Margin Over Membership: How to Sell MA When Carriers Are Pulling Back
For a few years the carriers were chasing growth. Richer benefits, more plans, more counties. For 2027 they've made a different call..
Profit first. Growth second.
You're going to see it all over the market. Fewer plans. Higher premiums. More cost sharing. Our job this AEP is to sell well inside that reality and keep our clients' trust while we do it.
What "Margin over Membership" Looks Like
Enrollment caps. Fifteen insurers set enrollment caps for 2027. A plan you like for a client might stop taking new members.
Higher costs. Higher premiums and out-of-pocket costs are part of 2027. Carriers raised cost sharing.
Fewer products. Individual MAPD products drop 8% to 425.
PPOs to HMOs. Carriers are moving members from PPOs toward HMOs. This is the one your clients will feel the most.
The HMO Shift is Real
UnitedHealthcare's 2027 portfolio prioritizes HMOs, C-SNPs and D-SNPs.
UHC says about 95% of Medicare eligibles in its footprint have HMO access, mostly at $0 premium. It also says HMO members save more than $175 a year compared with LPPO members.
Kaiser is going further. It's dropping its last three PPOs and will offer 117 MA plans in 2027, down from 126.
So if you've got clients on PPOs, expect some of those plans to change or go away. Expect the replacements to lean HMO.
How to Sell it
Lead with the trade-off. Clients handle bad news fine when it's explained clearly. What they hate is surprises. Tell them up front. Plans are tighter this year, here's why and here's what we can do.
Networks first. In an HMO heavy year the doctor check matters more than ever. Run every provider and every pharmacy before you show a single plan. If their cardiologist isn't in network, nothing else matters..
Show total cost. A $0 premium plan isn't automatically the cheapest plan for that client. Walk through copays, drug costs and MOOP.
UHC says more than 95% of its non-SNP members don't reach the annual MOOP, and many spend under $300 a year. That's good context. It's still worth showing each client their own worst case.
Ask about travel. PPO clients usually picked a PPO for a reason. Snowbirds. Kids in other states. A specialist across the state line. Find out why before you move them to an HMO.
Watch for caps. If a plan in your market is capping enrollment, don't build a client's whole decision around it. Have a second choice ready.
Setting Expectations
This is where good agents earn their keep.
Be straight with people. Some will pay more next year. Some will lose a benefit they liked. Some will need to switch networks.
Don't dress that up as something it isn't.
And never promise a client their costs won't go up or their doctors will stay in network. You can't control either one. Say what you know, show them the numbers and let them decide.
What you can promise is that you'll review it with them every single year. That's your value. That's what a trusted local agent looks like.
A Few Lines That Work This Year
"A lot of carriers made changes for 2027. Let's look at what changed for you."
"Before we look at any plan, let's make sure your doctors and prescriptions are covered."
"This plan works a little differently than your PPO. Here's what that means day to day."
Plain words. No pressure. Clients can tell when you're rushing them..
When MA Isn't the Best Fit Anymore
For some clients the 2027 changes tip the math.
If their PPO is gone and they can't live with an HMO network, a medsupp plus a PDP might be the better route. That depends on their health, their budget and whether they'd have to go through underwriting.
Have the conversation anyway. A client who hears every option from you doesn't go shopping somewhere else.
Bottom Line
Carriers are protecting their margins. That doesn't change what clients need from you.
They need somebody who tells them the truth, checks their doctors and drugs and finds the best fit in a tighter market. Do that and you'll keep your book through a rough year.
We're working through 2027 plan changes with our agents every day. If you want help with HMO and PPO conversations or AEP prep, talk to us at BROCK.
Industry Insight
What we're seeing in 2027 may not be a one-year adjustment.
For years, carriers chased enrollment growth. Now many are prioritizing profitability, risk management, and long-term sustainability. That's why agents are seeing fewer PPOs, more HMOs, higher cost sharing, and tighter plan designs
As Andrew Saul puts it, the headline isn't that Medicare Advantage is recovering or even getting worse. The headline is that Medicare Advantage is transforming.
Stay Ahead of the Changes
This year's carrier movements are only part of the story.
If you want more than headlines and carrier announcements, join us throughout the week:
Monday Medicare Market
Join Justin Brock and Andrew Saul live every Monday as they discuss:
2027 Medicare changes
Carrier exits
Service Area Reductions
Industry trends
Tuesday GPS Training
Learn how to identify the right opportunities and naviagte client conversations using Brock's GPS framework. The GPS process focuses on Medicare knowledge, health history, budge discussions, coverage reviews, and retirement conversations.
Wednesday Selling HDG to a SAR
Strategies for helping clients impacted by Service Area Reductions and evaluating High-Deductible Plan G opportunities.
Thursday Product + Carrier Highlights
A deeper dive into carrier opportunities and product positioning.
