The Centers for Medicare & Medicaid Services has barred MMM Healthcare, LLC, a San Juan, Puerto Rico, Medicare Advantage insurer, from enrolling new members in the plans under its Medicare Advantage-Prescription Drug contract H7522 for 2027. In a September 3 notice, CMS said every plan under that contract will be removed from the list of plans Medicare beneficiaries can choose during the 2027 Annual Election Period, which runs October 15 through December 7, 2026. The agency tied the action to three straight years in which the contract fell short of the federal 85 percent medical loss ratio requirement.
What the CMS notice takes off the 2027 plan list
The enrollment suspension notice was signed by John A. Scott, director of the CMS Medicare Parts C and D Oversight and Enforcement Group. It was addressed to Agustin Gonzalez Cuadrado, president of MMM Healthcare, and to Aimee K. Dailey, president of Medicare programs at Elevance Health, Inc.
CMS said MMM Healthcare is prohibited from accepting any Medicare Advantage-Prescription Drug enrollments for coverage that begins between January 1, 2027, and December 31, 2027, under contract H7522. All plans under the contract will be dropped from the menu of choices during the fall election period. The company may still accept and process enrollments that take effect on or before December 31, 2026, meaning the restriction is aimed at 2027 coverage rather than at the remainder of this year.
The notice also puts limits on how the company talks about the plans. CMS said MMM Healthcare’s marketing and communications must not mislead beneficiaries and must accurately reflect that the plans under H7522 are not available for enrollment during 2027. The agency warned that further enforcement actions could follow if it finds activity that confuses Medicare beneficiaries or misrepresents the plans.
A closed contract means a fresh plan comparison: With the H7522 plans off the 2027 list, anyone who was weighing them has to line up the remaining choices on premiums, prescriptions and doctors before December 7, the job the cost calculator spreadsheet and prescription-by-plan comparison in The 2027 Medicare Open Enrollment Decision Kit are built for.
Three years below the 85 percent spending floor
The medical loss ratio measures how much of a plan’s revenue goes to medical care and related benefits rather than to administration and profit. Section 1857(e)(4) of the Social Security Act requires Medicare Advantage organizations to keep that ratio at 85 percent or higher, and the same rule applies to Part D drug coverage.
According to CMS, MMM Healthcare reported ratios for contract H7522 of 72.9 percent for 2023, 75.4 percent for 2024 and 74.1 percent for 2025. Based on those figures reported by the company, CMS determined that the contract failed the 85 percent threshold for three consecutive contract years. CMS said it published the reporting instructions and workbooks for those years on June 12, 2024, May 30, 2025, and May 29, 2026.
The law leaves the agency little discretion once that pattern appears. When a contract falls below 85 percent for three or more consecutive years, CMS must suspend new enrollment for the second contract year after the third failing year. That formula is why a shortfall that ended with 2025 results translates into a closed door for 2027 coverage.
What current members and employer groups can and cannot do
The suspension also affects people already in the company’s plans. CMS said that during 2027, all individual-market plans under H7522 are precluded from accepting new enrollees, including beneficiaries already enrolled in an MMM Healthcare plan who might want to move to a different plan under the same contract.
Employer-sponsored retiree coverage is treated separately. If MMM Healthcare has employer group plans, it may apply for an employer group waiver to keep enrolling members into existing employer group plans. CMS said it will not allow the company to add new employer group plans to contract H7522 during 2027.
The notice does not say that current coverage ends, and it does not direct existing members to leave. For Medicare Advantage members who want to change coverage, Medicare’s guide to joining a plan lists the fall Open Enrollment Period, with changes taking effect January 1 as long as the plan receives the request by December 7, and a separate Medicare Advantage Open Enrollment Period from January 1 through March 31 for people already in a Medicare Advantage plan.
How the suspension could end, or get worse
CMS laid out a path back. If MMM Healthcare submits a 2026 medical loss ratio report in 2027 showing at least 85 percent for H7522, the agency will let the company resume enrollment for coverage starting on or after January 1, 2028, and offer the plans during the 2028 Annual Election Period, scheduled for October 15 through December 7, 2027. If the 2026 ratio again falls below 85 percent, enrollment will stay closed through 2028.
The stakes rise after that. CMS reminded the company that if the contract fails to reach 85 percent for five consecutive years, federal law requires CMS to terminate it. The notice adds one exception: if the contract has non-credible experience in 2026 because it lacks enough enrollment to meet the minimum member months under the ratio rules, it will not be subject to sanctions during 2028.
MMM Healthcare had until September 14, 2026, to file a written rebuttal with Kevin Stansbury, director of the CMS Division of Compliance Enforcement, and until September 21 to request a hearing before a CMS hearing officer. CMS stated that neither step pauses the suspension. A similar case shows how reversals work. CMS suspended enrollment in Wellcare of Missouri’s contract H7518 for 2025 over the same three-year shortfall, then released that suspension effective January 1, 2026, after the insurer reported a 2024 ratio above 85 percent.
Comparing 2027 options before December 7
For older Americans on fixed incomes, the practical effect of a plan’s removal is a narrower field of choices during the most important weeks of the Medicare calendar. Premiums, drug copays, pharmacy networks and doctor networks can differ sharply between plans offered by the same company, and between counties served by the same plan.
The federal Medicare Plan Compare tool lists the plans available in a given area and lets beneficiaries enter their prescriptions and preferred pharmacies to estimate yearly costs. The Annual Notice of Change mailed by a current plan shows what will be different in 2027. Checking that each regular doctor and each prescription is covered by any replacement plan, and confirming the premium and out-of-pocket maximum, is the most reliable way to avoid surprise bills in January.
Beneficiaries who were considering one of the H7522 plans can expect those options to be missing from the 2027 lists during the fall election period. Anyone unsure whether a current or prospective plan falls under that contract can confirm the contract number with the plan or with Medicare before making a choice.
When a familiar plan drops off the list
The CMS notice explains why the H7522 plans are gone for 2027, but it cannot say which remaining plan covers a particular set of prescriptions and physicians at the lowest total cost. That comparison still has to be done plan by plan before the December 7 cutoff.
The 2027 Medicare Open Enrollment Decision Kit includes a cost calculator spreadsheet that compares plans on cost, drugs and doctors, a provider call script for confirming network status, and the Open Enrollment calendar for keeping the fall deadlines in view.
Work through the replacement choices with The 2027 Medicare Open Enrollment Decision Kit.
This article was prepared with AI assistance and reviewed against the linked official sources.
