The Medicare Advantage market remains a bit of a paradox: it may look unchanged from a national level heading into 2027, but seniors will have fewer plans to choose from in more than half of the states and growth continues to be driven by special needs plans.
The retreat continues what began in 2025, when insurers cut plans, reduced benefits and scaled back broker commissions to rebuild their margins as medical costs outpaced reimbursement, leaving nearly three million enrollees needing to find new coverage for 2026. This coming year, total market exits are concentrated among health system-owned and regional plans, while national carriers are once again trimming counties, benefits, and shifting away from PPOs.
Ahead of Oct. 1, when insurers can discuss their 2027 portfolios, a majority of the industry expected less rich benefits and said their MA business was unprofitable. CMS raised 2027 payments by 2.48% (counting risk score trends, the increase is 4.98%), or more than $13 billion, which the industry largely said was not sufficient to counter the broader market headwinds.
Add the end of the Part D premium stabilization program alongside an ever-growing list of health systems paring down the MA plans they accept, seniors are facing a second year of upheaval heading into the annual enrollment period, which runs Oct. 15 to Dec. 7.
Here’s what else to know:
Premiums and enrollment counts
- Plans are expecting MA enrollment of 34 million beneficiaries in 2027, or about 47.4% of all Medicare enrollees. This would be flat compared with the 2026 projections, but actual MA enrollment was 36.1 million as of June.
- CMS projects the weighted average monthly MA premium will fall 16.5%, from $14.37 to $12. The average Part D premium in MA-PD plans will drop from $11.32 to $7, and the number of plans available nationwide will dip from 5,553 to about 5,532.
- About eight in 10 enrollees can keep their plan at the same or a lower premium, CMS said.
- Wyoming will have the highest 2027 average MA premium at $69.23, followed by Minnesota at $59.40 and South Dakota at $56.04. Nevada has the lowest at 56 cents.
- The cheapest Part D plan in 2027 will cost $5.30 a month in 44 states plus D.C. The highest floor is in New York, where the cheapest plan is $37.30.
Where insurers are pulling back
- Plan options will fall in 28 states. Florida is losing the most plans, falling from 611 to 560, and Wyoming will see the steepest percentage drop, from 14 plans to eight.
- For standard MA plans, HCSC is leaving the most counties, dropping from 948 to 450, following its purchase of Cigna’s Medicare business in 2025. Devoted Health is adding the most counties, expanding from 999 to 1,341.
- Some of the largest insurers are each exiting more than 100 counties, with Centene leaving 344, UnitedHealthcare 140 and Aetna 123. Humana is leaving 57 counties and Elevance’s footprint is shrinking by 56.
- Twelve payers that sold MA plans in 2026 will not offer any in 2027. Eight of those are owned at least in part by health systems, including Providence, Memorial Hermann and Christus Health. Wellmark, BCBS North Dakota and BCBS Mississippi will also exit the market.
- Molina, Presbyterian Health Plan, and Horizon BCBS New Jersey are among some plans that will stay in MA, but only through special needs plans.
- Only four organizations are entering the market in 2027, including St. Luke’s Health Plan in Idaho and MultiCare Health System in Washington state.
- Fifteen insurers have set enrollment caps on 65 plans across 11 states for 2027. Caps range from 410 to 56,345 members, and a plan that reaches its cap stays closed to new enrollees until members leave.
Special needs plans continue to grow
- The number of special needs plans will grow 9.4% in 2027, from 1,800 to 1,969. C-SNPs account for nearly all the growth, rising from 562 to 754, or 34%.
- New enrollment in some dual-eligible plans will be limited in 2027 to people also enrolled in the insurer’s affiliated Medicaid plan.
- HCSC, Aetna, Centene, Humana and CareSource are each pulling dual-eligible plans from more than 100 net counties.
- Devoted Health is adding SNPs in a net 350 counties, the biggest growth of any insurer. UnitedHealthcare will offer SNPs in the most counties overall (2,762), followed by Humana (2,259), Aetna (1,733), Elevance (1,584), Centene (1,582) and Devoted (1,339).
UnitedHealthcare
- UHC will offer 852 MA plans in 2027, up from 846, as it cuts 34 PPOs and adds 40 special needs plans.
- UHC will sell MA plans in 2,791 counties, up from 2,787, but it’s pulling standard plans from 140 of them, leaving most of those markets with only its special needs plans. The insurer is leaving 34 counties entirely, including all of Wyoming.
- Bobby Hunter, who was named president of UnitedHealthcare this month, said during a Sept. 28 media briefing that MA funding has not kept pace with medical and pharmacy costs.
“What it’s resulted in is us having to take a little bit more of a refined approach to how we think about a portfolio of plans,” he said. “While some plans may see changes to their annual maximum out-of-pocket limits, it’s important to note that more than 95% of our non-special needs plan members never reach that limit.”
Humana
- Humana will offer 861 MA plans in 2027, down from 887, as it drops 37 PPOs while adding a handful of HMOs and special needs plans, including C-SNPs in Pennsylvania, Utah and Wisconsin.
- Humana is leaving 57 counties and exiting Minnesota. Overall, it will sell MA plans in 2,600 counties across 45 states and Washington, D.C. The company previously said its 2027 plan exits will affect about 600,000 members, after it added more than 1.2 million members during the last enrollment period.
Devoted Health
- Devoted Health will offer 740 MA plans in 2027, up from 427, a 73% increase. Its C-SNPs are more than doubling, from 122 to 255. The insurer is also adding PPOs, rising from 113 to 189.
- Devoted is entering 342 counties and expanding into Connecticut, Michigan, New Hampshire, New Jersey and New York. Overall, it will sell MA plans in 1,341 counties across 34 states.
Aetna
- Aetna will offer 654 MA plans in 2027, up from 642, as it adds 29 C-SNPs and cuts 20 PPOs.
- Aetna is pulling standard plans from 123 counties and exiting Maryland and New Hampshire. Overall, it will sell MA plans in 2,072 counties, down from 2,139, and it is pulling dual-eligible plans from a net 168 counties.
Elevance Health
- Elevance will offer 308 MA plans in 2027, down from 345, with most of the cuts coming from dual-eligible plans. Its chronic condition plans are expanding into Colorado and Maine, though the number of those plans overall is dipping from 57 to 52.
- Elevance is pulling standard plans from 56 counties and exiting South Carolina. Overall, it will sell MA plans in 1,590 counties across 23 states and Puerto Rico, nearly unchanged from 1,594 last year.
Centene
- Centene will offer 210 MA plans in 2027, down from 303, cutting nearly a third of its lineup. Its standard plans fall from 187 to 110, and its dual-eligible plans from 111 to 97.
- Centene is pulling standard plans from 344 counties and exiting Hawaii, Oklahoma and Tennessee. It is also dropping standard plans in Nevada and Ohio, where it will sell only special needs plans. Overall, it will sell MA plans in 1,692 counties, down from 1,853.
HCSC
- HCSC will offer 200 MA plans in 2027, down from 283, as it cuts 48 PPOs and 35 HMOs, while its special needs plans hold steady at 51.
- HCSC will sell MA plans in 478 counties in 2027, down from 948, and exit Connecticut, Kansas, Montana, New York, Oregon, Utah and Washington, D.C. Its sharpest pullbacks are in its own Blue Cross Blue Shield states, where its county footprint falls from 229 to 47 in Texas, 100 to seven in Illinois and 58 to six in Oklahoma.
Kaiser Permanente
- Kaiser will offer 117 MA plans in 2027, down from 126, and is dropping its last three PPOs. Its remaining standard plans are all HMOs.
- Kaiser is leaving two counties in Nevada and three in Washington state, but it will remain in the nine states and Washington, D.C., where it sells MA.
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