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October 1, 2026

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

Payers

7 Health System Insurers to Exit Medicare Advantage in 2027

The retreat from Medicare Advantage is accelerating. Seven health system-affiliated insurers are among 11 total health plans leaving the individual MA market for 2027, according to CMS data reported by Becker's Hospital Review.

Some payers are not exiting outright but narrowing their footprint. Molina Healthcare, Horizon Blue Cross Blue Shield of New Jersey, New York City-based MJHS Health System's Elderplan, and Albuquerque-based Presbyterian Health will stay in MA next year only through special needs plans, which serve specific populations such as dual-eligible or chronically ill members.

The moves reflect mounting financial pressure on MA. Rising medical costs, tighter CMS reimbursement, stricter risk-adjustment rules, and higher utilization have squeezed margins across the industry. Health systems that launched their own plans to capture premium dollars and coordinate care are finding the economics harder to sustain. For the seniors enrolled in these plans, the exits mean shopping for new coverage during open enrollment and potential disruptions to existing provider relationships.

More in Payers

Payers

CMS Projects Lower MA Premiums, Flat Enrollment for 2027

CMS projects lower average Medicare Advantage premiums and flat enrollment of 34 million for 2027, a figure that already trails current membership of 36.1 million.

Why it matters: Medicare Advantage now covers nearly half of all Medicare enrollees, so its premium and growth trajectory shapes revenue for insurers, providers, and the federal budget.

Payers

PBMs Become Rare Bipartisan Target in Washington and States

A bipartisan push in Congress and statehouses aims to rein in pharmacy benefit managers, including proposals to force CVS and rivals to split their PBM and pharmacy businesses.

Why it matters: PBMs sit at the center of US drug pricing, and forced divestiture would upend the business models of the largest healthcare conglomerates.

Payers

Payer AI Is Driving Up the Hidden RCM Tax on Providers

Payer AI is accelerating claim denials and underpayments, fueling a multi-billion dollar cost to providers that some call the RCM Tax.

Why it matters: As insurers automate claim denials, providers that fail to modernize their revenue cycle risk losing significant revenue to rework and unappealed claims.