5 Actions to Take Now for a Strong 2027 Medicare Advantage Bid

With Medicare Advantage bids due June 1 for the 2027 plan year, plan sponsors face a compressed window in which they must complete numerous activities amid medical cost trend and regulatory uncertainty. Aligning strategy, analytics, operational readiness, and regulatory awareness will set the foundation for a strong, stable, and competitive bid.

During the first of a two-part webinar series on MA bid basics, experts from BluePeak Advisors and Milliman outlined the top 10 activities that plans should prioritize between February and May 31 for a successful bid submission on June 1. If plans haven’t already begun strategizing these areas, here are five actions bid teams should take now to prepare:

1. Understand the current market landscape and your competitive positioning. CMS enrollment data, especially coming out of the Annual Election Period, offers real-time detection of emerging trends that should influence your bid strategy. Beyond those numbers, plans should perform a comprehensive shopping and switching analysis on a regional basis, looking at the demographic mix of members moving between plans and their risk score patterns, advised Simon Moody, principal and consulting actuary with Milliman. (Milliman’s MACVAT tool can help.)

This analysis could include the impact of supplemental benefit changes on member movement. “What seemed innovative last year may now be table stakes, or conversely, may have proven too costly without sufficient member value,” said Moody. When assessing your market, keep an eye out for “big swings in membership” that may force a competitor to “make dramatic changes” or exit the market altogether, as well as major provider network disruptions that weren’t easily detected in the Medicare Plan Finder, he added. “For example, a hospital system termination or a major provider group dispute may not show up in CMS data but can dramatically reshape the competitive landscape.”

2. Gather detailed information on the market for membership modeling. You’ve evaluated the competitive landscape, but it’s important to understand how those market dynamics will affect your membership forecasting, emphasized Dawn Odrzywolski, senior consultant with BluePeak. Those forecasts should consider details such as retention rates, agent activity, overall market growth, and distribution channel. Think through all of the most likely scenarios that may play out,” including potential membership shifts resulting from competitor moves, said Odrzywolski. If you have access to it, mine historical data to “review past enrollment activity, retention rates or even switching patterns when there were big changes in your market.”

3. Translate leadership priorities into the goals and strategic pillars of your bid strategy. Odrzywolski suggested grouping goals into three categories:

1) “Must do,” e.g., meet regulatory requirements, terminate certain plans or launch new ones;

2) “Should-do,” i.e., goals that are more competitive and strategic in nature, such as offering benefits to support market segmentation; and

3) “Want-to-do,” i.e., wish list items that may enhance member experience and improve retention.

When making such considerations, be sure to align with leadership on margin and premium expectations, she added. These targets can drive the decision to, for example, maintain a $0 premium PPO plan — which many plans abandoned in 2026 — or introduce a low-premium HMO to support your “age-in” growth strategy.

Since CMS announced that it was sunsetting the Medicare Advantage Value-Based Insurance Design model at the end of 2025, many plans have embraced Special Supplemental Benefits for the Chronically Ill (SSBCI). If you’re considering SSBCI for 2027, make sure you understand the evolving requirements, including a bibliography of the clinical literature that supports the benefits you’re offering. That document must be on file by the bid deadline but does not get submitted to CMS, explained Wendy Edwards, BluePeak’s area vice president, health plan services consulting. Additionally, Part D plans that expressed interest in the new BALANCE model, which aims to increase access to GLP-1 drugs, should work with their actuaries and PBMs on whether it’s worth it to participate in that demonstration.

Keeping in mind the above focus areas and your leadership’s priorities, consider your overall strategic direction for 2027. Are you looking to grow via richer benefits or more competitive positioning, or are you seeking margin preservation through selective product enhancements or market segmentation? Maintain alignment with leadership through scheduled checkpoint meetings that you schedule now, added Odrzywolski.

4. Review your prior authorization (PA) policies to confirm they are clinically appropriate and evidence-based, according to CMS’s 2024 final rule requirements. Moreover, scrutinize your PA practices for their potential effects on member experience, provider relations, and Star Ratings. Lastly, consider PA impacts by specific benefit category in the Plan Benefit Package and make sure you have quantifiable and tangible medical management assumptions behind the trend reflected in your Bid Pricing Tool.

5. Determine formulary strategy and drug cost implications. This is the first year that maximum fair prices (MFPs) are being applied to select Part D covered drugs under the Medicare Drug Price Negotiation Program. As more drugs receive MFP status, the rebates associated with them could decrease or go away entirely. It will be important to recognize where rebates are still available, prioritize rebates for non-MFP brand and specialty drugs, and work closely with your PBM on which therapeutic classes and specific drugs offer the strongest rebate opportunities in the post-MFP environment.

Moreover, assess how your formulary compares to your competitors and how formulary differences may be driving membership gains or losses. Certain trade-offs may need to be considered carefully in your bid development. “The plans that succeed will be those that adapt quickly, model conservatively and maintain close coordination between pharmacy, financial and actuarial functions,” said Moody.

From April to June, your bid team will conduct more detailed pricing exercises, considering utilization patterns, risk adjustment trends and regulatory changes that have yet to be finalized.