With Medicare's annual enrollment period on the horizon, major insurers are offering a look at their plans for the coming year as new federal data offers a broader view of the current landscape.
The story of Medicare Advantage in 2027 is a bit of a mixed bag, with elevated costs and utilization continuing to force insurers to weigh tradeoffs between geographic reach, benefit design and supplemental coverage. In a note published Tuesday, analysts at Leerink Partners said that commentary from brokers and available data point to reduced benefits in the coming year.
"Medicare Advantage insurers are prioritizing margin—they are cutting benefits, raising member cost-sharing, withdrawing PPOs and limiting broker commissions," the analysts wrote.
A report from analysts at Stephens also dives into where plans may be adjusting their geographic footprints as they adapt portfolios in a complex market.
Medicare's annual enrollment period begins on Oct. 15 and continues through Dec. 7.
Digging into market exits, member costs
Per the Stephens report, footprints overall for most key players in MA are stable. Only one plan included in the analysis, Molina Healthcare, is fully exiting individual MA for the coming year, though it will continue to offer special needs plans.
On a county-level basis, Humana has the largest footprint for 2027, with 2,694 counties. That's a 1% increase from 2026, when the insurer offered MA plans in 2,655 counties. UnitedHealthcare is close behind, offering plans in 2,534 counties for 2027, a 2% decline from its 2026 footprint of 2,597 counties.
Other payers slimming down their footprints include CVS Health's Aetna, which will offer MA plans in 1,980 counties for 2027, down 5% from its 2026 footprint of 2,083 counties. Elevance Health will also trim its footprint by 5% from 1,030 counties in 2026 to 974 counties in 2027.
The largest decline among major payers is at Centene, which is cutting its MA footprint by 20% from 1,731 counties to 1,387 counties, per the Stephens report.
The Stephens analysis also finds that the average out-of-pocket maximum in MA for 2027 will increase by 9.1%. Among major insurers, the highest average was at Centene, with an increase of 16.1% in average OOP for 2027.
The highest increase overall was for Clover Health, with average OOP maximums increasing next year by 28.5%, Stephens analysts found.
"Relative to footprint expansion, most of the public [managed care organizations] will be reducing the number of counties served by their individual offerings while [special needs plan] market expansion is mixed," they wrote.
What key payers have on deck
UnitedHealthcare, the largest insurer in the market, is putting a focus on affordability and access for its 2027 slate with an emphasis on "preserving the core benefits that customers rely on," said Bobby Hunter, president of UHC, during a briefing with reporters.
Part of this effort, Hunter said, is a renewed emphasis on HMO plans rather than PPO plans. In the former, a patient generally needs a referral from a primary care provider to seek specialty care, while in a PPO they can typically secure any in-network care they want on their own.
The company said in an announcement that about 95% of Medicare eligibles within its geographic reach will have access to an HMO plan, with most offering a $0 premium. UHC said that enrollees in HMOs saved more than $175 per year in OOP costs compared to PPOs.
Hunter said that these plans allow for more effective care coordination, as they lean on primary care at the center of the experience as the "quarterback of care."
"It’s important that the primary care provider is in the driver seat," Hunter said.
Plan exits for the insurer, he said, are more concentrated in the PPO space as UnitedHealth doubles down on HMO plans.
Another area where the insurer is looking to get at the cost equation is in striking a balance between the core medical benefit and supplemental benefits, and offering options that allow enrollees to choose what they value. Hunter said that includes plans that focus more on the "essentials" in the medical benefit and plans that offer a bit more robust "extras," like dental, vision and hearing coverage.
This also tracks with what analysts were hearing from brokers. In the Leerink note, they wrote that the company "is pulling back hardest from broker-sold PPOs." The Stephens report also backs up the focus on HMOs: in 2026, UnitedHealthcare offered 6,462 HMO plans in its portfolio, and that has grown to 7,009 for 2027.
That HMO growth is even as the company trimmed down the total number of individual MA plans on offer from 12,421 to 11,734, per Stephens.
UnitedHealthcare added that it's investing in improvements to its UCard program, and for 2027 that translates to better security and convenience. Members can access enhanced digital tools to manage their UCard benefits and can spend the funds at more than 70,000 retailers across the country.
Humana, similarly, is centering affordability and choice in its 2027 plan offerings, per a company announcement. The insurer cites a recent survey from Morning Consult of Florida Seniors that found that they highly value affordability, access, choice and stability in their benefits.
One area where it's expanding, according to the announcement, is in chronic special needs plans, or C-SNPs, where Humana is adding three states to its footprint: Pennsylvania, Utah and Wisconsin. The company added that it's maintaining $0 copayments on in-network primary care visits and hundreds of prescriptions in eligible plans.
Dental, hearing and vision benefits are available across plans, and there are multiple options at $0 or low premium, Humana said.
"Members consistently tell us they value affordable coverage and access to quality care and benefits such as pharmacy, dental and vision that support their everyday health needs," said Aaron Martin, president of insurance at Humana, in the announcement. "That feedback continues to guide our Medicare Advantage offerings and reinforce the important role the program plays in helping people navigate healthcare with confidence."
Elevance Health, meanwhile, said in its announcement that it's putting a focus on a "local approach" in its MA offerings. Plans are built around the provider relationships, needs and preferences of the communities that they serve, the company said.
Similar to Humana, Elevance put a focus on its special needs plans, including C-SNPs and dual special needs plans, or D-SNPs. In the dual plans, depending on design, members can tap into personalized care coordination and a range of benefits including transportation, over-the-counter options, dental, vision and hearing.
The company said that these products build on an established foundation, "while supporting the continued evolution" of their offerings.
"Our 2027 approach builds on Elevance Health’s experience, healthcare relationships and capabilities to serve more members and support a strong member experience," said Aimée Dailey, president of government health benefits at Elevance Health, in the announcement. "That experience across Medicare and Medicaid enables us to meet members’ needs today while strengthening the foundation for greater coordination over time."
Alignment Healthcare is adding 10 additional counties for the 2027 plan year, putting 934,000 additional Medicare eligibles in its footprint. The expansion includes new counties in Texas, North Carolina, California and Nevada, per a company announcement.
The insurer has also inked several key network agreements to expand options for its members, including Hoag and Astrana Health.
A highlight in its portfolio for 2027 is the new Central Health Harmony plan, which will be available in Los Angeles and Orange counties. This plan is built for Asian-American seniors in the region, offering a culturally competent experience in Chinese, Korean and Vietnamese, including more than 600 in-language providers in the network.
The plan taps into wellness offerings like acupuncture, cupping and reflexology, according to the announcement, and has added traditional Asian wellness products to its over-the-counter benefit.
"Every senior deserves a health plan that sees them as a person, not a number, and provides support throughout their health journey," said Dawn Maroney, president of Alignment Health and CEO of Alignment Health Plan, in the announcement. "Our commitment is simple: make healthcare easier to navigate and help members live healthier, more confident lives."