More than 3 million Medicare Advantage enrollees need to find new plans for 2027 in third year of turmoil

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Fewer health insurance plans. Higher out-of-pocket costs. Skimpier supplemental benefits.

This upheaval is what senior citizens will have to contend with when Medicare Advantage open enrollment for 2027 coverage begins on Thursday. That’s why it’s even more important that enrollees review their plan options so they aren’t hit with unexpected bills and other surprises next year, experts say.

Medicare Advantage, which covers just over half of Medicare’s roughly 71 million enrollees, is going through its third year of turmoil as health insurers overhaul their offerings. The changes are largely being spurred by medical costs outpacing reimbursements from the federal government, which pays insurers to provide coverage to Medicare enrollees – though critics say that insurers are overbilling for patient care.

Millions of senior citizens and other enrollees will have to find new Medicare Advantage plans because their policies are being terminated, while others could have to pay more for their coverage and care.

The disruption also comes as Americans prepare to vote in the midterm elections, where the rising cost of healthcare and other necessities is a key concern. Senior citizens are a reliable voting bloc that both parties are trying to woo. President Donald Trump announced this month that he is sending a $90 payment to about 20 million senior citizens to help them cover part of their Medicare premiums – but those enrolled in Medicare Advantage plans aren’t eligible.

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Medicare Advantage plans had grown rapidly in popularity as insurers expanded their offerings and benefits to lure the growing senior population. They are often more attractive than traditional Medicare to budget-conscious older Americans because they have limits on out-of-pocket spending and provide some supplemental benefits, such as dental, vision and hearing coverage. However, they typically have more limited doctor networks than traditional Medicare, and certain treatments can be subject to prior authorization.

But in recent years, insurers have been discontinuing their less profitable Medicare Advantage plans and seeking to stabilize their offerings, even if it means fewer policyholders. Insurers estimate that enrollment will drop to 34 million people, or 47.4% of total Medicare enrollment in 2027, though the Centers for Medicare and Medicare Services expects actual enrollment to be higher than projections and is stressing stability in the Medicare Advantage market. Open enrollment ends on December 7.

“CMS is fighting to keep high-quality care options affordable and accessible for the millions of beneficiaries who rely on Medicare Advantage and Part D prescription drug plans,” CMS Administrator Dr. Mehmet Oz said in a statement.

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Nearly 3.2 million Medicare Advantage enrollees, or almost 11%, will have to shop for new policies for 2027 because their insurers are no longer offering their plans, said Jared Strock, founder of Medicare Market Insights, a weekly newsletter for the Medicare industry leaders. That compares with about 2.9 million and 2 million enrollees whose plans were terminated for this year and for 2025, respectively. Prior to that, only 1% to 2% of enrollees typically lost their plans year to year.

Major insurers, including Humana, UnitedHealthcare, CVS’ Aetna and several Blue Cross and Blue Shield carriers, are among those culling their offerings or pulling out of geographic areas, according to Strock, who reviewed CMS data. Many of the plans being canceled are preferred provider organization, or PPO, policies, which give patients more flexibility and include out-of-network coverage.

To be sure, most enrollees will still have a choice of multiple policies. The average beneficiary will have 28 Medicare Advantage plans with prescription drug coverage to select from, although that’s down from a high of 36 plans in 2024, according to KFF , a nonpartisan health policy research group.

Still, a small but growing share of older Americans will not have any of these plans in their area. Some 638,000 people in 193 counties will be in this situation for 2027, up from 399,000 people in 123 counties this year, according to KFF.

The number of plans offered varies widely by state and county, said Haitham Aly, a principal at Oliver Wyman, a consulting firm. Rural residents are more likely to see insurers pull out, but those living in the Southeast typically have a wider array of choices.

“It’s very regionally driven,” he said. “There are some states where there’s minimal disruption as far as plan offerings to consumers. There are other states where there are a lot more drastic changes happening.”

Overall, there will be 5,532 Medicare Advantage plans next year, decreasing by only 21, according to CMS. But that figure includes so-called special needs plans that cater to specific categories of enrollees. Insurers are expanding their selection of policies for those with chronic conditions – particularly certain heart and lung diseases and diabetes. One incentive to do so is that they receive higher federal reimbursements for sicker enrollees.

Some 744 chronic condition plans are available for next year, up from 376 in 2025, according to Strock. Enrollment in those types of plans has skyrocketed to more than 1.8 million, up from about 401,000 in the fall of 2021.

Insurers are also expected to trim the generosity of their supplemental benefits, though CMS has yet to release its overview of these offerings for 2027, experts said. Enrollees may find that their dental and hearing benefits don’t cover as much care as they have in the past, their medical transportation benefits are curtailed or their allowances for over-the-counter products are reduced.

Many enrollees whose plans are not being terminated could see their costs increase for 2027, which is why they need to review their options. Insurers are trying to return to or boost the profitability of their policies as they contend with higher prices and greater healthcare usage among patients.

Average monthly premiums, weighted for enrollment, will dip 7% to $12.11 overall, but much will depend on what type of Medicare Advantage policy an enrollee has, Strock said. The plans that don’t cater to people with chronic conditions or other special needs will see their premiums jump 23% to $14.80 a month. Just over 1 in 5 people with non-special needs coverage will be hit with a premium increase.

The plans for those with chronic conditions, on the other hand, will be less expensive.

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Meanwhile, insurers are also raising the out-of-pocket limits that enrollees will face, leaving them on the hook for more of the cost of care. On average, the enrollment-weighted maximum for in-network services will be $6,603, up 9% from this year, Strock said. Some 70% of enrollees will see their out-of-pocket cap increase, compared with 35% for this year.

And nearly three-quarters of enrollees will have to pay more for prescription medications, with the average enrollment-weighted deductible jumping 23% to $509 for plans with drug coverage. Only 12% of enrollees are expected to be in plans with no deductible, down from 60% in 2024.

“Better funding brought Medicare Advantage premiums down for 2027, but a record number of seniors will have to find new coverage, and many will pay more when they need care,” Mary Beth Donahue, CEO of the Better Medicare Alliance, a coalition of insurers, providers, business groups and community organizations that advocates for Medicare Advantage, said in a statement to CNN. “Seniors shouldn’t have to face this disruption every year.”

Those in traditional Medicare who buy standalone Part D drug policies from insurers will also see some changes for 2027.

More than 1 million people are losing their Part D plans and will have to pick new options, said Brooks Conway, principal at Oliver Wyman. CVS’ Aetna is leaving the market, which is dominated by Humana and Centene.

No plans with $0 premiums will be available, though almost every state will have policies with monthly premiums of less than $20, he said. Part of the reason is that Trump discontinued a Biden-era subsidy for insurers aimed at stabilizing their costs after the Democrats’ Inflation Reduction Act in 2022 left carriers on the hook for more of the drug spending by sicker enrollees.

While CMS is highlighting that the average Part D monthly premium will increase less than $1 to $36 for next year, some insurers are hiking premiums by more than $50 a month. So enrollees should check the cost of their plans for 2027.

“Those people won’t be technically forced to shop, but if they do shop, they’ll have significant premium reductions,” Conway said.

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医疗保险计划减少。自付费用增加。补充福利减少。

专家表示，2027 年联邦医疗保险优势计划 (Medicare Advantage) 的开放注册将于本周四开始，届时老年人将不得不面对这一变化。因此，参保人仔细审查他们的计划选项就显得尤为重要，以免明年收到意料之外的账单或其他意外情况。

覆盖联邦医疗保险（Medicare）约7100万参保人中略超过一半的联邦医疗保险优势计划（Medicare Advantage）正经历着第三年的动荡，因为健康保险公司正在对其产品进行全面改革。这些变革主要是由于医疗成本的增长超过了联邦政府的报销额度，联邦政府向保险公司支付费用，由保险公司为联邦医疗保险参保人提供医疗服务——尽管批评人士指出，保险公司存在过度收费的情况。

数百万老年人和其他参保人将不得不寻找新的医疗保险优势计划，因为他们的保单将被终止，而其他人可能不得不为他们的保险和护理支付更多费用。

此次混乱正值美国民众准备参加中期选举之际，医疗保健和其他必需品价格上涨是此次选举的关键议题。老年人是两党都力图争取的可靠选民群体。本月，唐纳德·特朗普总统宣布将向约2000万老年人发放90美元的补贴，以帮助他们支付部分医疗保险费——但参加联邦医疗保险优势计划（Medicare Advantage）的老年人不符合资格。

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社会保障金是否跟得上您的生活成本上涨？分享您的故事

随着保险公司为了吸引日益增长的老年人口而不断扩大产品和服务范围，联邦医疗保险优势计划（Medicare Advantage）迅速发展壮大。对于注重预算的美国老年人来说，这类计划通常比传统的联邦医疗保险更具吸引力，因为它们限制了自付费用，并提供一些补充福利，例如牙科、视力和听力方面的保障。然而，与传统的联邦医疗保险相比，这类计划的医生网络通常更为有限，而且某些治疗可能需要事先获得授权。

但近年来，保险公司一直在逐步停止盈利能力较弱的联邦医疗保险优势计划（Medicare Advantage），并寻求稳定其产品组合，即便这意味着投保人数会减少。保险公司预计，到2027年，参保人数将降至3400万人，占联邦医疗保险总参保人数的47.4%。不过，联邦医疗保险和医疗补助服务中心（CMS）预计实际参保人数将高于预期，并强调联邦医疗保险优势计划市场的稳定性。开放注册期将于12月7日结束。

“CMS正在努力确保数百万依赖联邦医疗保险优势计划和D部分处方药计划的受益人能够负担得起高质量的医疗保健选择，并且能够获得这些选择，”CMS局长梅赫迈特·奥兹博士在一份声明中表示。

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据面向联邦医疗保险行业领袖的周刊《联邦医疗保险市场洞察》（Medicare Market Insights）创始人贾里德·斯特罗克（Jared Strock）称，近320万联邦医疗保险优势计划（Medicare Advantage）参保人，约占总数的11%，将不得不为2027年寻找新的保单，因为他们的保险公司不再提供该计划。相比之下，今年和2025年分别约有290万和200万参保人的计划被终止。在此之前，通常每年只有1%到2%的参保人会失去他们的计划。

据查阅了美国医疗保险和医疗补助服务中心（CMS）数据的斯特罗克称，包括Humana、UnitedHealthcare、CVS旗下的Aetna以及多家蓝十字蓝盾保险公司在内的多家大型保险公司，都在缩减服务范围或退出某些地区。许多被取消的计划都是优选医疗机构（PPO）计划，这类计划为患者提供更大的灵活性，并包含网络外医疗服务。

可以肯定的是，大多数参保人仍然会有多种保险方案可供选择。据无党派健康政策研究机构凯撒家庭基金会（KFF）称，平均每位受益人将有28种包含处方药保障的联邦医疗保险优势计划可供选择，尽管这一数字低于2024年36种计划的峰值。

然而，仍有一小部分但不断增长的美国老年人所在地区将无法获得任何此类计划。据凯撒家庭基金会（KFF）的数据显示，到2027年，将有193个县的约63.8万人面临这种​​情况，高于今年123个县的39.9万人。

奥纬咨询公司（Oliver Wyman）负责人海瑟姆·艾利表示，各州和各县提供的保险计划数量差异很大。农村居民更有可能面临保险公司撤出市场的情况，但居住在东南部的居民通常有更多选择。

他说：“这很大程度上取决于地区情况。有些州对消费者提供的保险计划几乎没有造成任何影响。而另一些州则发生了更为剧烈的变化。”

据美国医疗保险和医疗补助服务中心（CMS）的数据显示，明年联邦医疗保险优势计划（Medicare Advantage）总数将达到5532个，仅减少21个。但这一数字包含了所谓的特殊需求计划，这些计划专门针对特定类别的参保人。保险公司正在扩大针对慢性病患者的保险选择范围，尤其是某些心脏和肺部疾病以及糖尿病患者。促使他们这样做的一个原因是，他们可以从病情较重的参保人那里获得更高的联邦报销。

据斯特罗克称，明年将有约744种慢性病保险计划可供选择，高于2025年的376种。这类保险计划的参保人数已飙升至超过180万，而2021年秋季的参保人数约为40.1万。

专家表示，保险公司预计也会削减补充福利的慷慨程度，尽管美国医疗保险和医疗补助服务中心（CMS）尚未发布2027年相关福利的概述。参保人可能会发现，他们的牙科和听力福利覆盖范围不如以往，医疗交通福利有所缩减，或者非处方药的报销额度有所降低。

许多参保人即使保单未被终止，也可能面临2027年保费上涨的风险，因此他们需要重新审视自己的选择。保险公司正努力恢复或提高保单的盈利能力，以应对不断上涨的医疗价格和患者日益增长的医疗需求。

斯特罗克表示，按参保人数加权计算，平均每月保费将下降7%至12.11美元，但具体金额很大程度上取决于参保人所购买的联邦医疗保险优势计划（Medicare Advantage）的类型。不针对慢性病患者或其他特殊需求人群的计划，其保费将上涨23%至每月14.80美元。超过五分之一的非特殊需求人群将面临保费上涨。

另一方面，针对慢性病患者的计划费用会更低。

佛罗里达州曾是退休人士的理想之地，如今一些老年人却面临危机。

与此同时，保险公司也在提高参保人的自付费用上限，这意味着他们需要承担更多的医疗费用。斯特罗克表示，平均而言，网络内服务的加权平均最高自付费用将达到6603美元，比今年上涨9%。约70%的参保人将面临自付费用上限提高的情况，而今年这一比例为35%。

近四分之三的参保人将需要支付更多处方药费用，平均参保人加权自付额将上涨23%，达到509美元（适用于包含药品保险的计划）。预计只有12%的参保人会选择无自付额的计划，低于2024年的60%。

“资金的增加降低了2027年联邦医疗保险优势计划（Medicare Advantage）的保费，但创纪录数量的老年人将不得不寻找新的保险，而且许多人在需要医疗服务时将支付更多费用，”倡导联邦医疗保险优势计划的保险公司、医疗服务提供商、商业团体和社区组织组成的联盟“更佳联邦医疗保险联盟”（Better Medicare Alliance）首席执行官玛丽·贝丝·多纳休（Mary Beth Donahue）在给CNN的一份声明中表示。“老年人不应该每年都面临这种困境。”

参加传统医疗保险并从保险公司购买独立D部分药品保险的人，在2027年也将看到一些变化。

奥纬咨询公司负责人布鲁克斯·康威表示，超过100万人将失去他们的D部分医疗保险计划，不得不选择新的方案。CVS旗下的安泰保险公司（Aetna）即将退出市场，该市场目前由哈门那保险公司（Humana）和森特恩保险公司（Centene）主导。

他表示，虽然不会提供零保费的保险计划，但几乎每个州都会有月保费低于20美元的保单。部分原因是，在民主党2022年通过《通货膨胀削减法案》后，特朗普终止了拜登时期旨在稳定保险公司成本的补贴。该法案使得保险公司需要承担更多重症患者的药品支出。

尽管美国医疗保险和医疗补助服务中心 (CMS) 强调，明年 D 部分医疗保险的平均月保费涨幅不到 1 美元，至 36 美元不等，但一些保险公司却将保费提高了 50 美元以上。因此，参保人应该查看一下自己 2027 年的保险计划费用。

康威说：“这些人不会被迫购物，但如果他们购物，就能享受大幅保费折扣。”