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November 12, 2026

Takeaways from the most recent news in the technology and policies shaping healthcare.

Payers

CMS Projects Lower MA Premiums, Flat Enrollment for 2027

CMS is signaling calmer waters for Medicare Advantage. In a Sept. 28 news release previewing 2027, the agency projected lower average premiums and enrollment of 34 million beneficiaries, or roughly 47.4% of all Medicare enrollees, according to Becker's Hospital Review. That figure is essentially flat compared with the 2026 projection.

The projection sits below current reality. Actual MA enrollment reached 36.1 million as of June, so CMS is forecasting membership that trails where the program already stands. That gap suggests the agency expects the years of rapid MA growth to plateau as plans absorb tighter payment rules, higher medical costs, and benefit trims.

For payers, lower projected premiums are a competitive marketing point but come amid margin pressure that has pushed insurers to exit markets and cut supplemental benefits. For hospitals and beneficiaries, the practical question is whether stable premiums hold once final bids and star ratings land ahead of the annual enrollment period.

More in Payers

Payers

Hospitals Split on Owning Health Plans as Systems Exit

Several large health systems have sold or closed their insurance arms in the past two years, exposing a widening divide over whether providers should own health plans.

Why it matters: Whether a hospital owns an insurer shapes its revenue, risk, and leverage against payers, making it one of the defining strategic bets in healthcare.

Payers

Humana, Athenahealth Expand Electronic Prior Authorization

Humana and Athenahealth are scaling electronic prior authorization across 180,000-plus clinicians, with most September transactions requiring no manual staff work.

Why it matters: Prior authorization is a leading driver of provider burnout and administrative cost, and automation embedded in the EHR is how new federal mandates get put into practice.

Payers

How Health Plans Tell If Their Payment Ops Can Scale

Health plans can gauge whether their payment operations can truly scale by watching exception volume, return rates, and digital payment share as transaction counts rise.

Why it matters: Payment infrastructure that fails under growth drives up administrative costs and strains provider relationships just as a plan expands.