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

Alignment Healthcare sues CMS over 2027 star-ratings methodology

Alignment Healthcare filed a lawsuit against CMS in District of Columbia federal court over the methodology for 2027 Medicare Advantage Star Ratings. The insurer alleged that CMS departed from a system of predictable, valid measures developed with input from providers, plans, and the public.

• Fierce Healthcare · Oct 12, 2026 · In the lawsuit filed Friday in District of Columbia federal court, the insurer says that the Centers for Medicare & Medicaid Services "has completely departed from Congress’s vision of leveraging predictable, valid measures developed with input from providers, plans, and the public" in establishing the methodology for the star ratings.

Editor's note: The cited Fierce Healthcare article states that Alignment filed suit Friday in District of Columbia federal court over CMS's 2027 Star Ratings methodology and includes the quoted allegation. Published October 12, 2026, its reference to the preceding Friday supports October 9, 2026.

Clover Health says its PPO MA plans earned five stars for 2027

Clover Health said CMS awarded its PPO Medicare Advantage plans five stars and its HMO plan 4.5 stars for 2027. Clover Health said the ratings would affect payment year 2028.

• Clover Health · Oct 8, 2026 · Clover Health Investments, Corp. (Nasdaq: CLOV) (“Clover,” “Clover Health” or the “Company”), today announced that the Centers for Medicare & Medicaid Services (“CMS”) has awarded its PPO Medicare Advantage (“MA”) plans a rating of 5 Stars and its HMO MA plan a rating of 4.5 Stars for 2027, which will affect payment year 2028.

Editor's note: The cited Clover Health release, dated October 8, 2026, states that CMS awarded its PPO MA plans 5 Stars and HMO MA plan 4.5 Stars for 2027, affecting payment year 2028.

Aetna says over 69 percent of MA members are in four-star plans

Aetna said more than 69% of its Medicare Advantage members were in 2027 plans rated four stars or higher. The ratings were assigned by CMS.

• CVS Health/Aetna · Oct 8, 2026 · announced today that more than 69 percent of its Medicare Advantage (MA) members are in 2027 plans rated 4 stars or higher (out of 5 stars) by the Centers for Medicare & Medicaid Services (CMS).

Editor's note: The cited Aetna/CVS Health release states that more than 69% of its Medicare Advantage members are in 2027 plans rated four stars or higher by CMS. It is published October 8, 2026 and says the CMS ratings data were published that day.

Humana says 95 percent of MA members are in four-star plans

Humana said 95% of its Medicare Advantage members were enrolled in plans rated four stars or higher for 2027. Healthcare Dive reported that its analysis of CMS data put Humana's corresponding percentage at 93%.

• Humana · Oct 8, 2026 · today announced improved Star Ratings for 2027, highlighted by 95% of its Medicare Advantage members being enrolled in plans rated 4.0 stars or above by the Centers for Medicare and Medicaid Services (CMS).
• Healthcare Dive · Oct 9, 2026 · Humana, which suffered a major ratings collapse two years ago, saw the percentage of its members in 4+star plans rocket from 41% in 2026 to 93% in 2027, according to a Healthcare Dive analysis of stars data released Thursday by the CMS.

Editor's note: Humana’s release states that 95% of its Medicare Advantage members are enrolled in 2027 plans rated 4.0 stars or above. Healthcare Dive reports its CMS-data analysis found 93% of Humana members in 4+ star plans for 2027; its Oct. 9 article says CMS released the data Thursday, Oct. 8.

HCSC plans to cut its Medicare Advantage county footprint

Health Care Service Corporation will sell Medicare Advantage plans in 478 counties in 2027, down from 948, and will exit Connecticut, Kansas, Montana, New York, Oregon, Utah and Washington, D.C. Counting standard Medicare Advantage plans alone, the footprint falls from 948 counties to 450, the largest county exit of any insurer, following HCSC's purchase of Cigna's Medicare business in 2025. Its sharpest pullbacks are in its own Blue Cross Blue Shield states, where Texas falls from 229 counties to 47.

• Becker’s Hospital Review · Oct 1, 2026 · HCSC will sell MA plans in 478 counties in 2027, down from 948, and exit Connecticut, Kansas, Montana, New York, Oregon, Utah and Washington, D.C.

Editor's note: The cited Becker's page states that HCSC will sell Medicare Advantage plans in 478 counties in 2027, down from 948, and will exit the seven listed jurisdictions. The page was published October 1, 2026.

Highmark retains all 2026 Medicare Advantage states and counties

Highmark said it would operate in every state and county where it offered a Medicare Advantage plan in 2026. It said plan changes would vary by geography and plan for 2027.

• Highmark · Oct 1, 2026 · For 2027, Highmark will continue to operate in all of the states and counties where it offered a Medicare Advantage plan in 2026, however there will be changes that vary by geography and plan, with the changes focused on maintaining affordability and preserving access to meaningful coverage.

Editor's note: The page states that Highmark will continue operating in all states and counties where it offered Medicare Advantage plans in 2026, with 2027 changes varying by geography and plan. It is dated Thursday, October 1, 2026.

Healthcare Dive reports UnitedHealthcare dental-benefit reductions

Healthcare Dive reported that cuts to UnitedHealthcare's dental benefits affected almost 70 percent of its members, citing Leerink analyst Whit Mayo. UnitedHealth Group said all members would have access to $0 primary-care and preventive-care services.

• Healthcare Dive · Oct 1, 2026 · However, cuts to UnitedHealthcare’s dental benefits affected almost 70% of its members, Leerink analyst Whit Mayo found.
• UnitedHealth Group · Oct 1, 2026 · All members will have access to $0 primary care visits, $0 preventive care services and $0 Tier 1 prescription drug copays in 2027.

Editor's note: Editor: dropped a claim that $0 Tier 1 prescription-drug copays were also retained, which the cited report does not carry; it names primary care and preventive care only.

KFF reports fewer MA-PD plan choices for 2027

KFF reported that Medicare beneficiaries will have an average of 28 Medicare Advantage prescription-drug plan options in 2027. That was down from an average of 32 options in 2026, excluding employer plans and special-needs plans not open for general enrollment.

• KFF · Oct 1, 2026 · KFF’s analysis of plan offerings shows that, on average, Medicare beneficiaries will have the option of 28 Medicare Advantage prescription drug (MA-PD) plans in 2027, a decline from the 32 options available in 2026 (excluding employer plans and special needs plans not available for general enrollment).

Editor's note: The KFF page states that the average beneficiary will have 28 MA-PD options in 2027, down from 32 in 2026, with the specified exclusions. It is published October 1, 2026.

Healthcare Dive reports UnitedHealthcare and Humana plan cuts for 2027

Healthcare Dive reported that UnitedHealthcare was removing about 690 Medicare Advantage plans for 2027. It reported that Humana was removing about 2,400 plans.

• Healthcare Dive · Sep 29, 2026 · UnitedHealthcare, the largest MA insurer, is nixing about 690 plans, while Humana, the second-largest, is culling about 2,400.
• UnitedHealth Group · Oct 1, 2026 · Approximately 95% of Medicare-eligible individuals in UnitedHealthcare's footprint will have access to a Medicare Advantage HMO plan in 2027, with most having a $0 premium.
• UnitedHealthcare · Oct 1, 2026 · Effective Jan. 1, 2027, we’re making some changes to UnitedHealthcare® Medicare Advantage service areas and discontinuing some plans.
• Reuters, via The Business Standard · Oct 1, 2026 · Hunter said UnitedHealth next year will exit locations where it currently offers a higher proportion of preferred provider organizations, or those that give members an option to see providers outside of the plan network.

Editor's note: Date corrected from 2026-09-28 to 2026-09-29. The page states that UnitedHealthcare is nixing about 690 plans and Humana is culling about 2,400 for 2027. It was published on September 29, 2026, not September 28, 2026.

CMS opens PY2024 RADV medical-record submission window

CMS scheduled the payment-year 2024 RADV medical-record submission window to open on September 18, 2026. Selected Medicare Advantage organizations must submit records and coversheets through the Centralized Data Abstraction Tool.

• Centers for Medicare & Medicaid Services · Aug 28, 2026 · MR submission window opens: September 18, 2026.

Editor's note: The document's Important Dates section states that the PY 2024 RADV medical-record submission window opens on September 18, 2026. It also instructs audited MA organizations to submit medical records and coversheets through CDAT.

House Ways and Means advances H.R. 4093

The House Ways and Means Committee ordered H.R. 4093 favorably reported as amended by a 25–15 vote. The committee adopted a substitute amendment and rejected a Doggett amendment by a 16–21 roll-call vote.

• House Ways and Means Committee · Sep 16, 2026 · Amendment filed by Mr. Doggett to H.R. 4093 was not agreed to by a roll call vote of 16 yeas and 21 nays.
• Healthcare Leadership Council · Sep 16, 2026 · Greater transparency will support smarter policymaking and help seniors make more informed decisions about the coverage that best meets their healthcare needs.

Editor's note: The page states that H.R. 4093 was ordered favorably reported as amended by a 25–15 roll-call vote, that the substitute amendment passed by voice vote, and that the Doggett amendment failed 16–21. The page dates the markup September 16, 2026.

Aetna stops commissions on certain Medicare Advantage plans

Aetna stopped paying broker commissions on certain Medicare Advantage plans on September 15. Becker’s reported that Aetna confirmed the change.

• Becker’s Payer Issues · Aug 21, 2026 · Aetna will stop paying broker commissions on certain Medicare Advantage plans beginning Sept. 15, the company confirmed to Becker’s.

Editor's note: The page states that Aetna will stop paying broker commissions on certain Medicare Advantage plans beginning September 15, 2026, and says the company confirmed this to Becker’s.

CMS makes PY2024 RADV audit enrollee lists available

CMS made enrollee data lists available in CDAT for selected payment-year 2024 contract-specific RADV audits. The guidance set September 11, 2026, as the date for viewing and downloading the lists.

• CMS · Aug 28, 2026 · “EDL available in CDAT for viewing and downloading: September 11, 2026.”

Editor's note: The document states that CMS will make an enrollee data list available in the audited contract's CDAT portal and lists “EDL available in CDAT for viewing and downloading: September 11, 2026” among its important dates.

CMS opens second preview for preliminary 2027 star ratings

CMS made its second plan preview available from September 9 through September 15, 2026. The preview process includes draft cut points before official Medicare Advantage ratings are released.

• CMS memorandum via DocumentCloud · Sep 8, 2026 · “The second plan preview will be available starting September 9, 2026 and will end on September 15, 2026 at 11:59 p.m. Pacific time.”
• Healthcare Dive · Sep 10, 2026 · “Earlier this week, the CMS released draft cutpoints, the thresholds the agency uses to convert MA plans’ quality and performance scores into a 1 to 5 star rating, as part of the preview process before regulators announce official results in early October.”

Editor's note: The memo states that the second plan preview starts September 9, 2026 and ends September 15, 2026 at 11:59 p.m. Pacific time. It also says measure-level cut points are available during the preview and that the Star Ratings data are preliminary before the final release.

Plan non-renewal letters are due by October 2; open enrollment runs October 15 to December 7

With insurers having told investors which 2027 plans will end on December 31, members learn by letter in early October, leaving a window before open enrollment closes on December 7. Those whose plan is terminated get a guaranteed-issue right to buy Medigap if they return to Original Medicare, a protection lost if they simply pick another MA plan.

• 24/7 Wall St. · Sep 5, 2026 · Insurers spent the summer telling Wall Street exactly which Medicare Advantage plans are disappearing on December 31. Enrolled members get a letter in October, a closing enrollment window in December, and a rare legal protection most will never realize they… This post may contain links from our sponsors and affiliates, and Flywheel Publishing may receive compensation for actions taken through them.

MedPAC reports variation in risk-standardized MA plan bids

The Medicare Payment Advisory Commission presented preliminary analysis of 2024 Medicare Advantage HMO and PPO bids. It found that the 90th-percentile risk- and geography-standardized bid was about 40 percent higher than the 10th-percentile bid.

• Medicare Payment Advisory Commission · Sep 4, 2026 · After risk and geographic standardization, 90th percentile bid was about 40 percent higher than 10th percentile bid.

Editor's note: The presentation is dated September 4, 2026 and describes a preliminary analysis of 2024 Medicare Advantage HMO and PPO plan bids. It states that, after risk and geographic standardization, the 90th-percentile bid was about 40 percent higher than the 10th-percentile bid.

UnitedHealthcare removes 30 percent of prior authorization requirements

UnitedHealthcare said it would eliminate 30 percent of prior-authorization requirements beginning October 1, 2026. The reduction includes commercial, Medicare Advantage, Medicaid, and Affordable Care Act plans.

• UnitedHealthcare · Sep 1, 2026 · “That’s why beginning Oct. 1, 2026, we’re eliminating 30% of prior authorization requirements for the following plans:”
• Healthcare Dive · Sep 2, 2026 · “The insurance giant sent a memo to providers on Tuesday disclosing the codes, which it said amounted to roughly 30% of its preapproval requirements for its commercial, Medicare Advantage, Medicaid and Affordable Care Act plans.”

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

Editor's note: The page is dated September 1, 2026 and states that UnitedHealthcare will eliminate 30% of prior authorization requirements beginning October 1, 2026. It lists commercial, Medicare Advantage, Community, Individual Exchange, and Oxford plans.

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.

The Villages Health System agrees to $541.5 million FCA settlement

The Villages Health System agreed to a $541.5 million settlement resolving self-disclosed False Claims Act allegations concerning Medicare Advantage diagnosis codes. The U.S. Department of Justice alleged that unsupported codes increased Medicare Advantage payments; the settlement did not determine liability.

• U.S. Department of Justice · Aug 26, 2026 · The Villages Health System LLC (TVH), a healthcare provider group headquartered in The Villages, Florida, has agreed to a $541.5 million settlement to resolve self-disclosed allegations that it violated the False Claims Act by causing the submission of false diagnosis codes in order to increase payments that they received from the Medicare Advantage program.
• Healthcare Dive · Aug 27, 2026 · The Villages Health, a healthcare provider in Central Florida, has agreed to pay $541.5 million to settle allegations that it overbilled Medicare, the Department of Justice announced Wednesday.

Editor's note: The DOJ page states that TVH agreed to a $541.5 million settlement over self-disclosed False Claims Act allegations involving false Medicare Advantage diagnosis codes, and says the claims are allegations only with no determination of liability. It is dated August 26, 2026.

Centene will cut Medicare Advantage plans and exit three states in 2027

Centene told third-party marketing organisations it would withdraw completely from Oklahoma, Tennessee and Hawaii for 2027, part of a cost-cutting retreat from Medicare Advantage. Trade reporting put the pullback at 133 plans across 158 counties and roughly 340,000 members.

• KFF Health News Morning Briefing (Modern Healthcare) · Aug 21, 2026 · “The insurer plans to completely withdraw from Oklahoma, Tennessee and Hawaii, according to a notice the company distributed to third-party marketing organizations last week.”
• Modern Healthcare · Aug 20, 2026 · Centene is scaling back its Medicare Advantage presence next year as the health insurance company looks to cut costs.
• The Healthcare Labyrinth · Aug 20, 2026 · Current reporting indicates Centene will leave Oklahoma, Tennessee and Hawaii, eliminating 133 plans across 158 counties and affecting approximately 340,000 members.

Editor's note: Hand-checked: the withdrawal sentence appears verbatim in the KFF Health News Morning Briefing of August 21, 2026, which carries the Modern Healthcare report of 8/20; the Modern Healthcare lede and the plan, county and member counts were each read on their own pages.

Providence Health Plan will close entirely after its Medicare Advantage deal collapses

Providence Health Plan said it was shutting down completely after a deal with a national insurer to keep its Medicare Advantage business running fell through. The failed agreement affects more than 64,000 MA members, on top of the more than 260,000 commercial and 58,000 Medicaid enrollees covered by the wind-down it announced in May, most of them in Oregon.

• Healthcare Dive · Aug 19, 2026 · “Providence Health Plan is completely shutting down, after a deal with a national insurer to keep its Medicare Advantage business running fell through.”
• Healthcare Finance News · Aug 19, 2026 · More than 64,000 Medicare Advantage members are affected by the failed agreement.

Editor's note: Hand-checked against Healthcare Dive of August 19, 2026 and Healthcare Finance News; both quoted sentences appear on their pages. The broker-blog source for the withdrawn bid was dropped.

UnitedHealthcare considers leaving 34 MA counties for 2027

A preliminary broker filing indicated that UnitedHealthcare was considering leaving 34 Medicare Advantage counties in 12 states for 2027. The filing was not final.

• Healthcare Dive · Sep 9, 2026 · UnitedHealthcare is considering leaving 34 counties in 12 states, according to a preliminary filing with brokers reviewed by Modern Healthcare in August.

Editor's note: The article states that UnitedHealthcare was considering leaving 34 counties in 12 states based on a preliminary broker filing reviewed in August, and that the list was not final. The article was published September 9, 2026, so the node's August 2026 date accurately reflects the filing/reporting event.

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.

CMS files notice appealing Clover star-ratings ruling

CMS filed a notice of appeal to the U.S. Court of Appeals for the Eleventh Circuit against the May ruling that it had exceeded its authority on ten star-ratings measures, according to Clover's 10-Q and a Becker's report citing a July 21 court filing; the appellate docket shows the case opened July 22. CMS had meanwhile recalculated Clover's rating to 4.5 stars and begun recalculating other 2027 quality-bonus ratings.

• Clover Health Form 10-Q · Aug 5, 2026 · On July 21, 2026, CMS filed its Notice of Appeal of the district court's decision in the Stars Litigation with the United States Court of Appeals for the Eleventh Circuit.
• Becker’s Hospital Review · Jul 22, 2026 · The case will now move to the U.S. Court of Appeals for the Eleventh Circuit, according to a July 21 court filing.
• Georgetown Law Health Care Litigation Tracker · Date Filed July 22, 2026

responded to Clover wins a ruling that CMS exceeded its authority on ten star-ratings measures.

Editor's note: Hand-checked: Clover 10-Q and Becker's date the notice July 21; the Eleventh Circuit docket opened July 22.

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 begins recalculating certain 2027 quality bonus ratings

CMS issued guidance that it was voluntarily recalculating 2027 Quality Bonus Payment ratings for certain Medicare Advantage contracts. CMS said the recalculation resulted from the preceding court decision.

• Clover Health Form 8-K · Jun 18, 2026 · On June 17, 2026, CMS issued updated guidance informing all Medicare Advantage Organizations that it was voluntarily recalculating the 2027 Quality Bonus Payment ratings for certain Medicare Advantage contracts as a result of the preceding decision.

was answered by Elevance Health sues HHS and CMS over star-ratings recalculation.

Editor's note: The filing states that CMS issued updated guidance on June 17, 2026, voluntarily recalculating 2027 Quality Bonus Payment ratings for certain Medicare Advantage contracts because of the preceding decision. The quoted language appears verbatim apart from formatting.

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.

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.

2027 advance notice proposes an almost flat 0.09 percent payment update

CMS proposed a net average increase of just 0.09 percent, about $700 million, for 2027, its smallest in years, citing the star ratings, risk-adjustment trends and the continued phase-in of the 2024 risk model. Insurers and Wall Street read the notice as confirmation that 2027 benefits and footprints would shrink further.

• Centers for Medicare & Medicaid Services · Jan 26, 2026 · If finalized, the proposed policies are projected to result in a net average year-over-year payment increase of 0.09%, or over $700 million in MA payments to plans in CY 2027.

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.

was answered by UnitedHealthcare removes 30 percent of prior authorization requirements.