About 638,000 people with Medicare live in counties where no Medicare Advantage plan with drug coverage will be offered for general enrollment in 2027, up from 399,000 this year, according to an updated KFF analysis published Thursday, Nov. 5. The number of counties with no such plans rose to 193 from 123.
The analysis, based on federal plan landscape data, found that the average beneficiary can still choose from 28 Medicare Advantage prescription drug plans, known as MA-PDs, for 2027. But choices are shrinking in many places as several large insurers leave more counties than they enter and more companies exit the market than join it.
The findings arrive in the middle of Medicare’s open enrollment period, which runs through Dec. 7, when people can change how they get their Medicare coverage for next year.
How many Medicare Advantage plans can seniors choose from in 2027?
It depends heavily on where they live. KFF found that 20% of beneficiaries, nearly 13 million people, can choose from more than 40 MA-PDs in 2027, down from 27%, or 16.6 million people, in 2026. Those large markets are concentrated in 137 counties, mostly in Pennsylvania, Ohio and Michigan, plus Los Angeles County. Lancaster County, Pennsylvania, has the most options in the country, with 66.
At the other end, nearly 7 million people will have just 1 to 10 MA-PDs available in 2027, up from 4.8 million for 2026.
Where will there be no Medicare Advantage drug plans?
The 193 counties without any MA-PD for general enrollment are in 16 states: Alaska, California, Colorado, Idaho, Kansas, Minnesota, Montana, Nebraska, Nevada, New Hampshire, North Dakota, Oklahoma, Oregon, South Dakota, Utah and Vermont, as well as U.S. territories other than Puerto Rico. New Hampshire, North Dakota and Oklahoma are new to that list this year. No county in Alaska, home to about 110,000 beneficiaries, has a general-enrollment MA-PD for 2027.
In six of those counties, one in Nebraska and five in South Dakota, a Medicare Advantage plan without drug coverage is still available. KFF noted that some counties without general-enrollment plans may still have cost plans or special needs plans, which are limited to people who meet specific criteria.
Which insurers are leaving counties?
KFF reported that UnitedHealth Group is exiting 228 counties and entering 9, while Humana is exiting 62 counties and entering 4. Health Care Service Corporation is making the largest reduction, leaving 498 counties and entering none, and Centene is exiting 359 counties while entering 15. Elevance Health is exiting 66 counties and entering 10.
Two firms, Clear Spring Health and Molina Healthcare, are leaving the MA-PD market entirely, though Molina will still offer special needs plans in many counties. Overall, 10 firms are exiting the Medicare Advantage market for 2027 and four are entering for the first time.
Some companies are growing. Devoted Health is entering 342 counties and leaving none, and CVS Health is entering 63 new counties while exiting 186. The average beneficiary can choose from plans offered by seven companies in 2027, one fewer than this year.
Exits are not limited to rural areas. KFF cited Miami-Dade County, Florida, where Health Care Service Corporation is no longer offering MA-PDs, and Monroe County, New York, where Humana left the market. KFF said the decisions suggest “a combination of factors are at play, including local market characteristics, cost pressures, shifts in firm-level strategies, and ultimately the insurers’ assessment of profitability.”
What should seniors do if their plan or insurer is leaving?
Anyone whose plan is ending should have received a notice from the plan. HNC’s earlier report on the 4.3 million Medicare enrollees losing their plans explains those options. Even if your plan is staying, it is worth confirming that it is still offered in your county and that your doctors and drugs are still covered.
- Compare plans by ZIP code with Medicare’s official Plan Finder, or call 1-800-MEDICARE (1-800-633-4227).
- Get free, unbiased one-on-one help from your State Health Insurance Assistance Program (SHIP) through shiphelp.org.
- If no Medicare Advantage plan fits, traditional Medicare paired with a stand-alone Part D drug plan is available in every state.
- Before leaving Medicare Advantage for traditional Medicare, check how Medigap rules work in your state. Our report on Medigap denials explains the risk.
KFF’s analysis looked only at which plans are available, not at changes in premiums, benefits or other plan features.
Key Takeaways
- 193 counties in 16 states and several territories will have no Medicare Advantage drug plan for general enrollment in 2027, affecting about 638,000 people, up from 399,000.
- The average beneficiary can still choose from 28 MA-PDs, but the share with more than 40 options fell to 20% from 27%.
- UnitedHealth Group, Humana, Health Care Service Corporation, Centene and Elevance are leaving more counties than they enter; Devoted Health is expanding into 342 counties.
- Ten firms are exiting the Medicare Advantage market and four are entering.
- Open enrollment runs through Dec. 7; compare plans on Medicare’s Plan Finder or with free SHIP counseling.
Frequently Asked Questions
How many counties have no Medicare Advantage drug plans in 2027?
KFF found 193 counties with no MA-PD available for general enrollment in 2027, up from 123 in 2026. About 638,000 beneficiaries live in them.
Which states have counties with no Medicare Advantage drug plans?
Alaska, California, Colorado, Idaho, Kansas, Minnesota, Montana, Nebraska, Nevada, New Hampshire, North Dakota, Oklahoma, Oregon, South Dakota, Utah and Vermont, plus U.S. territories other than Puerto Rico.
How many Medicare Advantage plans does the average person have in 2027?
The average beneficiary can choose from 28 Medicare Advantage plans with drug coverage, offered by seven companies, according to KFF.
When is Medicare open enrollment?
Medicare’s open enrollment period ends Dec. 7. Changes made during it take effect Jan. 1, 2027.
Where can I get free help choosing a Medicare plan?
Use Medicare’s Plan Finder at medicare.gov, call 1-800-MEDICARE, or contact your State Health Insurance Assistance Program through shiphelp.org.
Featured image: Senior woman using a laptop at home. (Shixart1985, CC BY 2.0, via Wikimedia Commons)
