Your Medicare Advantage plan may not be there in 2027: the county-level retreat

Medicare Advantage has always been a county-by-county market, and that is the thing to keep in view right now. Nationally the program looks stable: the average beneficiary still has 28 Advantage plans that include drug coverage, down from 32 in 2026, and the biggest insurers are still selling plans across most of the country. Locally, in the counties where an insurer decided a plan was not worth keeping, the choice can fall from several plans to one, or to none.

That gap is wider this year than last. In its most recent county-level analysis, KFF found that 193 counties will have no Medicare Advantage prescription drug plan available for general enrollment in 2027, up from 123 counties in 2026, and that those counties are home to about 638,000 Medicare beneficiaries — up from 399,000. That is roughly 1% of everyone with Medicare.

Because coverage is sold county by county, this is not a national story you can read off the headlines. It is a check you run on your own address, and the window for acting on it opens October 15 and closes December 7, 2026.

What the analysis actually counts

Two terms do the work here, and they are not interchangeable:

• An MA-PD is a Medicare Advantage plan that includes prescription drug coverage. Almost all Advantage enrollees are in one. KFF’s county counts are MA-PD counts, and they exclude special needs plans, employer-group plans, cost plans and other arrangements not open to general enrollment.
• A Medicare Advantage plan without drug coverage (MA-only) still counts as Medicare Advantage, but it will not carry your prescriptions.

With that in mind, the county picture for 2027:

Measure	2026	2027
Counties with no MA-PD for general enrollment	123	193
Beneficiaries living in those counties	399,000	638,000
Share of beneficiaries able to choose from more than 40 MA-PDs	27%	20%

Those 193 counties sit in 16 states (Alaska, California, Colorado, Idaho, Kansas, Minnesota, Montana, Nebraska, Nevada, New Hampshire, North Dakota, Oklahoma, Oregon, South Dakota, Utah and Vermont) and in U.S. territories other than Puerto Rico. Three states are on the list for the first time — New Hampshire, North Dakota and Oklahoma. Alaska again has no MA-PD open for general enrollment in any county, which affects about 110,000 beneficiaries there.

The six counties that keep an MA-only option but lose drug coverage are Boyd, Nebraska and Aurora, Beadle, Bon Homme, Brown and Charles Mix, South Dakota. In the other 187 counties, KFF found no Medicare Advantage plan for general enrollment either with or without drug coverage — though cost plans and special needs plans, which restrict who can enroll, may still exist in some of them.

Which insurers are pulling back

KFF’s footprint table is the clearest way to see that this is a set of individual business decisions as much as a market-wide retreat. Changes of 50 counties or more, for 2027:

Insurer	Counties with MA-PDs, 2026	2027	Entering	Exiting
Health Care Service Corporation	948	450	0	498
Centene Corporation	1,731	1,387	15	359
UnitedHealth Group	2,523	2,304	9	228
CVS Health	2,083	1,960	63	186
Blue Cross Blue Shield of Michigan Mutual	282	106	1	177
Group 1001 (Clear Spring Health)	138	0	0	138
Molina Healthcare	75	0	0	75
Elevance Health	1,030	974	10	66
Humana	2,652	2,594	4	62
Devoted Health	999	1,341	342	0

Two things stand out. First, the two largest insurers — UnitedHealth Group and Humana — are each leaving far more counties than they are entering: UnitedHealth is exiting 228 and entering 9, Humana 62 and 4. UnitedHealth’s footprint across U.S. counties falls from nearly 80% to about 70%, while Humana still offers MA-PDs in about 80% of counties, the widest reach of any insurer. Second, Group 1001 and Molina are leaving the MA-PD market entirely — Molina keeps selling special needs plans elsewhere.

Not everyone is retreating. Devoted Health is adding 342 counties without leaving any, and CVS Health is entering more new counties than any insurer other than Devoted (63), even while exiting 186.

The withdrawals are not all rural. KFF notes that Health Care Service Corporation is ending MA-PDs in Miami-Dade County, Florida, and that Humana has left Monroe County, New York (Rochester). But the sharpest losses land where the Medicare population is small: in four Minnesota counties — Brown, Lake of the Woods, Morrison and Renville — three insurers each stopped offering MA-PDs for 2027.

The human scale of the churn is larger than the county counts suggest. Quartz reported that UnitedHealth Group and Humana are discontinuing plans that together cover more than a million members — roughly 390,000 at UnitedHealth and roughly 600,000 at Humana — with UnitedHealthcare President Bobby Hunter attributing the cuts to “funding pressures, rising medical costs, rising drug costs, and increased utilization.”

Why the national numbers are also true

None of the above contradicts CMS’s September 28 release. Both things are correct at once:

• Nationally, approximately 5,532 Medicare Advantage plans will be offered for 2027, a small step down from 5,553 in 2026.
• More than 99% of Medicare beneficiaries will have access to at least one Advantage plan, and 97% will have access to ten or more.
• Around eight in ten current Advantage members can stay in their plan at the same or a lower premium.
• Enrollment is projected at about 34 million people, or 47.4% of everyone with Medicare.
• The weighted average monthly Advantage premium falls from $14.37 to $12.00.

The averages are weighted across thousands of plans in thousands of counties. They can improve in a year when your county gets worse, and they tell you nothing about whether the specific plan you are enrolled in still exists. That is the whole reason to check the county question separately — the premium arithmetic is in our companion guide, Medicare open enrollment 2027.

If your plan is leaving

Medicare’s own rule is blunt: if a plan stops participating in Medicare, you have to join another Medicare health plan or return to Original Medicare. It does not continue by default. The paperwork that tells you which case you are in:

• Plan Non-renewal Notice — sent by your plan, in October, when it is leaving the Medicare program. This is the notice to open the moment it arrives.
• CMS Part C Non-renewal Reminder Notice — sent by Medicare, in November, to people whose Part C plan is leaving.
• Medicare Advantage Plan Reassignment Notice — sent in late October or early November to people who receive Extra Help. If your Advantage plan is leaving and you do not choose, Medicare says it will automatically enroll you in a stand-alone Medicare drug plan for the coming year. If that is you, you do not lose drug coverage, but you lose the bundled Advantage arrangement — and that is a real change worth reviewing rather than accepting by default. That notice also notes your chance to buy a Medigap policy, a chance that exists precisely because the plan is going away.

Nobody is required to sit still for a plan they did not choose. Medicare’s own guidance for people whose plan’s contract with Medicare ends is that a grace period applies and a Special Enrollment Period becomes available; where that applies to you, your notice will name the dates.

Five checks before you decide

1. Confirm whether your plan is still offered where you live. Look the plan up by county in the Medicare Plan Finder at Medicare.gov. If it is gone, it is not an option to keep, no matter how good last year was.
2. Read the Plan Non-renewal Notice and the Annual Notice of Change together. The first says your plan is leaving; the second, which arrives in September, shows what changed in a plan that is staying. Between them you can tell a price change from a disappearance.
3. Check your doctors against the 2027 network. Directories go stale. Call the office and ask whether it will accept that specific plan next year. A network change usually costs more than a premium change.
4. Enter every prescription into the Plan Finder. Check the tier, the deductible, the pharmacy and any prior-authorization rule. A plan with a $0 premium can still be the expensive one.
5. Decide whether Original Medicare fits better than a thin local market. If insurers are leaving your county, the honest comparison is not plan-versus-plan but bundled Advantage coverage versus Original Medicare plus a supplement and a stand-alone drug plan — a different set of choices, with its own rules and its own timing, and one worth starting before you are forced to move.

Free, unbiased help is available: 1-800-MEDICARE (1-800-633-4227) is staffed 24 hours a day, and Medicare.gov lists the counseling offered by your State Health Insurance Assistance Program.

The scam that follows this news

Plan exits are a gift to anyone running a Medicare fraud. The tells do not change:

• Nobody legitimate calls you first to sell a plan or to “review your Medicare.” 1-800-MEDICARE does not cold-call you about a better plan.
• Never give your Medicare number to someone who contacted you. That number is the key to your coverage and your medical identity.
• “Your plan is being cancelled, act now” is the pressure line. Real plan changes arrive by mail, in writing, with a date — and a notice you can read twice.
• Medicare, Social Security and CMS do not charge a fee to enroll, switch plans or “hold your coverage.”

If something sounds off, hang up and call 1-800-MEDICARE yourself, or report it at reportfraud.ftc.gov. Our companion guide Is That Really America.gov? A Scam-Spotting Checklist covers the same tells for government-service pitches.

What this is not

It is not a premium story. Whether your premium goes up is a separate question from whether your plan exists, and a plan can disappear from your county while the national average falls.

It is not an America.gov service — yet. CMS’s plan-year release routes beneficiaries to Medicare.gov, the Plan Finder and 1-800-MEDICARE, and says nothing about the new federal portal. The 2027 enrollment calendar runs on the CMS dates, not the portal’s roadmap; our guide to that split is Medicare Enrollment Is Moving Toward America.gov.

It is a snapshot, not a permanent map. Insurers file their footprints each year, and a county that loses a plan for 2027 can regain one in a later year. The list is worth checking annually, not memorizing.

One limitation to state plainly: KFF’s county analysis excludes Connecticut for 2027 because of a mismatch between the census codes in the CMS landscape file and Medicare’s enrollment data. Numbers for Connecticut are therefore missing from the county counts above, not zero.

Bottom line

The Medicare Advantage market is not collapsing — the average beneficiary still has 28 drug-covering plans to choose from, and most people can keep what they have. But plan availability is set county by county, and this year 193 counties have no MA-PD open for general enrollment, up from 123, affecting about 638,000 people. If you are in one of those counties, or in the roughly one million plans being discontinued, doing nothing is a choice with consequences. Open the October notice, look up your county in the Plan Finder, and finish before December 7, 2026.

This article is general information about Medicare plan availability, not insurance advice, and it is not a substitute for advice about your own coverage. Medicare Advantage plan availability and requirements vary by county and state, and by territory — check your plan’s notice and the Medicare Plan Finder for your address. It is AI-written and independently AI-reviewed before publication; the review standard and this article’s findings are recorded in the network’s editorial review log.