For 2027, many Medicare Advantage plans are trimming the extras families count on, like dental allowances, Part B premium givebacks, and over the counter allowances, and about 3.2 million people have to pick a new plan because theirs is ending. At the same time, ACA marketplace coverage costs more for many people under 65 because the enhanced premium tax credits expired and more payers are decreasing how many regions they serve on the Marketplace.
Updated October 19, 2026. We are occupational therapists, not insurance agents, and we do not sell plans. For advice on a specific plan, use the free counseling resources listed below.
If a thick envelope from your Medicare or insurance plan, landed on the kitchen counter this fall, or a letter said a plan is ending, you are not the only one trying to make sense of it. This year has more moving parts than usual. Here is what is actually changing, why it matters for safety at home, and what to do before the deadlines.
What is changing with Medicare Advantage plans for 2027?
The biggest change is that more plans are ending, and many plans that continue are offering less. About 3.2 million Medicare Advantage enrollees, almost 11%, have to shop for a new plan for 2027 because their insurer is no longer offering it, according to a Medicare Market Insights review of CMS data reported by the Associated Press. That is up from about 2.9 million for 2026 and 2 million for 2025.
The two largest insurers account for a big share. Humana says about 600,000 members are in plans ending in 2027, and UnitedHealthcare says about 390,000 members are affected by its plan closures, according to Healthcare Brew. UnitedHealthcare said its cuts focused on PPO plans, as insurers continue shifting toward HMOs and special needs plans.
For plans that continue, the extras are where the cuts show up. A Leerink Partners analysis of Medicare Plan Finder data, reported by Healthcare Dive, found:
- UnitedHealthcare dental cuts affected almost 70% of its members.
- Centene (Wellcare) reduced dental for 45% of its members, Aetna for 36%, and Elevance for 23%.
- Humana reduced or eliminated the Part B giveback for 62% of its members, while modestly increasing dental allowances.
- Several insurers raised cost sharing or maximum out of pocket limits.
CMS describes the 2027 Medicare Advantage market as stable, and most people still have many plans to choose from. The average beneficiary has 28 Medicare Advantage plans with drug coverage available, down from 36 in 2024, according to KFF figures in the AP report. The takeaway: you may be able to keep the same plan name, but that does not mean the same benefits came with it.
Which Medicare extras are people losing, and why does it matter at home?
The extras that help people stay safe at home were already shrinking before 2027. Between 2025 and 2026, the share of Medicare Advantage enrollees in plans offering over the counter benefits fell from 79% to 68%, and the share in plans offering bathroom safety devices fell from 32% to 21%, according to KFF. Meal and transportation benefits declined too.
Here is why that matters from where we sit. In a home visit, the bathroom is usually where we start, and those over the counter benefits could on some plans be used to purchase a grab bar, the shower chair, or the raised toilet seat. Original Medicare does not cover those items. CMS lists grab bars as self help devices, and raised toilet seats and bathtub seats as convenience items, none of which count as durable medical equipment. When a plan drops the benefit, that cost moves to the family.
Original Medicare does cover some equipment when a doctor orders it for use at home, including walkers and hospital beds, each with its own coverage rules. A bedside commode, for example, is covered only when someone is confined to their bed or room.
What should you do during Medicare open enrollment?
Medicare open enrollment runs October 15 through December 7, 2026, for coverage that starts January 1, 2027. Here is the order we would work in:
- Read the Annual Notice of Change. Plans had to mail it by September 30. Look past the premium to the extras: dental allowance, over the counter allowance, bathroom safety or home safety benefits, Part B giveback, maximum out of pocket limit, drug list, and whether their doctors are still in network.
- If the plan is ending, do not wait. The insurer sends a letter (Humana's are dated October 2). You can choose a new plan during open enrollment, and when a plan's contract is not renewed, Medicare also gives a special enrollment period from December 8 through the last day of February. If you do not join another plan before the current one ends, you are enrolled in Original Medicare, and you would need to pick a separate drug plan to keep prescription coverage.
- Compare on Medicare Plan Finder. Use Medicare.gov Plan Finder to check doctors and prescriptions first, then open each plan's Summary of Benefits to see the actual 2027 dollar amounts for extras. Those amounts are set plan by plan, so do not assume last year's allowance carried over.
- Use 2026 allowances before they reset. Many over the counter and flex allowances reset at the end of the year and do not roll over. Check your plan rules and catalog, and use what is left before December 31.
- Get free, unbiased help. Every state has a State Health Insurance Assistance Program (SHIP) with free counselors who do not sell plans. Find yours at shiphelp.org, or call 1-800-MEDICARE.
If you or your person stays in a Medicare Advantage plan, there is one more window: the Medicare Advantage Open Enrollment Period, January 1 through March 31, 2027, allows one change, such as switching Advantage plans or returning to Original Medicare.
What about the $90 Medicare payment and other 2027 costs?
The $90 payment is a one time rebate, not a lower premium. It went out in early October 2026 to about 21 million people enrolled in Part B under Original Medicare who do not pay the income related surcharge (IRMAA) and do not get Medicaid help with their premium, according to KFF. People in Medicare Advantage plans do not get it, even if they pay the Part B premium.
The official 2027 Part B premium has not been announced yet; CMS usually releases it in November. The Medicare Trustees project $209.50 a month, up from $202.90 in 2026, and KFF notes that increase alone would use up most of the $90 payment. For prescriptions, the yearly Part D out of pocket cap rises to $2,400 in 2027, up from $2,100.
What is happening with ACA Marketplace plans for 2027?
This part may be about you even if you're not on Medicare. Many caregivers cut back hours or leave a job to care for someone, and many buy coverage on the ACA marketplace. So do adults under 65 with disabilities who are not yet on Medicare.
Marketplace coverage is getting more expensive for several connected reasons. The extra federal help with premiums ended, insurers are raising prices, and in many areas fewer insurers are competing for your business. Each of those traces back to changes in federal law and federal rules over the last few years.
Why are ACA Marketplace premiums going up?
The enhanced premium tax credits that lowered Marketplace premiums expired at the end of 2025. According to KFF, Marketplace enrollment fell from 21.8 million to 19.2 million in 2026, and the average amount enrollees paid toward their premiums rose 58%.
For 2027, insurers proposed a median premium increase of 15%, according to a Peterson-KFF analysis of 276 insurers' rate filings. The biggest driver insurers cite is the rising cost of care: they expect medical costs to grow about 10% next year, compared with about 8% in recent years. They also expect a sicker group of enrollees. When financial help shrinks, healthier people are more likely to drop coverage, and the analysis estimates that shift adds about 4 percentage points to 2027 premiums, on top of about 4 points in 2026. Insurers' filings also point to the expired credits, the 2025 budget reconciliation law, and a 2025 federal Marketplace rule as sources of upward pressure.
Why are there fewer insurers in some areas?
Insurer participation hit a record high in 2025 and has been falling since. The average state had 9.6 Marketplace insurers in 2025 and 9.0 in 2026, and the number of counties with only one insurer rose from 93 to 165, according to KFF. About one in three counties has fewer insurers than the year before. For 2027, 11 insurers have announced they are leaving the Marketplace in some or all of the states they serve, per KFF's 2027 tracker. The largest is Cigna, which is leaving all 11 of its states and about 369,000 members, according to STAT.
Why are insurers leaving? KFF points to the same chain of events. When enrollment drops, the market gets smaller, and the people who stay tend to be sicker, so some insurers decide a state or county is no longer worth serving. Cigna described its Marketplace business as small and shrinking.
Fewer insurers matters for your price. Your tax credit is based on a benchmark plan in your area, and when fewer companies compete, there is less pressure to keep that price down. A Health Affairs study found that adding one insurer to a county was associated with a 3.5% lower benchmark premium, and an Urban Institute analysis of 2026 premiums found markets with five or more insurers had substantially lower premiums than markets with one or two. One insurer said it plainly in its 2027 filing: "Limited competition and regional monopolies have reduced downward pricing pressure."
What changed in the law, and when?
Here is the timeline of the federal changes behind these trends, so you can see how they connect:
- 2021: The American Rescue Plan Act temporarily expanded the premium tax credits for two years, including for people earning above 400% of the federal poverty level, per KFF.
- 2022: The Inflation Reduction Act extended the expanded credits through December 31, 2025.
- June 2025: CMS finalized the Marketplace Integrity and Affordability rule, which tightened income and eligibility verification and ended Marketplace eligibility for DACA recipients. A federal court paused some of its provisions in August 2025.
- July 2025: The 2025 budget reconciliation law (H.R. 1, Public Law 119-21) was signed. Its Marketplace changes include ending tax credit eligibility for some lawfully present immigrants (some starting in 2026, others in 2027), requiring people to repay the full amount of any excess tax credit, and adding verification before enrollment that could effectively end automatic renewals starting in 2028. It did not extend the enhanced credits.
- End of 2025: The enhanced credits expired. Extension votes in Congress did not pass, and no extension has been enacted as of October 2026, according to KFF.
- May 2026: CMS finalized the 2027 Marketplace payment rules on May 15, after some insurers had already filed their 2027 rates.
Put together: less federal help led many people to drop coverage, the people who stayed were sicker on average, prices rose, and some insurers left. Where fewer insurers remain, there is less competition holding prices down.
What should you do during Marketplace open enrollment?
The original tax credits still exist. Under those rules, help is limited to households earning up to 400% of the federal poverty level, so going even slightly over that line can mean no credit at all, as the Center on Budget and Policy Priorities explains. Under the 2025 budget law, people who underestimate their income have to repay the full excess credit at tax time. If caregiving changed your income this year, update your estimate carefully when you shop.
If your insurer is leaving, you will get a notice, and you will need to choose a new plan. Even if your plan is staying, compare it against what else is offered in your area, and check that your doctors and prescriptions are covered before you switch.
Marketplace open enrollment for 2027 coverage runs November 1, 2026, through January 15, 2027, on HealthCare.gov. Enroll by December 15 for coverage that starts January 1. States that run their own Marketplace can have different dates, so check your state's site.
What about Medicaid?
Medicaid work requirements are coming. Federal law requires states to start them by January 1, 2027, for adults ages 19 to 64 covered through Medicaid expansion, who will need to show 80 hours a month of work or other qualifying activities, according to a summary of the CMS rule. The law exempts some family caregivers, including caregivers of a person with a disability, but states define who counts differently. If you or someone you care for is on Medicaid, ask your state Medicaid agency how the exemption works where you live.
How can you pay for home safety equipment when benefits shrink?
When a plan stops paying for bathroom safety, the goal is to spend wisely, not to go without. A few options:
- HSA and FSA cards. We accept both. Many FSAs have a year end deadline, so read our guide to using HSA and FSA benefits before they expire.
- Local programs. Some communities help pay for equipment. See our payment options page for what we accept and programs we know.
- Buy in the right order. Start with the spots where falls are most likely for your person. Our bathroom fall prevention collection and full range of bathroom aids are a good place to start.
If you are not sure what you or your person actually needs, just ask SAMIE, our clinically trained AI assistant. Describe what is going on at home and SAMIE walks you to the right equipment and resources. If you would rather talk it through with a person, book a virtual visit with Dr. Brandy or find an occupational therapist near you.
Frequently asked questions about Medicare and ACA Marketplace changes for 2027
When is Medicare open enrollment for 2027?
Medicare open enrollment runs October 15 through December 7, 2026, for coverage that starts January 1, 2027. People already in a Medicare Advantage plan also get one change between January 1 and March 31, 2027.
What happens if my Medicare Advantage plan is ending in 2027?
You can choose a new plan during open enrollment or during a special enrollment period that runs from December 8 through the last day of February. If you do not join another plan before the current one ends, you are enrolled in Original Medicare and would need a separate drug plan for prescription coverage.
Are Medicare Advantage plans cutting dental benefits in 2027?
Many are. A Leerink Partners analysis found UnitedHealthcare dental cuts affected almost 70% of its members, and Centene, Aetna, and Elevance also reduced dental for large shares of members. Check the 2027 Summary of Benefits for your specific plan.
Does Medicare cover grab bars or shower chairs?
Original Medicare does not cover grab bars, raised toilet seats, or bathtub seats, because CMS does not classify them as durable medical equipment. Some Medicare Advantage plans offer a bathroom safety benefit, but only 21% of Advantage enrollees were in plans offering one in 2026, down from 32% in 2025.
Who gets the $90 Medicare payment?
People enrolled in Part B under Original Medicare who do not pay IRMAA and do not get Medicaid help with their premium. People in Medicare Advantage plans do not get it.
Are ACA subsidies going away in 2027?
The enhanced premium tax credits expired at the end of 2025, but the original ACA tax credits still exist for households earning up to 400% of the federal poverty level. Many people are paying more as a result, and insurers are seeking a median premium increase of about 15% for 2027.
Why are there fewer insurers on the ACA Marketplace in 2027?
Enrollment dropped after the enhanced premium tax credits expired at the end of 2025, and the people who stayed tend to be sicker, so some insurers decided certain states or counties were no longer worth serving. Eleven insurers have announced exits for 2027, including Cigna in all 11 of its states, and counties with only one insurer rose from 93 in 2025 to 165 in 2026.
When is ACA open enrollment for 2027 coverage?
On HealthCare.gov, open enrollment runs November 1, 2026, through January 15, 2027, and you need to enroll by December 15 for coverage that starts January 1. State run marketplaces may have different dates.
Sources
- Associated Press via Honolulu Star-Advertiser: Millions lose private Medicare plans and face rising costs (October 9, 2026)
- Healthcare Brew: Medicare Advantage plan benefits, options shift in 2027 (October 16, 2026)
- Healthcare Dive: 2027 Medicare Advantage benefit cuts (October 1, 2026)
- KFF: Medicare Advantage in 2026, supplemental benefits (June 5, 2026)
- KFF: The $90 payment to Medicare beneficiaries (October 5, 2026)
- KFF: Midterm election update, the ACA marketplaces (October 6, 2026)
- CMS: Medicare Advantage and Part D expected to remain stable in 2027
- CMS: Durable Medical Equipment Reference List (NCD 280.1)
- Peterson-KFF Health System Tracker: How much and why ACA Marketplace premiums are going up in 2027 (updated August 3, 2026)
- KFF: How has insurer participation in the ACA Marketplaces changed in 2026? (June 2026)
- KFF: Tracking insurer participation changes in the ACA Marketplaces in 2027 (October 7, 2026)
- STAT: Cigna to exit ACA individual market in 2027 (April 30, 2026)
- Health Affairs: Insurer competition in federally run Marketplaces is associated with lower premiums
- Urban Institute: Understanding the extraordinary increase in ACA premiums in 2026
- Federal Register: Marketplace Integrity and Affordability final rule (June 25, 2025)
- KFF: Inflation Reduction Act health insurance subsidies
- HealthCare.gov: Dates and deadlines for 2027 coverage
- CBPP: Enhanced premium tax credit expiration
