2026-10-15T09:00:44.944Z / 美国有线电视新闻网（CNN）
更少的健康保险计划、更高的自付费用、更精简的附加福利。
专家表示，这场动荡将是老年群体在2027年医疗保险优势计划开放注册期开始时必须应对的局面，该注册期将于本周四启动。因此参保者务必重新审视自己的计划选项，以免明年遭遇意外账单和其他突发状况。
覆盖美国医疗保险约7100万参保者中略超一半群体的医疗保险优势计划，正迎来其动荡的第三年，各家健康保险公司正在全面调整其保险产品。此次调整主要源于医疗成本增速超过联邦政府的报销额度——联邦政府向保险公司支付费用，为医疗保险参保者提供保障——但批评人士称，保险公司在患者护理方面存在过度计费行为。
数百万老年群体和其他参保者将不得不更换新的医疗保险优势计划，因为他们现有的保单将被终止；另有部分参保者可能需要为自身的保险和护理支付更高费用。
此次动荡正值美国准备举行中期选举之际，不断上涨的医疗保健成本和其他生活必需品费用是关键议题。老年群体是稳定的投票群体，两党都在竭力争取他们的支持。唐纳德·特朗普总统本月宣布，将向约2000万老年群体发放90美元补贴，帮助他们支付部分医疗保险保费，但医疗保险优势计划的参保者无权领取这笔补贴。
此前，随着保险公司扩大保险产品种类和附加福利以吸引不断增长的老年群体，医疗保险优势计划的受欢迎程度迅速攀升。对于在意预算的老年美国人而言，该计划通常比传统医疗保险更具吸引力，因为它设有自付费用上限，并提供牙科、视力和听力保障等部分附加福利。不过，该计划的医生网络通常比传统医疗保险更有限，某些治疗可能需要事先获得批准。
但近年来，保险公司一直在停办盈利能力较弱的医疗保险优势计划，力求稳定其保险产品阵容，哪怕这意味着参保人数会减少。保险公司估计，2027年的参保人数将降至3400万，占医疗保险总参保人数的47.4%，但美国医疗保险与医疗补助服务中心（CMS）预计实际参保人数将高于预测，并强调医疗保险优势市场的稳定性。开放注册期将于12月7日结束。
“CMS正竭力为数百万依赖医疗保险优势计划和D部分处方药计划的参保者，维持高质量、负担得起且可及的医疗选择，”CMS管理员穆罕默德·奥兹博士在一份声明中表示。
医疗保险行业领袖周报《医疗保险市场洞察》的创始人贾里德·斯特罗克表示，近320万医疗保险优势计划参保者（占总数近11%）将不得不为2027年选购新保单，因为保险公司不再提供他们现有的计划。相比之下，今年和2025年分别有约290万和200万参保者的计划被终止。在此之前，每年通常只有1%至2%的参保者会失去原有计划。
斯特罗克在查阅CMS数据后发现，包括哈门那、联合健康集团、CVS旗下安泰以及多家蓝十字蓝盾保险公司在内的大型保险公司，都在缩减其保险产品阵容或退出部分地理区域。许多被取消的计划是优选供应商组织（PPO）保单，这类保单为患者提供更多灵活性，并包含网络外就医保障。
可以肯定的是，大多数参保者仍有多种保险政策可供选择。无党派卫生政策研究机构KFF的数据显示，普通参保者将有28种带处方药保障的医疗保险优势计划可供选择，不过这一数字较2024年的峰值36种有所下降。
尽管如此，仍有一小部分但比例不断上升的美国老年人在其所在地区没有任何此类计划可供选择。KFF的数据显示，2027年将有193个县的约63.8万人面临这种情况，而今年这一数字为123个县的39.9万人。
咨询公司奥纬咨询的负责人海瑟姆·阿里表示，提供的保险计划数量因州和县而异。农村居民更有可能看到保险公司退出市场，但东南部地区的居民通常拥有更多选择。
“这在很大程度上由地区因素决定，”他说，“有些州的保险产品供应对消费者而言几乎没有中断，而有些州则正在发生大量剧烈变化。”
CMS数据显示，明年的医疗保险优势计划总数将达到5532个，仅减少21个。但这一数字包括针对特定参保群体的特殊需求计划。保险公司正在扩大针对慢性病患者的保险产品选择，特别是某些心肺疾病和糖尿病患者。这样做的一个激励因素是，为病情更严重的参保者提供服务可获得更高的联邦报销额度。
斯特罗克表示，明年将有744种慢性病相关计划可供选择，高于2025年的376种。这类计划的参保人数已从2021年秋季的约40.1万飙升至180多万。
专家表示，保险公司还预计将削减附加福利的慷慨程度，尽管CMS尚未发布2027年这些福利的概述。参保者可能会发现，他们的牙科和听力福利覆盖的护理服务不如以往，医疗交通福利被缩减，或非处方产品补贴额度减少。
许多保单未被终止的参保者可能会发现，2027年的费用有所上涨，这也是他们需要重新审视自身选择的原因。由于面临更高的价格和患者更高的医疗使用率，保险公司正努力恢复或提升其保单的盈利能力。
斯特罗克表示，按参保人数加权计算的平均月保费总体将下降7%，至12.11美元，但具体情况很大程度上取决于参保者所持的医疗保险优势计划类型。不针对慢性病患者或其他特殊需求群体的计划，其月保费将上涨23%，至14.80美元。每5名拥有非特殊需求保障的参保者中，就有超过1人将面临保费上涨。
另一方面，针对慢性病患者的计划费用则会更低。
与此同时，保险公司也在提高参保者将面临的自付费用上限，这意味着参保者需要自行承担更多的护理成本。斯特罗克表示，按参保人数加权计算的网络内服务最高自付费用平均为6603美元，较今年上涨9%。约70%的参保者将看到他们的自付费用上限提高，而今年这一比例为35%。
近四分之三的参保者将不得不为处方药支付更多费用，带药物保障的计划的按参保人数加权计算的平均免赔额将上涨23%，至509美元。预计只有12%的参保者的计划没有免赔额，低于2024年的60%。
“更充足的资金使2027年的医疗保险优势计划保费有所下降，但创纪录数量的老年人将不得不寻找新的保险保障，许多人在需要护理时将支付更多费用，”倡导医疗保险优势计划的联盟“更好医疗保险联盟”首席执行官玛丽·贝丝·多纳休在给CNN的一份声明中表示，“老年人不应该每年都面临这种中断。”
独立药物保障计划
选择传统医疗保险并从保险公司购买独立D部分药物计划的参保者，2027年也将面临一些变化。
奥纬咨询负责人布鲁克斯·康威表示，超过100万人将失去他们的D部分计划，不得不选择新的方案。安泰（CVS旗下）正退出这个由哈门那和森科拉主导的市场。
康威表示，将不再有保费为0美元的计划，但几乎每个州都将有月保费低于20美元的保单。部分原因是特朗普政府取消了拜登时代针对保险公司的一项补贴，该补贴旨在稳定保险公司的成本，因为2022年民主党通过的《通胀削减法案》使保险公司需要为病情更严重的参保者承担更多的药品支出。
尽管CMS强调，明年D部分计划的平均月保费将上涨不到1美元，至36美元，但部分保险公司的保费涨幅将超过每月50美元。因此参保者应核实2027年计划的费用。
“从技术上讲，这些人不必被迫更换计划，但如果他们选择更换，将大幅降低保费支出，”康威说。
More than 3 million Medicare Advantage enrollees need to find new plans for 2027 in third year of turmoil
2026-10-15T09:00:44.944Z / CNN
Fewer health insurance plans. Higher out-of-pocket costs. Skimpier supplemental benefits.
This upheaval is what senior citizens will have to contend with when Medicare Advantage open enrollment for 2027 coverage begins on Thursday. That’s why it’s even more important that enrollees review their plan options so they aren’t hit with unexpected bills and other surprises next year, experts say.
Medicare Advantage, which covers just over half of Medicare’s roughly 71 million enrollees, is going through its third year of turmoil as health insurers overhaul their offerings. The changes are largely being spurred by medical costs outpacing reimbursements from the federal government, which pays insurers to provide coverage to Medicare enrollees – though critics say that insurers are overbilling for patient care.
Millions of senior citizens and other enrollees will have to find new Medicare Advantage plans because their policies are being terminated, while others could have to pay more for their coverage and care.
The disruption also comes as Americans prepare to vote in the midterm elections, where the rising cost of healthcare and other necessities is a key concern. Senior citizens are a reliable voting bloc that both parties are trying to woo. President Donald Trump announced this month that he is sending a $90 payment to about 20 million senior citizens to help them cover part of their Medicare premiums – but those enrolled in Medicare Advantage plans aren’t eligible.
Medicare Advantage plans had grown rapidly in popularity as insurers expanded their offerings and benefits to lure the growing senior population. They are often more attractive than traditional Medicare to budget-conscious older Americans because they have limits on out-of-pocket spending and provide some supplemental benefits, such as dental, vision and hearing coverage. However, they typically have more limited doctor networks than traditional Medicare, and certain treatments can be subject to prior authorization.
But in recent years, insurers have been discontinuing their less profitable Medicare Advantage plans and seeking to stabilize their offerings, even if it means fewer policyholders. Insurers estimate that enrollment will drop to 34 million people, or 47.4% of total Medicare enrollment in 2027, though the Centers for Medicare and Medicare Services expects actual enrollment to be higher than projections and is stressing stability in the Medicare Advantage market. Open enrollment ends on December 7.
“CMS is fighting to keep high-quality care options affordable and accessible for the millions of beneficiaries who rely on Medicare Advantage and Part D prescription drug plans,” CMS Administrator Dr. Mehmet Oz said in a statement.
Nearly 3.2 million Medicare Advantage enrollees, or almost 11%, will have to shop for new policies for 2027 because their insurers are no longer offering their plans, said Jared Strock, founder of Medicare Market Insights, a weekly newsletter for the Medicare industry leaders. That compares with about 2.9 million and 2 million enrollees whose plans were terminated for this year and for 2025, respectively. Prior to that, only 1% to 2% of enrollees typically lost their plans year to year.
Major insurers, including Humana, UnitedHealthcare, CVS’ Aetna and several Blue Cross and Blue Shield carriers, are among those culling their offerings or pulling out of geographic areas, according to Strock, who reviewed CMS data. Many of the plans being canceled are preferred provider organization, or PPO, policies, which give patients more flexibility and include out-of-network coverage.
To be sure, most enrollees will still have a choice of multiple policies. The average beneficiary will have 28 Medicare Advantage plans with prescription drug coverage to select from, although that’s down from a high of 36 plans in 2024, according to KFF, a nonpartisan health policy research group.
Still, a small but growing share of older Americans will not have any of these plans in their area. Some 638,000 people in 193 counties will be in this situation for 2027, up from 399,000 people in 123 counties this year, according to KFF.
The number of plans offered varies widely by state and county, said Haitham Aly, a principal at Oliver Wyman, a consulting firm. Rural residents are more likely to see insurers pull out, but those living in the Southeast typically have a wider array of choices.
“It’s very regionally driven,” he said. “There are some states where there’s minimal disruption as far as plan offerings to consumers. There are other states where there are a lot more drastic changes happening.”
Overall, there will be 5,532 Medicare Advantage plans next year, decreasing by only 21, according to CMS. But that figure includes so-called special needs plans that cater to specific categories of enrollees. Insurers are expanding their selection of policies for those with chronic conditions – particularly certain heart and lung diseases and diabetes. One incentive to do so is that they receive higher federal reimbursements for sicker enrollees.
Some 744 chronic condition plans are available for next year, up from 376 in 2025, according to Strock. Enrollment in those types of plans has skyrocketed to more than 1.8 million, up from about 401,000 in the fall of 2021.
Insurers are also expected to trim the generosity of their supplemental benefits, though CMS has yet to release its overview of these offerings for 2027, experts said. Enrollees may find that their dental and hearing benefits don’t cover as much care as they have in the past, their medical transportation benefits are curtailed or their allowances for over-the-counter products are reduced.
Many enrollees whose plans are not being terminated could see their costs increase for 2027, which is why they need to review their options. Insurers are trying to return to or boost the profitability of their policies as they contend with higher prices and greater healthcare usage among patients.
Average monthly premiums, weighted for enrollment, will dip 7% to $12.11 overall, but much will depend on what type of Medicare Advantage policy an enrollee has, Strock said. The plans that don’t cater to people with chronic conditions or other special needs will see their premiums jump 23% to $14.80 a month. Just over 1 in 5 people with non-special needs coverage will be hit with a premium increase.
The plans for those with chronic conditions, on the other hand, will be less expensive.
Meanwhile, insurers are also raising the out-of-pocket limits that enrollees will face, leaving them on the hook for more of the cost of care. On average, the enrollment-weighted maximum for in-network services will be $6,603, up 9% from this year, Strock said. Some 70% of enrollees will see their out-of-pocket cap increase, compared with 35% for this year.
And nearly three-quarters of enrollees will have to pay more for prescription medications, with the average enrollment-weighted deductible jumping 23% to $509 for plans with drug coverage. Only 12% of enrollees are expected to be in plans with no deductible, down from 60% in 2024.
“Better funding brought Medicare Advantage premiums down for 2027, but a record number of seniors will have to find new coverage, and many will pay more when they need care,” Mary Beth Donahue, CEO of the Better Medicare Alliance, a coalition of insurers, providers, business groups and community organizations that advocates for Medicare Advantage, said in a statement to CNN. “Seniors shouldn’t have to face this disruption every year.”
Standalone drug coverage
Those in traditional Medicare who buy standalone Part D drug policies from insurers will also see some changes for 2027.
More than 1 million people are losing their Part D plans and will have to pick new options, said Brooks Conway, principal at Oliver Wyman. CVS’ Aetna is leaving the market, which is dominated by Humana and Centene.
No plans with $0 premiums will be available, though almost every state will have policies with monthly premiums of less than $20, he said. Part of the reason is that Trump discontinued a Biden-era subsidy for insurers aimed at stabilizing their costs after the Democrats’ Inflation Reduction Act in 2022 left carriers on the hook for more of the drug spending by sicker enrollees.
While CMS is highlighting that the average Part D monthly premium will increase less than $1 to $36 for next year, some insurers are hiking premiums by more than $50 a month. So enrollees should check the cost of their plans for 2027.
“Those people won’t be technically forced to shop, but if they do shop, they’ll have significant premium reductions,” Conway said.
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