Insurers project Medicare Advantage will shrink in 2027. CMS says they guess low. It has a point.

Will Medicare Advantage grow in 2027? Insurers project it will shrink. CMS says their projections run low. We checked, and CMS has a point.

In its 2027 release this week, CMS reported that insurers project 34 million people in Medicare Advantage next year. Today there are 36.3 million (35.8 million in February). Taken at face value, that is 1.8 to 2.3 million fewer people, and Medicare Advantage has not shrunk in any year since at least 2008.

The insurers' track record: for 2026 they projected 34.0 million and 36.3 million enrolled, 2.3 million too low. For 2024 they projected 33.8 million and 34.4 million enrolled, also too low. For 2025 they projected 35.7 million and got 35.6 million, about right.

What the projections do capture is the direction. Medicare Advantage added 2.3 million people in 2023, 1.9 million in 2024, 1.2 million in 2025 and 0.7 million in 2026. And 2026 was the first year its share of people with Medicare did not go up.

2026 was also the year about 3 million people lost their plan, and Medicare Advantage still grew. The 2027 file points to about 3 million losing their plan again, with 36 plans in the typical member's county instead of 41.

Our read: a drop of 2 million would be a first. The growth Medicare Advantage used to have looks gone.

Every number here comes from CMS files, and you can check them in our MCP: vladahealth.com/data-access