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Don't let coverage changes delay payment in 2027

Brennan Cantrell

November 9, 2026

Several insurance coverage changes heading into 2027 could increase the likelihood that patients arrive at your practice with insurance information that is no longer accurate.

Medicare Advantage coverage may change as some organizations have reduced service areas or exited certain counties, requiring beneficiaries to select new coverage options. More than 35 million beneficiaries are enrolled in Medicare Advantage plans, representing more than half of eligible Medicare beneficiaries.

Medicaid coverage may also change for some patients as states continue eligibility reviews and implement new eligibility and work-related requirements.

ACA Marketplace coverage became more expensive for many consumers in 2026. Premiums increased across both federally facilitated and state-based Marketplaces, while the expiration of enhanced federal premium tax credits increased the amount many enrollees had to pay for coverage. These changes may prompt some patients to switch plans, seek alternative coverage, or become uninsured.

Commercial coverage may also change because of life and employment transitions. Patients may move to a new employer-sponsored health plan, lose employer-sponsored coverage, add or remove family members from a policy, or transition between commercial, Medicare, Medicaid, or Marketplace coverage.

What this means for practices

For physician practices, these transitions create more chances for denied claims and payment delays. A returning patient may have a new plan, different member ID, updated prior authorization requirements, or a different provider network. Even patients who keep the same insurer may have a different product with different coverage rules. Unfortunately, practices often don't discover these changes until after a claim is submitted.

What to do

With coverage changes expected to increase in 2027, practices should do a quick eligibility check before each visit and verify the following items:

Active coverage status,
Payer and product information,
Member ID and group number,
Primary versus secondary coverage,
In-network participation status,
Referral requirements,
Patient deductible and cost-sharing obligations,
Updated demographic and contact information,
Any recent insurance card or coverage changes.

A few minutes spent verifying benefits before the visit can help prevent claims from being submitted to inactive coverage, reduce authorization-related denials, identify network issues, and minimize unexpected patient balances.

As coverage continues to shift across Medicare Advantage, Medicaid, and Marketplace plans, eligibility verification remains one of the simplest ways to reduce administrative burden, avoid payment delays, and protect practice revenue.

Additional reading

• Medical frailty and Medicaid work requirements: what to know

• Helping self-pay and uninsured patients afford primary care

— Brennan Cantrell, Market Transformation Senior Strategist at the American Academy of Family Physicians

Posted on Nov. 9, 2026