens up through natural attrition, according to the April memo. The agency baked enrollment caps into its August guidance for MA payers.
Ceci Connolly, president and CEO of the Alliance of Community Health Plans, recently told Becker’s that her organization made progress with CMS on “tweaks with respect to the regulatory perspective,” including enrollment caps.
“That is just, plain and simple, a responsible fiduciary kind of decision,” she said during an upcoming “Becker’s Payer Issues Podcast” episode. “They want to make certain that they can take care of everybody that enrolls.”
Becker’s reviewed the 65 MA plans — including MA plans with prescription drug coverage and special needs plans — with enrollment caps. These plans are available in 11 states and span 15 parent organizations. The caps range from 410 to 56,345 members.
Hawaii
Hawaii Medical Service Association (BCBS)
- Number of plans with enrollment caps: 5
- Highest enrollment cap: 12,800
- Lowest enrollment cap: 5,000
Maine
Martin’s Point Health Care
- Number of plans with enrollment caps: 9
- Highest enrollment cap: 22,350
- Lowest enrollment cap: 410
Maryland
Johns Hopkins Healthcare
- Number of plans with enrollment caps: 6
- Highest enrollment cap: 7,000
- Lowest enrollment cap: 500
CareFirst BCBS
- Number of plans with enrollment caps: 1
- Enrollment cap: 17,752
LifeBridge Health
- Number of plans with enrollment caps: 4
- Highest enrollment cap: 8,700
- Lowest enrollment cap: 3,150
Massachusetts
BCBS Massachusetts
- Number of plans with enrollment caps: 7
- Highest enrollment cap: 26,390
- Lowest enrollment cap: 1,560
Michigan
Henry Ford Health System
- Number of plans with enrollment caps: 2
- Highest enrollment cap: 35,000
- Lowest enrollment cap: 34,000
Minnesota
HealthPartners
- Number of plans with enrollment caps: 4
- Highest enrollment cap: 23,050
- Lowest enrollment cap: 1,875
Sanford Health
- Number of plans with enrollment caps: 2
- Highest enrollment cap: 4,500
- Lowest enrollment cap: 1,500
Nebraska
Sanford Health
- Number of plans with enrollment caps: 2
- Highest enrollment cap: 2,000
- Lowest enrollment cap: 1,000
BCBS Nebraska
- Number of plans with enrollment caps: 3
- Highest enrollment cap: 9,000
- Lowest enrollment cap: 5,000
New Jersey
Horizon BCBS New Jersey
- Number of plans with enrollment caps: 1
- Enrollment cap: 2,000
New York
Independent Health Association
- Number of plans with enrollment caps: 1
- Enrollment cap: 1,750
North Carolina
BCBS North Carolina
- Number of plans with enrollment caps: 5
- Highest enrollment cap: 19,582
- Lowest enrollment cap: 8,065
Wisconsin
HealthPartners
- Number of plans with enrollment caps: 2
- Highest enrollment cap: 6,100
- Lowest enrollment cap: 1,150
Group Health Cooperative of Eau Claire (Priority Health)
- Number of plans with enrollment caps: 1
- Enrollment cap: 2,500
Network Health
- Number of plans with enrollment caps: 10
- Highest enrollment cap: 56,345
- Lowest enrollment cap: 1,522
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