Medicare and Payer Changes for Florida Physicians: 2027 Guide

Updated October 30, 2026. Sean Orr, M.D., Florida Doctor Magazine.

A Florida physician who sees Medicare patients is dealing with several changes at once this fall. Medicare Advantage plans are leaving the state for 2027, four large Florida health systems are leaving UnitedHealthcare networks on January 1, CMS has proposed new rules for provider directories, and the physician fee schedule for 2027 is due in its final form in November. This page collects our coverage of those changes in one place, grouped by topic, with the dates that matter listed at the bottom. We update it as each story moves.

Medicare Advantage in 2027

About 57 percent of Florida Medicare beneficiaries are enrolled in Medicare Advantage, so plan changes here reach a large share of most practices’ schedules. Our report on the 51 Medicare Advantage plans Florida is losing for 2027 explains which hospital systems have left MA networks and what physicians are permitted to tell patients during open enrollment, which runs from October 15 to December 7.

CMS has also proposed rule CMS-4214-P, which would require MA plans to verify their provider directories every 90 days and publish accuracy scores. Our guide to the Medicare Advantage directory rule and what it means for Florida practices covers the contract clause physicians would see and how to comment before the deadline.

Two enforcement stories belong with these. The $541.5 million Villages Health upcoding settlement involved MA diagnosis codes added to charts without the treating physician, and every one of those codes carried a physician’s name. Separately, CMS has said provider payment suspensions will quadruple, and Florida AHCA is forcing Medicaid revalidation at the same time.

UnitedHealthcare in Florida

Lee Health, Sarasota Memorial, AdventHealth and UHealth are leaving UnitedHealthcare networks on January 1, 2027. Our guide to the 2027 UnitedHealthcare network split in Florida lists what the terminations cover and the steps independent physicians should take before that date.

Earlier this fall UnitedHealthcare removed prior authorization from about 1,700 procedure codes. Only about 120 of those codes apply to Medicare Advantage, and our piece on the October 1 UnitedHealthcare prior authorization change explains why most Florida practices will see less relief than the headline suggests.

Physician payment, prior authorization and price transparency

The 2026 fee schedule raised the conversion factor by 3.26 percent, and a new efficiency adjustment took most of that back for many specialists. Our analysis of the Medicare efficiency adjustment and Florida physician pay is the starting point for reading the 2027 final rule when CMS releases it.

On prior authorization, we have covered both the federal rulemaking and the work of appealing denials in a practice. See the CMS prior authorization rule for drugs (CMS-0062-P) and our practical guide on how Florida practices appeal prior authorization denials.

In October the FTC warned 24 large health systems that price quotes leaving out physician or facility fees may be deceptive, and federal agencies finalized changes to the rate files insurers publish. Our report on the 2026 price transparency rules for Florida physicians explains what the payer rule shows about your contracted rates.

For a practice that finds a billing problem of its own, the Justice Department and HHS will settle self-disclosed False Claims Act violations at 1.25 to 1.6 times the amount owed through April 22, 2027, as explained in our guide to the DOJ False Claims Act self-disclosure pilot for Florida physicians.

Medicare’s 2027 Physician Fee Schedule, finalized November 4, lowers the conversion factor to $32.63 for most physicians on January 1, pays 80% for a visit billed with a 0-day global procedure, and replaces G2211 with modifier B1, as explained in our guide to the 2027 fee schedule final rule for Florida physicians.

The companion 2027 hospital outpatient and ASC rule, also finalized November 4, raises ASC and hospital outpatient payments 2.3%, adds about 600 procedures to the ASC list and pays 340B drugs at ASP minus 28%, as explained in our guide to the 2027 OPPS/ASC final rule for Florida physicians.

Patients losing coverage

Two federal actions have removed coverage from large numbers of Floridians this year. CMS canceled 760,000 ACA marketplace enrollments on August 31, and Florida has more marketplace enrollees than any state. On October 1, H.R. 1 ended Medicaid for refugees, asylees and other lawfully present immigrants, which KFF estimates will affect nearly 177,000 Floridians. Both stories cover eligibility checks and claims steps a practice can take.

Local safety-net money is shrinking as well: Florida voters approved Amendment 3 on November 3, and public hospital districts that depend on property taxes face an estimated $323 million in losses over three years starting January 1, 2027.

Dates to watch

This guide was compiled with the assistance of AI writing tools under the editorial direction of Sean Orr, M.D., who holds editorial responsibility for its content. None of this constitutes legal or billing advice.