Health plan underwriting losses reached $10.4 billion sector-wide as Centene confirmed exits covering 340,000+ MA lives across 158+ counties, including full state withdrawals from Oklahoma, Tennessee, and Hawaii, for 2027. Humana's Villages Health subsidiary absorbed a $541.5 million fraud settlement on MA billing.
Centene exits 340K+ lives across 158+ counties for 2027
Centene informed brokers it will exit plans covering more than 340,000 lives across 158+ counties, including all of Oklahoma, Tennessee, and Hawaii, for plan year 2027.
MA enrollment caps promise to reshape 2027
Modern Healthcare reported that Medicare Advantage enrollment caps are expected to reshape the 2027 market by constraining plan growth.
Health plan underwriting losses balloon to $10.4B
A report found health plan underwriting losses have surged to $10.4 billion across the payer sector.
Providence Health Plan shuts down after MA deal falls through
Providence Health Plan announced it will shut down entirely after a Medicare Advantage deal fell through, exiting MA in 2027.
MA enrollees more likely to leave after complex diagnosis (JAMA)
A JAMA Health Forum study found that MA members with new complex diagnoses increasingly switch to traditional Medicare, with MediGap barriers, state protections, and plan limits cited as factors.
⊕ +2 from PriorAuth , Enforcement
MA plans denied 12% of prior auth requests in 2025
Home Health Care News reported the KFF finding that MA plans denied 12% of standard prior authorization requests in calendar year 2025.
CMS issues updated prior auth transparency guidance
CMS issued updated guidance on prior authorization transparency rules for payers under the CMS-0057-F framework.
California prior auth reform bill advances to governor
California legislation imposing prior authorization requirements on health plans reached the governor's desk for signature.
Health insurer CEO calls for banning prior authorization
A health insurer CEO publicly called for prior authorization to be made illegal, citing industry-wide frustration with the process.
MA denials draw federal attention
InsuranceNewsNet reported that Medicare Advantage denial practices are drawing increased federal regulatory attention.
Payer leaders respond to CMS RADV audit guideline changes
Payer industry leaders publicly responded to CMS changes in RADV audit guidelines, with commentary framing the changes as a shift in regulatory expectations.
Villages Health settles MA fraud case for $541.5M
Humana's Villages Health subsidiary agreed to pay $541.5 million to settle Medicare Advantage fraud allegations.
Bankrupt Villages Health ordered to pay $541M for bilking MA
A court ordered bankrupt Villages Health to pay $541 million for Medicare Advantage billing fraud.
Penn Highlands used AI to capture $7M in additional revenue
Penn Highlands Healthcare deployed Regard's AI clinical documentation tool across nine hospitals, achieving a 7-point CC/MCC capture improvement, a 10% case mix index lift, and $7M in added revenue, up from a $3M pilot result.
GoHealth delisted after Chapter 11, now lender-owned
GoHealth was delisted from Nasdaq in June 2026 following a prepackaged Chapter 11 restructuring and is now privately held by its lenders.
SelectQuote puts cash flow ahead of MA growth in Q4 earnings
SelectQuote used its fiscal Q4 2026 earnings call to prioritize cash generation and leverage reduction over near-term growth; revenue of $321.7M missed consensus of $375M.
⊕ +1 from Margin
Margin discipline is structural and permanent, not a cycle to wait out.
Overturned by: realised MA enrolment growing at or above market for the carriers who announced contraction, through two consecutive AEPs
Watching: Watch whether total 2027 MA county exits (across all carriers) exceed 2026's count in CMS plan benefit package filings published by October 1, 2026. by October 1, 2026
Last call: ● TESTING
Prior authorisation moves from payer discretion to regulated process.
Overturned by: twelve months with no federal rule advancing and penalties staying nominal and unnamed
Watching: Watch whether CMS or state attorneys general cite the KFF plan-level variation data in a formal enforcement or rulemaking action by Q1 2027. by Q1 2027
Last call: ● TESTING
Risk adjustment is a cost of participation, not a source of advantage.
Overturned by: any carrier attributing a margin beat to coding or risk-score improvement under V28, in two consecutive quarters
Watching: Watch whether CMS publishes final RADV extrapolation methodology guidance by December 31, 2026, locking in the dollar exposure carriers must reserve against. by December 31, 2026
Last call: ● TESTING
The independent distribution channel consolidates under financial stress.
Overturned by: a new entrant scaling profitably, or the channel carrying an AEP without a named intermediary failing
Watching: Watch whether SelectQuote's MA enrollment volume grows or contracts in AEP 2026 results reported by February 2027, as the first post-moratorium read on channel capacity. by February 2027
Last call: ● TESTING
The cost of margin recovery is passed through. Where it lands is unresolved.
Overturned by: margin recovery achieved through genuine cost reduction rather than transfer
Star ratings will be restructured, not merely disputed.
Overturned by: a full cycle published, unchallenged, with stable cut points
Penetration keeps rising. Who captures the growth is unresolved.