Medicare Advantage Enrollment Likely To Rise As 2027 Premiums Fall 16% — What Beneficiaries Should Know

Open enrollment for Medicare beneficiaries begins Oct. 15. With Medicare Advantage premiums projected to fall about 16% in 2027, many beneficiaries may be tempted to shift from traditional Medicare to private Medicare Advantage plans. The change in costs comes amid policy shifts, regulatory rollbacks and ongoing concerns about access to care, billing practices and market stability.

What's Driving the Shift

CMS Administrator Mehmet Oz has highlighted the projected 16% premium decline for 2027, and the current administration has approved larger-than-expected payment increases to Medicare Advantage plans — a 5.1% boost for 2026 and a finalized 2.5% increase for 2027. These moves could make Medicare Advantage plans more attractive by lowering premiums and stabilizing insurer finances.

Policy and Regulatory Changes

Regulatory changes at the Centers for Medicare & Medicaid Services have reduced the number of metrics used in the Medicare Advantage star ratings. CMS eliminated 11 quality and care measures — including some tied to call center performance, appeals and complaints — a change analysts estimate could free up nearly $19 billion in bonus payments to insurers over the next decade.

At the same time, CMS is exploring options such as potential auto-enrollment into Medicare Advantage for some beneficiaries and faces new cost pressures for plans resulting from the Inflation Reduction Act's redesign of the Part D outpatient drug benefit, which increases liability for high-cost enrollees.

Benefits and Trade-Offs for Beneficiaries

Medicare Advantage plans often attract enrollees with lower premiums, integrated prescription drug coverage and supplemental benefits such as vision, hearing and dental care. They can also limit out-of-pocket costs when beneficiaries remain inside plan networks.

However, critics and patient advocates note trade-offs: Medicare Advantage plans commonly use prior authorization, maintain narrower provider networks and may pose barriers for patients with complex or specialized care needs. Which option is better depends on an individual’s health profile, prescription needs and willingness to accept network restrictions.

Market Exits and Involuntary Disenrollments

Market instability is an increasing concern. A Johns Hopkins Bloomberg School of Public Health analysis found that roughly 10% of Medicare Advantage enrollees — about 2.9 million people — were forced to find new coverage for 2026 after insurers withdrew from markets. Average disenrollment rates rose from about 1% in 2018–2024 to 7% in 2025 and 10% in 2026. In Vermont, an estimated 92% of enrollees had to switch plans or return to original Medicare.

Billing Practices and Oversight

Medicare Advantage plans have faced accusations and findings of overbilling and upcoding, where insurers submit codes indicating more severe diagnoses or costlier treatments to increase federal reimbursements. CMS has pledged to expand audits and oversight to address overpayments, but critics argue penalties to date have been limited.

Advice for Beneficiaries

• Compare costs and benefits carefully during open enrollment — not just premiums but networks, prior authorization rules and drug coverage.
• Check provider networks to ensure access to specialists you may need, especially if you have chronic or complex conditions.
• Watch for plan exits in your area and have a backup plan in case your insurer withdraws coverage.

Bottom line: Falling premiums and increased payments to insurers may encourage more enrollees to choose Medicare Advantage, but beneficiaries should weigh potential savings against narrower networks, utilization controls and market volatility before switching from traditional Medicare.

Originally published on Forbes.com