2027 Medicare Open Enrollment is Here: What to Expect in Medicare Advantage

In my last article, I showed how Medicare Advantage carriers reset their strategies in 2026 to protect margin in a turbulent year. That turbulence carries into 2027 through new payment policy, new CMMI models, and major changes to state Medicaid programs. Open enrollment began on October 15, 2026, and runs through December 7, so the enrollment data has not arrived yet. However, I can still build a hypothesis for 2027 from what I measured between November 2025 and October 2026.

What carriers set up for 2027

• Humana exits plans covering roughly 600,000 members, about 8% of its MA business, and UnitedHealthcare discontinues plans affecting about 390,000. myplanfit

• UnitedHealthcare drops 34 PPO plans and adds 40 special needs plans. Aetna drops 20 PPOs and adds 29 chronic condition SNPs. myplanfit

• Oliver Wyman counts about 2.8 million general-enrollment members, 13% of 2026 enrollment, in plans that disappear for 2027. oliverwyman

• Aetna, Elevance and Centene told investors that 2027 bids focus on margin recovery, and UnitedHealthcare plans to trim supplemental benefits again. healthcaredive

My estimate for October 2027: Total Part C ends near 36.2 million members (range 36.0 to 36.4 million), a gain of about 0.2 million, or 0.5%.

• SNPs grow about 0.6 million to roughly 9.1 million, which slows from this year’s 9.6% because the one-time move of Medicare-Medicaid Plan members into D-SNPs does not repeat.

• Non-SNP Medicare Advantage loses about 0.4 million, because about 2.8 million general-enrollment members sit in plans that disappear for 2027 and carriers recapture only part of them.

• Medicare adds roughly 1.4 million eligibles, the same pace as this year, so traditional Medicare gains about 1.2 million and reaches about 35.4 million members (range 35.2 to 35.6 million). That implies MA’s share dips from 51.1% to about 50.4%, the first year-end decline. oliverwyman

Why I believe the carriers’ playbook works

UnitedHealthcare guided to about 1 million fewer MA members last year. CMS enrollment data show a 945,000 decline in its Part C book. UHC reported a medical loss ratio (MLR) of 88.4%, down from 89.9%, and raised guidance a third time. The carriers that shrank on purpose hit their numbers. beckerspayerhealthcaredive

Where I see divergence

• Humana pairs market exits with a quality bet. 95% of its members now sit in plans rated four stars or higher, and Evercore estimates $4.8 billion in quality bonus payments in 2028. Humana also restructured ownership of nearly 150 CenterWell clinics in a $2.8 billion deal with BlackRock. beinsurebeinsure

• HCSC cut its MA footprint in half, a pullback that affects about 127,000 of its roughly 800,000 members. It is the largest reduction of any major insurer for 2027. beckerspayer

• Consolidation moves toward scale. UCare terminated its Medicare Advantage contracts, and Medica acquired its Medicaid and individual plans. Providence plans to exit most of its health insurance business in 2027. insurancenewsnetbeckerspayer

Part D changes the math for beneficiaries

CMS ends the Part D premium stabilization demonstration, which affects 25 million standalone PDP enrollees. Going forward, $ 0-premium PDPs will exist only for enrollees with low-income subsidies. The national average MA premium drops to $12 a month from $14.37.

My hypothesis: the gap between a bundled MA-PD and a standalone drug plan will widen, which will push standalone Part-D enrollees toward MA. News - Articles - July 30, 2026 +2

The 2027 policy shocks

• Medicaid work requirements and semiannual redeterminations begin in 2027. A dual-eligible member who briefly loses Medicaid, even over an administrative issue, loses D-SNP enrollment automatically. That puts the fastest-growing MA segment at churn risk. advisoryoliverwyman

• CMS launches LEAD in 2027, a 10-year ACO model. It borrows prospective capitated payments from Medicare Advantage. Traditional Medicare gets more MA-like features. healthmanagementhealthaffairs

My 2027 call

General-population MA stays flat or slips slightly while SNPs keep growing, with chronic-condition plans leading the way. Carriers that earn growth through stars and care delivery pull ahead of those that cut their way to margin. Once again, this is simply a hypothesis and I will test this when CMS publishes the first 2027 enrollment files. One final note on new value-based care models such as LEAD. I don't believe it's a threat to MA yet, but if it's successful and the affiliated providers earn higher CAHPS scores. I'm keeping a close eye on large health systems that are exiting Medicare Advantage and placing their bets on VBC models. Before you go, if you found this article insightful, please check out my Podcast, The Outer Shell Podcast from Covalence Health - available on Apple Podcasts, Spotify, or YouTube - where I invite industry veterans and experts for in-depth conversations about issues that truly impact healthcare in our country.