Medicare Advantage's Retreat: From the 2026 Rate Hike to the 2027 Plan Exits and Open Enrollment

Federal judge denies Elevance star-ratings preliminary injunction

The U.S. District Court for the Southern District of Georgia denied Elevance Health's motion for a preliminary injunction over its Medicare Advantage star ratings. The court also denied the government's motion to dismiss the case.

• U.S. District Court for the Southern District of Georgia order, reproduced by Justia · Aug 27, 2026 · ORDER denying #34 Motion to Dismiss; denying #7 Motion for Preliminary Injunction.

Editor's note: The order states that the Southern District of Georgia denied both the government's Motion to Dismiss and Elevance's Motion for Preliminary Injunction. It was signed by Judge Lisa G. Wood on 2026-08-27.

2027 Part D base premium set at $41.33 under the IRA's 6 percent cap

CMS released the 2027 Part D national average bid and base beneficiary premium, $41.33, up from $38.99 in 2026, with the increase held to the Inflation Reduction Act's 6 percent-a-year premium stabilization limit. In the same release CMS said the Part D premium stabilization demonstration that had subsidised standalone drug plans in 2025 and 2026 would end, leaving plans to price the redesigned benefit on their own for 2027.

• Centers for Medicare & Medicaid Services · Jul 28, 2026 · For 2027, the base beneficiary premium will be $41.33.

GAO finds gaps in CMS plans for RADV audits

GAO found that CMS corrective-action plans were not sufficiently detailed and did not adequately monitor progress. The report addressed improper-payment and fraud risks in Medicare Advantage.

• U.S. Government Accountability Office · Jul 21, 2026 · CMS’s corrective action plans are not sufficiently detailed and do not adequately monitor progress.

Editor's note: The report states that CMS’s corrective action plans were not sufficiently detailed and did not adequately monitor progress, and it specifically discusses RADV audits, improper payments, and Medicare Advantage fraud risks. The letter is dated July 21, 2026.

Elevance Health sues HHS and CMS over star-ratings recalculation

Elevance Health sued the Department of Health and Human Services and the Centers for Medicare & Medicaid Services over the recalculation of Medicare Advantage quality ratings. Elevance Health alleged that the recalculation did not align with the Clover Health ruling and affected $115 million in payments.

• U.S. District Court for the Southern District of Georgia order, reproduced by Justia · Aug 27, 2026 · Plaintiffs filed the instant action on July 1, 2026.
• STAT · Jul 2, 2026 · Elevance Health has sued the U.S. government, alleging that federal efforts to recalculate its Medicare Advantage quality ratings didn’t align with a recent court ruling, costing the health insurer $115 million.

responded to CMS begins recalculating certain 2027 quality bonus ratings.

Editor's note: The order states that Elevance and affiliates sued HHS and CMS over the Star Ratings/QBP recalculation following Clover, alleging different treatment and an approximately $115 million increase in 2027 QBP payments under their proposed recalculation. It expressly states that plaintiffs filed the action on July 1, 2026.

Lloyd Doggett and colleagues introduce the Saving MEDICARE Act

Representative Lloyd Doggett and 44 colleagues introduced the Saving MEDICARE Act. The bill addresses Medicare Advantage payments, coding, quality bonuses, and RADV audit oversight.

• Office of Rep. Lloyd Doggett · Jul 1, 2026 · Today, U.S. Representative Lloyd Doggett (D-TX), Ranking Member of the House Ways & Means Health Subcommittee, joined by 44 colleagues, introduced the Saving Medicare Enrollees from Deceptive Insurers and Creating Ample Resources for Everyone (Saving MEDICARE) Act.

Editor's note: The page states that Rep. Lloyd Doggett, joined by 44 colleagues, introduced the Saving MEDICARE Act on July 1, 2026. It describes provisions concerning Medicare Advantage overpayments, diagnosis coding/upcoding, the Quality Bonus Program, and RADV audit oversight.

CMS recalculates Clover rating to 4.5 stars

CMS informed Clover that it had recalculated Clover's 2026 Star Rating to 4.5 stars. CMS instructed Clover to submit alternate bids using the 4.5-star rating.

• Clover Health Form 8-K · Jun 10, 2026 · On June 9, 2026, CMS informed Clover that, consistent with the Court’s order, it has recalculated Clover's 2026 Star Rating as 4.5 Stars, and has instructed Clover to submit alternate bids at 4.5 Stars.

Editor's note: The filing states that on June 9, 2026, CMS informed Clover it had recalculated the 2026 Star Rating to 4.5 Stars and instructed Clover to submit alternate bids at that rating.

KFF: Medicare Advantage holds 55 percent of eligible beneficiaries, but employer-group enrollment falls for the first time since 2010

KFF's annual enrollment update put 2026 MA penetration at 55 percent with UnitedHealthcare and Humana still holding almost half the market, but found enrollment growth slowing sharply, employer and union group plans down by about 31,000, and UnitedHealthcare down nearly 647,000 between March 2025 and March 2026 while Humana gained 1.3 million.

• KFF · Jun 5, 2026 · The 2026 enrollment in group plans is a slight decrease from 2025 (a decrease of about 31,000 enrollees), the first time since 2010 that enrollment in this type of plan has declined year-to-year (Figure 5).

Presbyterian Healthcare Services plans to end most MA plans in 2027

Presbyterian Healthcare Services decided to stop offering most Presbyterian Health Plan Medicare Advantage plans in 2027. The organization cited financial losses and Medicare Advantage market conditions.

• Healthcare Finance News · Jun 5, 2026 · Presbyterian Healthcare Services will stop offering most of Presbyterian Health Plan's Medicare Advantage plans in 2027, citing financial losses and broader challenges in the Medicare Advantage market.

Editor's note: The page states that Presbyterian Healthcare Services will stop offering most Presbyterian Health Plan Medicare Advantage plans in 2027, citing financial losses and broader Medicare Advantage market challenges. The article is dated 2026-06-05, which supports the node's June 2026 date.

Elevance Health wires $342.2 million to CMS

Elevance Health sent a $342.2 million wire payment to the Centers for Medicare & Medicaid Services in connection with a Medicare Advantage risk-adjustment enforcement matter. Court records reported that the wire transfer occurred on May 27.

• Fierce Healthcare / KFF Health News · Jun 26, 2026 · Elevance Health, which covers about 2 million people on Medicare, sent the money to the Centers for Medicare & Medicaid Services via wire transfer on May 27, court records show.

Editor's note: The article states that Elevance Health sent a $342,209,085.30 wire payment to CMS and that court records show the transfer occurred on May 27. It characterizes the payment as related to a CMS enforcement action involving Medicare Advantage billing-data compliance and overpayments.

2027 final rule reshapes star ratings and rolls back 2023 marketing safeguards

The contract-year 2027 rule dropped the planned health-equity reward in favour of the historical reward factor, removed a set of star measures including call-center tests and added a depression screening measure, codified the Inflation Reduction Act's Part D redesign, and eased marketing rules such as the 48-hour scope-of-appointment wait, effective October 1, 2026. CMS declined to finalise several beneficiary-protection proposals from the Biden era.

• Centers for Medicare & Medicaid Services · Apr 2, 2026 · First, for the 2027 Star Ratings, CMS is not implementing the Excellent Health Outcomes for All reward (previously called the Health Equity Index reward) that was developed to incentivize improved performance for a subset of enrollees and will continue the historical reward factor that encourages consistently high performance for all enrollees across all quality measures.

Enrollment data: MA grows only 3 percent to 35.5 million; UnitedHealthcare down 9 percent since October

A Healthcare Dive analysis of CMS enrollment files showed 35.5 million people in Medicare Advantage in February 2026 versus 34.4 million a year earlier, growth of about 3 percent against a historical pace of up to 10 percent. UnitedHealthcare fell to just under 9.4 million from 10.3 million before open enrollment; Elevance, Centene and CVS lost 14, 4 and 3 percent of members; Humana was the big gainer.

• Healthcare Dive · Feb 24, 2026 · Almost 35.5 million people were enrolled in the privatized Medicare programs as of February, compared with about 34.4 million people in the same month last year, according to new government data.

Humana guides to 25 percent individual MA growth for 2026 as rivals retreat, despite a star-ratings hit

Humana reported a $796 million fourth-quarter loss but said it had added roughly a million individual MA members during open enrollment, with over 70 percent of new sales switching from competitors, and expected about 25 percent growth for 2026. It guided to lower earnings because of the Bonus Year 2026 star-ratings headwind, with about 45 percent of members in 4-star-plus contracts.

• Humana Q4 2025 earnings release (SEC 8-K exhibit) · Feb 11, 2026 · Anticipates FY 2026 individual Medicare Advantage membership growth of 'approximately 25 percent' over 2025; driven by new sales and improved retention from the company's customer-led benefit strategy and changes to its customer service approach

UnitedHealth expects to shed 1.3 to 1.4 million Medicare Advantage members in 2026

On its fourth-quarter call UnitedHealthcare CEO Tim Noel said membership losses would exceed the company's plan because an intensely competitive enrollment season drove more plan-shopping than expected; the 2026 approach favoured margin over volume. UnitedHealth's full-year guidance implied MA membership of 7.2 to 7.3 million, down from about 8.4 million.

• Fierce Healthcare · Jan 27, 2026 · UnitedHealth now expects to lose between 1.3 million and 1.4 million Medicare Advantage members in 2026 across group, individual and dual special needs plans.

Kaiser Permanente affiliates agree to pay $556 million in FCA settlement

Kaiser Permanente affiliates agreed to pay $556 million to resolve False Claims Act allegations that they submitted invalid diagnosis codes for Medicare Advantage enrollees to obtain higher payments, one of the largest risk-adjustment settlements to date. Kaiser said the agreement contains no admission of wrongdoing or liability.

• U.S. Department of Justice · Jan 14, 2026 · Affiliates of Kaiser Permanente, an integrated healthcare consortium headquartered in Oakland, California, have agreed to pay $556 million to resolve allegations that they violated the False Claims Act by submitting invalid diagnosis codes for their Medicare Advantage Plan enrollees in order to receive higher payments from the government.
• Kaiser Permanente · Jan 14, 2026 · The agreement resolves a False Claims Act lawsuit and has no admission of wrongdoing or liability.

Editor's note: Hand-checked: DOJ release carries the $556 million figure; Kaiser statement carries the no-admission language.

Humana loses its second lawsuit over the 2025 star ratings, a day before open enrollment

Judge Reed O'Connor ruled that CMS acted lawfully when it downgraded Humana's ratings on the strength of a few failed test calls to its customer service lines, dismissing the case with prejudice. The 2025 downgrade had pushed most of Humana's members out of four-star plans and cost it an estimated billion dollars or more in 2026 bonus revenue; Humana appealed to the Fifth Circuit in late November.

• Healthcare Dive · Oct 14, 2025 · A federal judge ruled in favor of the CMS on Tuesday, one day before the start of Medicare open enrollment.
• Healthcare Dive · Dec 1, 2025 · The insurer continues to try to prove that regulators acted arbitrarily in downgrading its quality scores for 2025, despite numerous setbacks in the courts to date.

2026 star ratings: 40 percent of MA-PD contracts at four stars or better, covering 64 percent of enrollees

CMS posted the 2026 star ratings on the Plan Finder on October 9, 2025. About 207 MA-PD contracts, 40 percent, earned four or more stars, and the enrollment-weighted average rating edged up to 3.98 from 3.95. The ratings set the 2027 quality bonus payments that feed into the 2027 rate announcement.

• Centers for Medicare & Medicaid Services · Nov 18, 2025 · Approximately 40% of MA-PDs (207 contracts) that will be offered in 2026 earned four stars or higher for their 2026 overall rating.

UnitedHealthcare confirms full exits from 16 markets, 109 fewer counties, for 2026

As the 2026 plan files went public, UnitedHealthcare confirmed it would leave Medicare Advantage entirely in 16 markets, affecting about 180,000 members, and offer plans in one fewer state and 109 fewer counties. Humana cut 194 counties and three states, and Aetna about 90 plans across 100 counties; Elevance added counties but left the standalone Part D market.

• Insurance Business · Oct 2, 2025 · UnitedHealthcare will fully exit Medicare Advantage plans in 16 US markets for the 2026 plan year the company confirmed. The move, which will affect about 180,000 policyholders, has been described as part of a broader Medicare Advantage pullback previously announced, which is expected to impact 600,000 policyholders nationwide.

CMS projects the first fall in Medicare Advantage enrollment, to 34 million, as 2026 plans are filed

Previewing the 2026 landscape, CMS said plans' own bids projected enrollment of 34 million, down from 34.9 million and from 50 percent of Medicare to about 48 percent, though the agency expected actual enrollment to hold up better. Average MA premiums were projected to fall from $16.40 to $14.00 a month, with 99 percent of beneficiaries still having access to a plan.

• Centers for Medicare & Medicaid Services · Sep 26, 2025 · Based on plans’ projections, enrollment in MA is projected to be 34 million in 2026, a decrease from 34.9 million in 2025, with MA enrollment representing approximately 48% of all people enrolled in Medicare, compared to 50% in 2025.

Humana's 2025 plan and county exits touch about 560,000 members; it trims the expected loss to 500,000

Humana said its decision to leave unprofitable plans and counties for 2025 had affected roughly 560,000 members, partly offset by new sales, so it now expected individual Medicare Advantage membership to fall by up to 500,000 for the year rather than about 550,000. The insurer was still absorbing the loss of most of its 4-star-rated membership from the 2025 star ratings.

• Humana Q2 2025 prepared remarks (SEC 8-K exhibit) · Jul 30, 2025 · We now anticipate a FY 2025 decline of ‘up to 500,000’ individual MA members as compared to our previous expectation of a decline of ‘approximately 550,000’ members oWe now anticipate Consolidated revenues of ‘at least $128 billion’ versus our previous guidance of ‘a range of $126 billion to $128 billion’ supported by better than anticipated individual MA membership and higher than expected payor-agnostic patient growth and script volumes in CenterWell oUpdated FY 2025 Adjusted EPS guidance now contemplates an additional approximately $100 million of incremental investments to improve member and patient outcomes and support operational excellence, positioning the company for long-term success Additional investments focused on initiatives that have shown strong returns YTD

UnitedHealthcare will exit plans serving more than 600,000 Medicare Advantage members in 2026

Reporting second-quarter results under returning CEO Stephen Hemsley, UnitedHealth said outpatient medical costs were running well above expectations and that its insurance arm would leave plans covering over 600,000 people for 2026, mostly PPOs, and might also shrink its Affordable Care Act footprint. UnitedHealthcare CEO Tim Noel said the company would prioritise margin over membership.

• Healthcare Finance News · Jul 30, 2025 · Without giving details of which markets would be affected, UnitedHealthcare CEO Tim Noel said, “Additionally, and unfortunately, given these pressures, we have made the difficult decision to exit plans that currently serve over 600,000 members, primarily in less managed products such as PPO offerings.” The company is taking similar approaches for its Medicare supplement, Group Medicare Advantage and stand-alone Part D pricing for next year, Noel said.

UnitedHealth confirms criminal and civil Justice Department investigations into its Medicare business

After months of press reports, UnitedHealth Group disclosed in an 8-K that it had approached the Department of Justice and was complying with formal criminal and civil requests about its participation in Medicare, while insisting its practices were among the most accurate in the industry. The probe centred on risk-adjustment coding in Medicare Advantage; the company also launched a third-party review of its policies.

• UnitedHealth Group Form 8-K (SEC) · Jul 24, 2025 · UnitedHealth Group (the “Company”) proactively reached out to the Department of Justice after reviewing media reports about investigations into certain aspects of the Company’s participation in the Medicare program. The Company has now begun complying with formal criminal and civil requests from the Department.

Insurers pledge to Kennedy and Oz to cut prior authorization by 2026 and standardize it by 2027

At an HHS roundtable, Aetna, Humana, UnitedHealthcare, Elevance, Centene, Cigna, Kaiser Permanente, the Blues and AHIP committed to six voluntary reforms across Medicare Advantage, Medicaid managed care and commercial plans: fewer services subject to prior authorization in 2026, real-time electronic approvals and honouring other insurers' decisions by 2027. A year later, KFF Health News found insurers hedging on the promises.

• Centers for Medicare & Medicaid Services · Jun 23, 2025 · In a roundtable discussion hosted by HHS, health insurers pledged six key reforms aimed at cutting red tape, accelerating care decisions, and enhancing transparency for patients and providers.