For Medicare Advantage insurers, health plan compliance teams, and carriers preparing for the 2027 annual enrollment period, a new federal pathway changes the calculus.
Companies can now cap membership growth before it becomes unmanageable, and CMS has yet to fully define how the approach will work.
In “Medicare Advantage enrollment caps promise to reshape 2027,” Modern Healthcare examined a new CMS pathway that lets insurers cap Medicare Advantage enrollment. Network Health is among the carriers using it to limit sign-ups ahead of the 2027 season, which runs from Oct. 15 to Dec. 7. Helaine Fingold, Member of the Firm of Epstein Becker Green and counsel to health insurers on Medicare Advantage compliance and regulatory strategy, discussed the legal uncertainty surrounding the new approach.
The article reported that Network Health imposed a 2027 enrollment cap after its Medicare Advantage membership grew 36 percent over the past year. The move is part of a broader pullback, as Humana, Centene, and Aetna scale back Medicare Advantage offerings and marketing. Helaine explained that CMS previously approved caps only after enrollment growth threatened members' health and safety. That reactive standard has now been replaced with a proactive process CMS has yet to fully define. She cautioned that CMS's selective approach to granting these requests could invite legal challenges.
"It's hard to make distinctions between companies. From a legal basis, I don't know how it will hold up," Fingold said.
Get in Touch
To discuss how CMS's new proactive enrollment cap process may affect your health plan's Medicare Advantage growth strategy and regulatory risk for 2027, contact Helaine Fingold at hfingold@ebglaw.com.
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