Private Practice Outlook 2027

October 15, 2026

Brett W. Sparks

Now that we’ve entered the last quarter of 2026, let’s look ahead to what private practice providers can expect in 2027, starting with the latest insurance earnings. Six major health insurers reported $13.397 billion in 2026 second-quarter profit. The companies and their 2Q profit and margin are:

  • United: $5.484 billion in 2Q profit (a 4.9% margin)
  • CVS Health/Aetna: $2.979 billion in 2Q profit (2.8% margin)
  • Cigna: $1.660 billion in 2Q profit (2.3% margin)
  • Elevance Health: $1.463 billion in 2Q profit (2.9% margin)
  • Centene: $1.091 billion in 2Q profit (2.0% margin)
  • Humana: $694 million in 2Q profit (1.7% margin)

If you expected these profits to buffer the healthcare insurance market amid looming cuts in government spending and inflation, you’re forgetting that for-profit insurance companies are in the business of generating profits—and they expect to keep doing so in 2027. United has targeted a long-term earnings-per-share of 13% to 16%. Centene has a 12% earnings-per-share target. Cigna has a 10.55% forward growth rate. 

Insurance companies plan to hit those targets by increasing premiums, raising deductibles, and reducing coverage. Premiums for insurance plans are expected to rise by 8.2% to 15% in 2027, depending on the plan type.

  • ACA plans are expected to increase by an average of 15%.
  • Employer-sponsored plans are estimated to increase by an average of 8.2%.
  • Small group plans are estimated to increase by an average of 14%.
  • Federal employee plans are estimated to increase by an average of 10.9%.

Insurers are also eliminating underperforming plans, including Medicare Advantage plans, continuing a trend over the last couple of years as insurers have left the less profitable employer-sponsored and small-group markets. For the plans insurers keep, deductibles are expected to rise, while benefits, such as dental coverage for some Medicare Advantage plans, are expected to be eliminated.

You might wonder: How will insurers keep taking profits in such a difficult market? United’s 2Q reporting offers significant insight. United’s 2Q profit was driven by “improved medical cost ratios and stronger margins in its Optum division.”[1] Optum employs providers, so the inference is that United made more money by employing providers, which isn’t good for those providers or the independent providers that compete with them.

While individual markets always vary, health insurance will be more expensive in 2027, driven by increased revenue from provider services, to reach insurers’ targeted profits. This, plus inflation and policy changes in 2027 expected to reduce hospital services (including hospital closures), does not bode well for physicians who work for insurers or hospitals (the second-largest employer of physicians). Most employed physicians should get ready to hear the “do more with less” speech from their administrators as 2027 approaches.

Independent physicians should expect their insurance reimbursement to fall or remain flat, with more patients steered to insurer-aligned providers (who generate more profit for insurers). While this is bad news, the good news is that the conventional health insurance market’s challenges will create opportunities for independent providers to attract cash patients, expand services unrelated to insurance coverage, and experiment with payment models. Continued reliance on the conventional fee-for-service model in most markets is becoming more than unrealistic; it is looking outright delusional.

[1] https://www.reuters.com/legal/litigation/unitedhealth-group-raises-profit-forecast-third-quarter-earnings-beat-2026-10-13/