67 Counties Will Lose All General-Enrollment Medicare Advantage Plans in 2027

Sixty-seven U.S. counties, 63 of them rural, have no general-enrollment Medicare Advantage plans listed for 2027 after having at least one in 2026, MoneyGeek's analysis of Centers for Medicare & Medicaid Services (CMS) Medicare Advantage and Part D Landscape files found. General-enrollment plans are the individual Medicare Advantage plans that aren't limited to people with Medicaid, certain chronic conditions or institutional care.

Beyond those counties, MoneyGeek estimates that 2.83 million to 2.89 million general-enrollment members, or 13.2% to 13.6%, were in October 2026 plan-county combinations with neither their current plan nor an identified general-enrollment successor listed for 2027. The range reflects suppressed CMS enrollment counts and doesn't capture later file changes, continuation arrangements or individual eligibility.

If your plan is leaving, compare the 2027 plans in your county, including whether they cover your doctors and prescriptions, and check your right to buy a Medicare Supplement (Medigap) policy if you return to Original Medicare. For Medicare Advantage or Part D coverage starting Jan. 1, make sure the new plan receives your enrollment request by Dec. 31, 2026.

North Dakota has the most counties losing all general-enrollment Medicare Advantage plans for 2027, with 21. Minnesota follows with 15, then Oklahoma (seven), South Dakota (six) and Colorado (five). MoneyGeek's analysis of CMS files found 11 states with at least one county going from some general-enrollment plans in 2026 to none listed in 2027.

Crow Wing County, Minnesota, has the most Medicare-eligible residents among the 67 counties losing all general-enrollment plans, with 20,950 as of October 2026. Blue Cross and Blue Shield of Minnesota and Medica had nine general-enrollment plans there in 2026. Carroll County, New Hampshire, and Lake County, California, are next, each with more than 18,000 Medicare-eligible residents and only one general-enrollment plan in 2026.

Most of these 67 counties still list another private Medicare health plan for 2027. CMS lists a Medicare cost plan in 41 of them, all in North Dakota, Minnesota, South Dakota and Nebraska, and a Special Needs Plan (SNP) in 42, with some counties listing both. Cost plans are a separate Medicare plan type with their own rules, and SNPs only enroll people who qualify, such as those with both Medicare and Medicaid. Five of the 67 counties list neither option.

Nationally, general-enrollment Medicare Advantage plans fall from 3,350 in 2026 to 3,171 in 2027, with each contract and plan ID counted once. General-enrollment plan-county offerings drop 11.8%, and 2,236 counties have fewer general-enrollment plans to choose from. CMS says more than 99% of Medicare beneficiaries have access to at least one Medicare Advantage plan, a figure that includes plan types this study excludes. Among counties with October CMS eligibility data, which exclude Alaska and Connecticut, 0.7% of Medicare-eligible residents live in counties without a general-enrollment plan listed for 2027.

MoneyGeek estimates that 2,834,123 to 2,893,693 general-enrollment Medicare Advantage members were in October 2026 plan-county combinations with neither their current plan nor an identified general-enrollment successor listed for 2027. That's 13.2% to 13.6% of general-enrollment members. The estimate uses the CMS CY2027 Plan Crosswalk dated Oct. 1, 2026, and the range reflects suppressed enrollment counts of 10 or fewer. It doesn't capture later crosswalk changes, continuation arrangements a carrier may offer or individual eligibility, and 923 reported members with unresolved crosswalk results are excluded.

Plan disappearance alone overstates the disruption. About 3.76 million reported members were in plans whose ID isn't listed in their county for 2027, but about 925,000 of them are linked in the CMS crosswalk to a successor plan listed in their county. Those members can expect to move to the successor plan, though benefits, premiums and networks can change.

A different general-enrollment plan from the same parent company is listed in the county for about 71% of reported affected enrollment, or roughly 2 million members. That listing doesn't mean a member is moved automatically. The other plan may have different doctors, benefits or premiums.

SNPs are reported separately. MoneyGeek estimates that 310,860 to 348,700 SNP members were in plans without a listed SNP successor in their county. SNP eligibility depends on each member's circumstances, such as Medicaid status or a chronic condition.

A Johns Hopkins research letter in JAMA estimated that about 2.9 million Medicare Advantage enrollees in nonemployer HMO and PPO plans, including SNP members, were affected by plan exits for 2026. That study used March 2025 enrollment and a different plan population, and it isn't a direct comparison with MoneyGeek's 2027 estimate.

Yes: nonmetro counties account for 63 of the 67 counties losing their last general-enrollment Medicare Advantage plan, or 3.4% of nonmetro counties that had such a plan in 2026. Only four metro counties lose their last general-enrollment plan, 0.3% of metro counties with plans.

Rural Medicare Advantage members were also more likely to be in plans without a listed successor in their county: 19.2% to 21% of nonmetro general-enrollment members, compared with 12.1% to 12.3% of metro members. Insurer exits were close to even, though: at least one insurer drops all of its general-enrollment plans in 54.8% of nonmetro counties and 52.4% of metro counties.

North Dakota's county losses trace to one insurer. All 21 of its counties losing every general-enrollment plan lost NextBlue of North Dakota, a Medicare Advantage insurer CMS lists under Blue Cross Blue Shield of Michigan, and an estimated 42.8% to 45% of the state's general-enrollment members were in plans without a listed successor in their county. CMS lists Medica cost plans in all 21 of those counties for 2027.

Members of regional insurers, including health-system plans, were more than twice as likely to be affected. MoneyGeek classified CMS parent companies that offered general-enrollment plans in fewer than 10 states in 2026 as regional. They had 27.4% of reported general-enrollment members but 46.3% of reported affected members, about 1.31 million people. That's 22.5% of their reported members, compared with 9.9% of reported members in the eight national insurers' plans.
Regional insurer exits left a larger share of members affected in rural counties. Where at least one regional insurer dropped all of its general-enrollment plans in a rural county, 31.8% of reported members were affected, compared with 20.6% in rural counties where only national insurers exited and 14.6% in rural counties with no insurer exit. In metro counties, the shares were 14.4%, 12.1% and 10.1%. Wyoming is an exception to the regional pattern: about 2 in 5 of its members were affected, and all of its reported affected members were in national insurers' plans.

Minnesota had the most general-enrollment Medicare Advantage members affected for 2027, an estimated 341,972 to 342,562, or 68.2% of its general-enrollment members. Florida had about 302,000 to 303,000 affected members, New York about 218,000 to 219,000 and Texas about 190,000 to 199,000, but those totals are smaller shares of much larger markets.

More than 1 in 3 general-enrollment members were affected in nine states. After Minnesota, they're South Dakota (45.3% to 47%), Maine (44.6%), North Dakota (42.8% to 45%), Wyoming (40.4% to 40.9%), Nebraska (40% to 43.9%), Idaho (39.1% to 39.4%), New Mexico (37.6% to 37.9%) and Connecticut (36.8%).

Health Care Service Corporation leaves the most counties. It drops general-enrollment Medicare Advantage plans in 498 of the 948 counties where it offered them in 2026. CMS lists Health Care Service Corporation as the parent of Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas, and of HealthSpring. Centene, which sells Wellcare plans, follows with 359 county exits. UnitedHealthcare leaves 148 counties and enters eight, so it still serves 2,457 in 2027.

County exits and affected members rank insurers differently. Humana leaves only 61 of its 2,655 counties, but an estimated 534,593 to 538,413 of its general-enrollment members were in plans without a listed successor, about 19% of all affected members and more than any other parent company. Another general-enrollment plan from the same parent is listed in the member's county for 93.6% of Humana's reported affected enrollment, compared with 74.4% for UnitedHealth Group and 50.8% for Centene.

Group 1001, which sells Medicare Advantage plans as Clear Spring Health, and Molina Healthcare are among 12 CMS parent organizations with no general-enrollment Medicare Advantage plans listed for 2027. Clear Spring Health listed plans in 138 counties in Colorado, Georgia and Illinois in 2026 but has no matching October enrollment records, so it has no affected-member count. Molina Healthcare, Horizon Mutual Holdings (Horizon Blue Cross Blue Shield of New Jersey), Presbyterian Healthcare Services and Elderplan still list SNPs, so these insurers' general-enrollment exits aren't complete Medicare Advantage withdrawals.

Seven health-system insurers have no individual Medicare Advantage plans of any kind listed for 2027. They're Aspirus, BMC Health System's WellSense, CHRISTUS Health, Memorial Hermann, Providence, Sharp HealthCare and UMass Memorial Health's Mass Advantage.

The seven health-system insurers' general-enrollment plans account for an estimated 108,126 to 108,686 affected members, or 112,113 to 112,693 including SNP members. Employer-only plans aren't in the CMS files used here, so this doesn't describe employer group coverage.

Blue Cross Blue Shield of Michigan Mutual Insurance Co. is the parent CMS lists for NextBlue of North Dakota and for Wellmark-branded Medicare Advantage plans in South Dakota. Its exits account for all 21 of North Dakota's counties losing every general-enrollment plan and three of South Dakota's six.

Affected members were more often in lower-rated contracts. Among reported affected enrollment, 13.9% was in contracts with a 2026 Medicare Part C summary star rating of 3 stars or lower, compared with 4.2% of reported enrollment in continuing plans. CMS star ratings apply to whole contracts, not individual plans, and this comparison doesn't show why any insurer left.

You can join another Medicare Advantage plan, return to Original Medicare or choose another option such as a cost plan, if one serves your county and you're eligible. Medicare annual open enrollment runs Oct. 15 to Dec. 7, 2026, for coverage starting Jan. 1, 2027. Members whose plans aren't renewing also get a special enrollment period from Dec. 8, 2026, through Feb. 28, 2027, Medicare.gov says.

Coverage start dates depend on when you act under that nonrenewal special enrollment period, CMS's 2027 enrollment guidance says. Requests received Dec. 8 to Dec. 31, 2026, take effect Jan. 1, 2027. A request received in January or February takes effect the first day of the next month. If you return to Original Medicare, eligible applicants have until March 4, 2027, to apply for certain Medigap policies without denial or higher premiums because of health, but applying by that date doesn't by itself provide coverage back to January.

Members of a nonrenewing Medicare Advantage plan who don't join another plan before it ends are enrolled in Original Medicare. Original Medicare doesn't include Part D prescription drug coverage, though Part B covers certain outpatient drugs. Arrange a separate Medicare Part D plan unless you have other creditable drug coverage or Medicare reassigns you to a drug plan through Extra Help, and check your notices for the effective date.

Federal law gives eligible people a guaranteed-issue right to buy certain Medigap policies when their Medicare Advantage plan leaves Medicare or stops serving their area and they return to Original Medicare. During this window, an insurer can't deny the policy, charge more because of health or exclude pre-existing conditions. Eligible applicants can apply as early as 60 days before their plan coverage ends and no later than 63 days after, so the window for plans ending Dec. 31, 2026, runs from Nov. 1, 2026, to March 4, 2027.

The Medigap plans covered by this right depend on when you first became eligible for Medicare. People first eligible on or after Jan. 1, 2020, can buy Plans A, B, D, G, K or L where sold. For people eligible earlier, the list is Plans A, B, C, F, K and L, CMS told state insurance regulators in November 2024. Plan N isn't part of this federal minimum. Massachusetts, Minnesota and Wisconsin standardize Medigap policies differently, so plan letters differ there.

Federal law doesn't require insurers to sell Medigap policies to people under 65, so some people with Medicare due to disability may not have this right unless state law provides it. Illinois, Mississippi and North Carolina give people under 65 a guaranteed-issue right when their Medicare Advantage or other managed care plan ends, KFF reports. In Texas, people under 65 who get Medicare because of a disability can buy at least Plan A when they have a guaranteed-issue right after losing coverage, the Texas Department of Insurance says.

To use the plan-exit protection, you must return to Original Medicare and apply within the window, and choosing another Medicare Advantage plan doesn't extend that deadline. Without another guaranteed-issue right, most states let insurers use medical underwriting.

Some states do: every state follows the federal plan-exit guaranteed-issue right, and several add enrollment opportunities beyond it. People with Medicare can buy Connecticut Medigap policies and New York Medigap policies at any time of year. MoneyGeek checked the states below against state laws or insurance department guidance.

State Medigap rules beyond the federal minimum help most if you miss the federal window. A year-round Medigap rule doesn't let you leave Medicare Advantage at any time, but a New York or Connecticut resident who returns to Original Medicare during a later enrollment period can still buy a policy. In most other states, that person would need another guaranteed-issue right or would go through medical underwriting.

Outside the seven states in the table, no state law adds a year-round or annual Medigap window, KFF's 2026 review shows. Illinois has a voluntary version: Blue Cross Blue Shield of Illinois sells Medigap on a guaranteed-issue basis all year, KFF reports, though state law doesn't require it. At the other end, KFF lists 10 states and Washington, D.C., as following only the federal minimum for people 65 and older: Alabama, Arizona, Georgia, Hawaii, Mississippi, New Hampshire, North Carolina, North Dakota, South Carolina and South Dakota.

KFF classifies the other 32 states as adding guaranteed-issue rights tied to events such as a cut in retiree coverage or the loss of Medicaid. Some also expand options when a plan ends. Since July 1, 2026, for example, Maryland has let people who first became eligible for Medicare before 2020 and have a qualifying federal special enrollment period buy any Medigap policy open to new members, the Maryland Insurance Administration says.

Vermont and Washington sometimes appear on lists of states with extra Medigap protections, but neither offers year-round issue to people leaving Medicare Advantage. Vermont ties guaranteed issue to events such as a plan exit, and Washington's any-time switching rule covers only people who have Medigap Plan B through N.

Each hypothetical enrollee below is 70 years old, first became eligible for Medicare in 2021 and has a general-enrollment Medicare Advantage plan ending Dec. 31, 2026. The scenarios use plan listings from the CMS 2027 files and the laws reviewed above. They don't replace advice from a State Health Insurance Assistance Program.

Compare annual premiums and expected cost sharing for medical care and prescriptions under each option: a Medicare Advantage plan, or Original Medicare with a Medigap policy and a Part D plan. MoneyGeek’s 2026 quote analysis reports average Medigap Plan G premiums of $220 a month at age 65 and $279 at age 75. Get 2027 quotes before you decide. Extra benefits are part of that comparison, and fewer plans include them for 2027. MoneyGeek’s analysis of 2027 plan filings found that 52.7% of general-enrollment Medicare Advantage plans include comprehensive dental, eyewear, hearing aids and an over-the-counter allowance, down from 59.5% in 2026.

State Health Insurance Assistance Programs offer free help comparing 2027 options. Most people enrolled in Medicare Advantage can make one change during the Medicare Advantage open enrollment period, Jan. 1 to March 31, 2027. That period doesn’t apply to Medicare medical savings account plans.

These 67 counties had at least one general-enrollment Medicare Advantage plan in 2026 and have none listed for 2027. An estimated 31,191 to 32,151 general-enrollment members in these counties were in plans with no listed successor.

MoneyGeek compared the general-enrollment Medicare Advantage plans listed in each county in the CMS CY2026 Medicare Advantage and Part D Landscape file (version 202609, data updated Sept. 2, 2026) and the CY2027 file (version 202610, data updated Oct. 18, 2026). The CMS CY2027 Plan Crosswalk (dated Oct. 1, 2026) links each 2026 plan to any 2027 successor. General-enrollment plans are Medicare Advantage HMO, PPO, regional PPO, private fee-for-service and medical savings account plans that aren't SNPs. The analysis excludes cost plans, stand-alone drug plans, employer-only plans and U.S. territories.