AI, new product lines, shrinking broker networks and increasingly self-directed consumers will reshape the health insurance landscape in 2027, according to two reports from Forrester published Oct. 14, which covered the global insurance and healthcare industries broadly.
Here are the firm’s 10 health insurance industry predictions for next year:
1. Half of the 10 largest payers will launch alternative health plans.
Premiums will rise again across markets in 2027, with marketplace and small-group customers expected to see double-digit increases. Forrester said insurers typically respond to consumer complaints by rolling back or limiting benefits, which creates more confusion without addressing affordability. Existing alternative health plan examples include UnitedHealthcare’s Surest and Health Care Service Corporation’s new Easify Edge product.
2. More than half of consumers will start their healthcare journey using public AI models (such as ChatGPT or Claude), with 42% of consumers polled by Forrester already using an answer engine for healthcare advice. Gen Z and millennial consumers increasingly trust AI before turning to healthcare organizations, according to the report. Forrester warned that providers, payers and pharma will struggle to pull consumers back to proprietary digital experiences as AI assistants take on the role of helping people compare, navigate and coordinate care.
3. A third of insurers will integrate agentic AI into customer experience, but most will not let it make binding coverage or claims decisions. Forrester pointed to Allianz’s Project Nemo as an example of how large payers are using agentic AI to automate analysis and orchestrate workflows. But the regulatory environment means most firms will stop short of letting unsupervised AI agents set prices, deny claims or authorize payouts.
4. AI agents, not physicians, will perform 20% of routine care check-ins.
Workforce shortages will persist and demand for care will continue to outpace capacity, according to the report. Incumbent health systems and digital-native challengers will increasingly deploy medically trained AI agents for medication renewals, chronic condition monitoring, care navigation and wellness support. Forty-one percent of U.S. online adults are at least somewhat interested in receiving medical care through medically trained AI models, per Forrester’s data. The firm says healthcare organizations need to define which interactions AI agents can safely own, redesign clinical workflows around human escalation and create reimbursement and governance models for AI-mediated check-ins.
5. GLP-1 adoption will reach 20% of Americans, inspiring new drug pathways.
More than half of U.S. online adults now research medications on their own before talking to a doctor, and one-fifth have medications delivered directly to their homes, according to the report. Forrester said the GLP-1 experience is becoming a blueprint for how consumers expect healthcare to work, and those expectations will extend to other chronic, lifestyle and preference-sensitive conditions. Pharma companies will invest more in direct-to-consumer strategies and virtual care partnerships and less in traditional distribution channels. Forrester said providers and payers need to rethink economic models built around monetizing sick care and focus on long-term outcomes.
6. At-home tests will become a new digital divide and increase healthcare inequities. Forrester predicts 25% of U.S. consumers will routinely use at-home diagnostics to confirm health insights before interacting with traditional providers by 2027. As wealthier consumers gain access to increasingly sophisticated health intelligence through wearables, digital wellness programs and AI coaches, the firm warned healthcare organizations risk a new form of inequity in prevention, early detection and outcomes.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
