Next year is shaping up to be tumultuous for Medicare Advantage as insurers continue to shore up their profits.

Why it matters: Benefit cuts and insurer exits from certain markets mean more upheaval for seniors — and right before the midterm elections.

Driving the news: Based on insurance broker commentary, "it appears 2027 sets up as another year of broad-based industry benefit reductions with [Humana] and [UnitedHealthcare] likely cutting the most," a Leerink analyst note declared earlier this week.

• Common strategies include removing "giveback" benefits that pay part of beneficiaries' Part B premium, cutting major dental benefits, increasing copays for specialist care, as well as changing out-of-pocket drug costs.
• Some plans are even capping enrollment midway through the sign-up period, the note says.
• The insurance brokers get an early look at next year's plan design and benefits.

Details: UnitedHealthcare apparently has dropped around 13% of plans offered across 18 states, according to the note.

• And Humana is receiving "a good bit of negative feedback on benefit changes, suggesting much less rich plans."
• The analyst note adds that these changes are a positive development for the big insurers.
• United and Humana declined to comment.

The big picture: Medicare Advantage used to be a very lucrative business for insurers, but that stopped being the case in recent years.

• Underlying medical costs rose higher than insurers expected post-pandemic, while their relationships with providers became more fraught and federal policymaking turned much less friendly.
• A HealthScape Advisors survey of health plan leaders from 35 plans earlier this year found that nearly 70% expected their overall MA benefit packages will be less rich in 2027.
• The outlook comes after a couple of years of higher plan turnover, with one study estimating 10% of Medicare Advantage enrollees experienced plans leaving their market in 2026.

"More than half of Medicare beneficiaries continue to choose Medicare Advantage because it offers more comprehensive coverage and greater affordability than traditional fee-for-service Medicare," said Susan Reilly, vice president of communications for the Better Medicare Alliance, the advocacy group for the private health insurance option.

• "But there is no question that seniors continue to feel the negative impacts of recent funding pressure and major policy changes," she added. "That's why policymakers must protect Medicare Advantage, fund the program, and prioritize stability for seniors moving forward."
• "At a time of sharply rising medical costs and high utilization of care, health plans will continue to focus on keeping coverage and care as affordable as possible for MA beneficiaries," said Chris Bond, a spokesperson for the big insurer group AHIP.

Yes, but: Some economists have long argued that the plans are significantly overpaid by the federal government, and the excess is what enables such generous benefits compared with traditional Medicare.

Flashback: Regardless of the extent of forthcoming benefit cuts and plan exits, remember that they'll come after the federal government abandoned a proposal to keep plans' 2027 payment rates flat. Instead, the final 2027 MA payment rule provided a $13 billion pay bump.

• The initial proposal received fierce blowback from the industry and its allies, who warned of dire consequences for seniors if it was implemented.

What they're saying: "We think we're going to be very competitive in terms of our pricing next year," United CFO Wayne DeVeydt said during Wells Fargo's annual health care conference yesterday. "We still have a few markets where we're right-sizing some of the products, but I think we'll be well-positioned for 2027."

• And both United and Humana have framed benefit and market participation changes as necessary to meet their margin goals.
• "We expect that our approach to 2027 MA bids will drive solid progress against our goal of delivering a sustainable pre-tax margin of at least 3% in 2028," Humana CEO Jim Rechtin said in the company's second quarter earnings call.
• CFO Celeste Mellet said on the same call the company estimates that plan exits will impact around 600,000 members.

What we're watching: The Trump administration has indicated it's not finished with MA policymaking.

• At a recent event hosted by Paragon Health Institute, Medicare innovation center director Abe Sutton previewed more action to come.
• "Having thoughtful reforms in place to help address some of the issues there and advance the ball and move the system in a free market direction makes sense to do," he said. "And so I think you could expect to see action from us in that space."

Pharmaceutical companies and health insurers are viewed as some of the most corrupt industries in a new poll that finds bipartisan majorities of voters favor cracking down on price gouging and holding bad actors accountable.

Why it matters: The way Americans blame corruption for driving up their costs creates an opening for reform-minded politicians to take on vertically integrated corporations and predatory pricing practices.

• The question is whether policymakers want to confront politically powerful interests they're now widely viewed as protecting.

What they found: The Global Strategy Group survey found drug companies and insurers ranked among the top four "most corrupt" industries among a list of 12, joined by oil and gas firms and Big Tech and AI labs.

• Republicans (45%) and independents (42%) were more likely to call out the prescription drug industry. Democrats singled out oil and gas.
• The online survey took place late last month and included more than 1,600 registered voters. The margin of sampling error is +/-3.1 percentage points at the 95% confidence level.

3 in 5 (60%) agreed that cracking down on price gouging is the best way to reduce costs, compared with only 1 in 3 (33%) who say capping the prices of prescription drugs or utilities is the best solution.

• Steps like banning unfair price increases during emergencies, prosecuting corporate crimes and capping hidden fees rank as more important to lowering costs than banning elected officials from becoming lobbyists or requiring the Department of Justice to be independent.

Context: Candidates this year are accusing primary or general election opponents of working to protect drugmakers, insurers and other powerful health interests instead of the public.

• The Trump administration has embraced its own anti-corruption message on Medicaid and other social supports, though so far it has largely blamed blue states for not taking fraud seriously.