A KFF analysis reveals that 638,000 Medicare beneficiaries in 193 counties will have no general Medicare Advantage drug plan in 2027. This marks a significant increase from 2026, when 399,000 beneficiaries in 123 counties faced the same issue.
The affected counties span 16 states and U.S. territories, excluding Puerto Rico. New Hampshire, North Dakota, and Oklahoma are the latest additions to this list. Notably, Alaska has no general-enrollment Medicare Advantage drug plan in any county, impacting approximately 110,000 beneficiaries.
A Growing Gap in Coverage
The 16 states with at least one county lacking a Medicare Advantage drug plan include Alaska, California, Colorado, Idaho, Kansas, Minnesota, Montana, Nebraska, Nevada, New Hampshire, North Dakota, Oklahoma, Oregon, South Dakota, Utah, and Vermont. In some counties, alternative options like Medicare Advantage plans without drug coverage or special needs plans are available.
The choices for beneficiaries are shrinking. The percentage of beneficiaries with over 40 Medicare Advantage drug plans has dropped from 27% in 2026 to 20% in 2027. While the average beneficiary will still have 28 plans to choose from, some areas, like Lancaster County, Pennsylvania, offer as many as 66 options.
Insurers Retreat, Devoted Health Expands
Several major insurers are reducing their presence. Health Care Service Corporation, Centene, UnitedHealth Group, CVS Health, and Blue Cross Blue Shield of Michigan are withdrawing from hundreds of counties, although some are also entering new ones. Meanwhile, Devoted Health is expanding into 342 counties.
For those in newly affected states, the transition can be sudden. Beneficiaries in North Dakota or Oklahoma who had a general Medicare Advantage drug plan in 2026 may find no comparable option in 2027, forcing them to explore alternatives.
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The Centers for Medicare & Medicaid Services (CMS) asserts that the program remains stable overall, with over 99% of beneficiaries having access to at least one Medicare Advantage plan. However, KFF’s county-level data highlights local disparities that national figures might obscure.
The absence of a Medicare Advantage drug plan in a county does not mean beneficiaries lose Medicare coverage.
Stand-Alone Drug Plans Shrink, Premiums Rise
Stand-alone drug plan options are also decreasing. The average beneficiary will have nine stand-alone plans in 2027, down from 11, with total plans dropping from 360 to 316. No zero-premium stand-alone plan will be available to those who do not qualify for low-income assistance.
Premium changes vary. While CMS estimates the average stand-alone drug plan premium will rise from $35 to $36 per month, KFF found that AARP Medicare Rx Preferred enrollees face increases of $50 or more in every state. Approximately 4 million stand-alone plan enrollees who paid no premium in 2026 will incur costs in 2027, regardless of whether they stay or switch plans.
Lower premiums often come with trade-offs. KFF advises beneficiaries to review each plan’s covered drugs, drug tiers, deductibles, and cost-sharing, as cheaper plans may cover fewer medications or charge more at the pharmacy. Centene’s Wellcare Value Script and Wellcare Classic are among the lowest-premium plans, costing around $5.30 per month in 45 states and $7.30 in 33 states.
Beneficiaries whose Medicare Advantage plan is leaving their area typically receive a special enrollment period to choose new coverage, which may extend beyond December 7.
High-Risk Groups Face Coverage Challenges
The most affected individuals include those in the 193 counties and enrollees whose current insurer is exiting, even if other plans remain. Older adults on multiple prescriptions, people with chronic conditions, and caregivers managing a parent’s coverage face the highest risk of increased costs or coverage gaps if they miss the enrollment deadline.
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Practical steps include reviewing the Annual Notice of Change or plan termination letter received this fall. Beneficiaries should list all prescriptions, doses, and pharmacies, along with preferred doctors and hospitals. Using the Medicare Plan Finder or calling 1-800-MEDICARE can help compare plans based on total yearly cost, not just monthly premiums.
CMS Administrator Dr. Mehmet Oz encouraged beneficiaries to use the open enrollment period to review their coverage. Free, unbiased assistance is available through each state’s State Health Insurance Assistance Program (SHIP).
Changes also affect provider networks, not just plan availability. A recent report highlighted a hospital network split impacting Hampton Roads Medicare Advantage members, demonstrating that a plan may remain available while a familiar hospital is no longer included.
Enrollment Window Opens with New Tools
Starting in October, Medicare.gov users can access more details on preventive services and will see messages about changes to their current plans. Since KFF’s analysis does not examine costs or benefits, enrollees must check these details themselves during the approximately seven-week enrollment window.
Open enrollment for 2027 runs from October 15 through December 7, 2026, with new coverage starting on January 1.
However, some popular plans will see increases of $50 or more, and zero-premium plans will not be available to those without low-income assistance. Free help is available through state SHIP programs, 1-800-MEDICARE, and the Medicare Plan Finder on Medicare.gov.
