The Medicare Advantage (MA) market continues to contract as several insurers reduce their geographic footprint or discontinue products for the 2027 plan year. Rising medical costs, changes to CMS payment and Star Ratings policies, and ongoing financial pressures are driving many organizations to reassess their participation in the program. At the same time, provider concerns regarding prior authorization, reimbursement, and administrative burden continue to strain relationships between health systems and MA plans.
These market changes are directly affecting beneficiaries. A recent JAMA study estimated that approximately 10% of Medicare Advantage enrollees were required to change plans for 2026 because their insurer exited the market, although most retained access to another MA option during open enrollment.
Several insurers have already announced significant changes for 2027:
- Humana will exit selected Medicare Advantage markets affecting approximately 600,000 beneficiaries.
- Clear Spring Health has completed its withdrawal from the Medicare Advantage market.
- Molina Healthcare will discontinue its standard Medicare Advantage Prescription Drug plans and focus on products for dual-eligible beneficiaries.
- Presbyterian Health Plan will discontinue most of its Medicare Advantage plans, affecting approximately 30,000 members.
For gastroenterologists, these developments have implications beyond plan availability. Changes in provider networks, prior authorization requirements, site-of-service policies, and coverage determinations may affect patient access to endoscopic procedures and other GI services while increasing administrative complexity for practices.
ASGE will continue to monitor Medicare Advantage policy developments and advocate for coverage and payment policies that preserve patient access to high-quality, evidence-based gastrointestinal care while reducing unnecessary administrative burden.