Newsletter

WHAT EARLY CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) FILINGS SUGGEST FOR 2027 MA & MEDIGAP PLANS

Early 2027 filings with the Centers for Medicare and Medicaid Services (CMS) point to another year of tight margins for Medicare Advantage (MA) carriers. Rising utilization, higher hospital reimbursement demands, and pressure from GLP‑1 and other specialty drugs are pushing plans toward leaner benefits and more restructuring.

PPO Plans: Most Likely To Be Cut

PPOs remain the costliest MA product. Early filings suggest:

• More PPO terminations
• Shrinking service areas
• Tighter networks and reduced out‑of‑network coverage

This is especially important in snowbird states like Florida.

Impact on Medicare Supplement (Medigap) Plans: Unhealthier Members Will Drive Rate Pressure

When PPOs exit or shrink, affected members receive a Guaranteed Issue right to enroll in certain Medicare Supplement (Medigap) plans.

The key dynamic:

Unhealthier PPO members are the ones most likely to move into Medicare Supplement (Medigap) plans.

They need:

• Predictable costs
• No networks
• Fewer authorization barriers

This higher‑risk influx raises claims inside Medicare Supplement (Medigap) blocks, which leads to larger premium increases. This trend is expected to continue into 2027.

Medicare Advantage (MA) Benefits: Expect Higher Cost Sharing

To stay within CMS revenue limits, many 2027 MA plans are expected to:

• Raise specialist and hospital copays
• Reduce dental/vision/hearing allowances
• Shrink Over-The-Counter benefits
• Increase prior authorization

Giveback Plans: Likely To Decline

Giveback (Part B rebate) plans surged from 2021–2024, but filings show a pullback.

Expect In 2027:

• Fewer giveback plans
• Smaller giveback amounts
• Givebacks concentrated mostly in HMO plans

Bottom Line for 2027

Beneficiaries should expect:

• Fewer PPO options
• Narrower networks
• Higher Medicare Advantage (MA) cost‑sharing
• More high‑risk members entering Medicare Supplement (Medigap) plans
• Continued Medicare Supplement (Medigap) premium pressure
• Fewer and smaller giveback plans

Disclaimer:



This article provides general educational information only. It does not describe, predict, or market benefits for any specific 2027 Medicare Advantage, Part D, or Medicare Supplement plan, and the predictions included in this article might or might not come to fruition. Final 2027 plan benefits will not be available until the Centers for Medicare and Medicaid Services (CMS) releases approved plan data later in the year.

MEDICARE’S NEW BALANCE GLP-1 INITIATIVE BEGINS JULY 1

Medicare’s new BALANCE GLP‑1 initiative—set to begin July 1—marks a major shift in how Medicare will support access to weight‑loss medications for beneficiaries. The initiative launches through the Medicare GLP‑1 Bridge, a temporary demonstration that runs from July 1, 2026 through December 31, 2027, offering eligible Medicare Part D beneficiaries access to select GLP‑1 medications for a flat $50 monthly cost.

What the BALANCE / GLP‑1 Bridge Initiative Does

The GLP‑1 Bridge is designed to expand affordable access to evidence‑based weight‑loss medications—such as Wegovy, Foundayo, and Zepbound—while Medicare prepares for the full BALANCE Model, which will launch in 2027. The BALANCE Model will integrate GLP‑1 medications with lifestyle and nutrition interventions to improve long‑term metabolic health.

Cost And Eligibility

Beginning July 1, Medicare beneficiaries with Part D or MA‑PD coverage may qualify for a $50 monthly supply of approved GLP‑1 medications. To be eligible, individuals must meet clinical criteria such as:

• BMI (Body Mass Index) ≥ 35, or

• BMI (Body Mass Index) ≥ 30 with conditions like heart failure, uncontrolled hypertension, or chronic kidney disease, or

• BMI (Body Mass Index) ≥ 27 with pre‑diabetes, prior heart attack or stroke, or symptomatic peripheral artery disease.

Prior authorization is required, and providers will submit requests through a centralized CMS (Centers for Medicare and Medicaid Services) system.

The Medicare GLP-1 Bridge will operate separataely from the Medicare Part D benefit, with its own prior authorization, claims routing, and payment flow. Per the Centers for Medicare and Medicaid Services (CMS), the Bridge “will operate outside of the Medicare Part D benefit’s coverage and payment flow, and Part D sponsors “will not carry risk” for these drugs under the program. Although Zepbound, which is approved only for weight loss, is not permitted to be included in Part D plan formularies, some carriers have approved coverage for this medication on a formulary exception basis under the Part D plan when certain very restrictive criteria have been met.

Why This Matters

GLP‑1 medications have shown significant benefits for weight reduction and related chronic conditions, but high costs have kept many Medicare beneficiaries from accessing them. CMS leaders describe the program as a way to make these treatments predictable, affordable, and accessible, while improving long‑term health outcomes for Medicare beneficiaries. 

TrumpRx.co: WHAT MEDICARE BENEFICIARIES SHOULD KNOW

A new discount program is drawing attention — but it’s important to understand what it is and what it isn’t.

TrumpRx.co is a prescription discount website that offers lower cash prices on certain medications. It works similarly to GoodRx, SingleCare, and other coupon platforms: you search for your medication, download a coupon, and present it at participating pharmacies.

Key points for Medicare beneficiaries:

• It is not insurance. Using a coupon means you are paying the pharmacy’s cash price, not using your Medicare Part D plan.
• Cash payments do not count toward your Part D deductible or out‑of‑pocket maximum.
• Prices vary widely. Some drugs may be cheaper than your plan copay; others may not.
• Useful for non‑covered drugs. If your Part D plan excludes a medication, a discount card can sometimes offer a lower cash price.

When it may help:

• Your plan’s copay is unusually high.
• You take a medication not on your plan’s formulary.
• You want to compare cash prices before filling a prescription.

When to be cautious:

• If you are working toward the Part D deductible or catastrophic phase.
• If you take expensive brand‑name medications where coupons rarely beat insurance pricing.

Bottom line: TrumpRx.co is another tool in the toolbox — but Medicare beneficiaries should compare prices carefully and understand that discount cards do not coordinate with Part D (i.e., prices paid under TrumpRx.co do not count toward Part D deductibles or toward the catastrophic limit).

About Paul Cholak

Paul is a licensed, independent health and life insurance agent and has over forty years of benefits experience and specializes in helping Medicare beneficiaries obtain health insurance. However, he offers a complete array of life and health insurance products to individuals of all ages.

He guides Medicare beneficiaries through the steps of getting insurance and is available to help clients both BEFORE and AFTER they've made their purchase decision.

Disclaimer for Part C and D plans: "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY: 1-877-2048) to get information on all your options."

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