We talked about the 2027 CMS Final Rule on Medicare Advantage Payments and the 2027 Final Rule on Star ratings earlier in the week. What are others saying now about these two critical pieces impacting the 2027 Medicare landscape?
AHIP, the leading advocacy group for insurance companies, said, “As health plans incorporate the policies released in recent days, they will continue to focus on keeping coverage and care as affordable as possible during this time of sharply rising medical costs,” said Chris Bond, spokesperson for AHIP.
Fierce Healthcare also reports that the American Medical Group Association (AMGA) “objected” to the slight payment increase included in the 2027 CMS Final Rule on Medicare Advantage Payments, saying the rule “fails to keep pace with the real-world costs of delivering care to Medicare patients.”
Aetna, Elevance, and UnitedHealthcare reacted negatively to the draft 2027 MA rate proposal from CMS earlier this year, according to Deft Research, and stated some specific actions they may have to take in response. What will they think of the final rule now?
First Quarter MA Plans’ Results and Guidance – A First Clue
First-quarter results for public MA plans will be coming very soon. The Medical Loss Ratio (MLR) they report for their Medicare MA segment is a very important number to see, along with the trend for this number compared to last year’s 1st-quarter Medicare MLR and the Medicare MLR for the 4th quarter of 2025.
An increasing Medicare MLR for an MA plan is a sign of rising costs that the plan must address with its CMS revenue. Will the 2027 rate increase be enough to meet the MA plan’s margin needs?
The MA plan’s guidance may reveal a clue to the answer. If the guidance is positive, saying the MLR costs are meeting their 2026 projections and they feel good about the rest of the year, that’s a sign that the CMS MA payment rate may work for their financial margin requirements.
Any guidance indicating they’re uncertain or negative about the rest of 2026 is a negative signal about the CMS MA payment rate’s impact on their financial margin requirements.
So, What Do MA Agents Do Now?
- Find your MA plans partners’ first-quarter results when they report them to learn about the items we mentioned above. If you have any questions about what you find, please reach out to us as we’re here to help you find answers.
- The last couple of years have seen changes to the Medicare Advantage landscape that we guided Medicare agents through, so the same guidance is in play now to address what the future may bring. A diverse portfolio of products is essential for all Medicare agents to protect their clients and book, so now’s a great time to review your portfolio to see where it can improve to better protect Medicare clients and your bottom line.
- It’s never a bad time to review how you help clients who receive negative news about their current Medicare plan and may need different options for the upcoming plan year. When evaluating this client outreach, assess the plan’s scalability based on the number of clients and partners who may need it.
- As part of this process, Medicare agents should ask their MA partners to confirm which network providers are value-based care or Accountable Care Organization participants with the MA plan, if they don’t already have this list of providers and their locations.
- You want to have the best doctors available to refer your Medicare clients to, so if you don’t already have this list, requesting it is a good step for client service and preparation to help clients who may need to change doctors in the future if they must switch to a new health plan.
The Agility Difference
Agility will continue to provide Medicare and all insurance agents with updates like this, so you know what is happening and can best prepare for 2027. As the insurance market continues to evolve, Agility helps you deliver the best client experience with our team’s decades of expertise, setting you up for growth in any environment.
With Agility, you receive the latest information like this about what’s happening in the insurance industry and what you can do about it for your immediate use. You also receive Dedicated Producer Support at (866) 590-9771 or support@enrollinsurance.com to answer your insurance questions and connect you with our Medicare, ACA, and ancillary experts.
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