For nearly two decades, Medicare Advantage plans grew steadily, becoming the choice for more than half of all Medicare beneficiaries. But starting in 2025, that season of growth reached its apex. The past two years have brought significant changes. Some plans have cut benefits like dental, vision, and hearing coverage. Some insurers have pulled out of entire counties. As a result, millions of beneficiaries have had to shop for new coverage.
If you're on a Medicare Advantage plan, these last two years reveal an important pattern, and it's helpful to understand this as you prepare to look at 2027 plans this month. Read below to learn more about what's been happening and why, plus what to watch for as enrollment season kicks off.
Two Years of Significant Shifts in Plans
The total number of Medicare Advantage plans available nationally declined 10 percent last year, dropping from over 3,700 in 2025 to under 3,400 plans in 2026. Nearly 3 million people with Medicare Advantage plans (about 10 percent of all enrollees) had to find alternative coverage as some health insurers exited markets and scaled back plan options.
The largest insurers led the pullbacks. UnitedHealthcare reduced its coverage in 109 counties, while Humana decreased presence in 194 counties. In some regions, the disruption was more severe. In 122 counties across 13 states, approximately 391,000 beneficiaries lost access to any Medicare Advantage plan at all. Vermont experienced the most dramatic shift: 92.2 percent of Medicare Advantage enrollees in the state had to find alternative coverage. Other rural states were hit hard too: Wyoming now has just three Medicare Advantage-Prescription Drug plans available, South Dakota has four, and Minnesota also saw dramatic reductions.
The changes described here were the second year of a broader trend. So what are the underlying drivers of these changes and what should you do about it?
Why This Is Happening
The root cause centers around profitability. Federal policy changes that aimed to reduce overpayments resulted in lower reimbursement rates from the government to insurers. Meanwhile, following the pandemic, beneficiaries began seeking healthcare they postponed, which drove up medical costs faster than insurers had projected. The combination squeezed profit margins across the industry.
In response, the industry shifted rapidly from prioritizing enrollment growth to prioritizing profitability. The financial pressure remains to this day. CMS projects a 2.48 percent average rate increase for 2027—higher than initially proposed, but still lower than what many insurers need to sustain robust benefit packages. That's why the pattern we've seen these last two years is likely to continue.
What We've Seen Plans Do
Over the past two years, beneficiaries have experienced several types of changes:
Benefit reductions. For example, Aetna, Elevance, and UnitedHealthcare have cut allowances for over-the-counter health and wellness items. UnitedHealthcare and Humana cut OTC benefits for special needs plans. Some deductibles have risen on prescription drugs and medical services.
Network changes. Plans are shifting away from Preferred Provider Organization (PPO) plans, which offer more provider choice. They're prioritizing HMO designs (health maintenance organizations), which have more limited networks.
Geographic targeting. While some carriers expand into select markets, they simultaneously exit others, choosing to focus on areas where they can maintain better margins. Some insurers have pulled out of certain counties or even entire states. This is especially common in rural areas, where profitability is harder to achieve.
Who Should Be Paying Closest Attention
Seniors living in rural areas should pay particular attention. Over the past two years, rural beneficiaries have been disproportionately affected by plan terminations. While rural residents comprise only 14 percent of typical Medicare Advantage enrollees, they represented nearly 23 percent of those whose plans were terminated in 2025.
Certain states have seen more disruption than others. Vermont, Idaho, Wyoming, North Dakota, South Dakota, Maryland, and New Hampshire all saw more than 40 percent of their Medicare Advantage enrollees forced to switch plans between 2025 and 2026.
If you live in a rural area or a state that's seen significant plan activity, pay close attention to 2027 announcements to see if plans have changed in your region, and reach out to us for help.
What to Watch for this Month
Even before CMS releases 2027 plan details in mid-October, there are some important things you can do to prepare:
Review your Annual Notice of Change (ANOC) statement. You should have received this in September. Don't just glance at the plan name and assume everything is the same.
- Look for benefit changes. Check whether dental, vision, or hearing benefits have changed. Are OTC allowances being reduced? Has your prescription drug deductible increased? Are out-of-pocket maximums higher?
- Examine network changes. Did your plan shift from a PPO to an HMO? Are the doctors and hospitals you use still in-network? This is a critical detail that's easy to miss.
Keep your eyes out for a termination notice. Humana, UnitedHealthcare, Aetna, and other carriers signaled they may make additional plan exits this year. When a plan exits a county, the carrier is required to send impacted members a notice at least 60 days prior. So be sure to open all mail from your current plan, especially if you live in a rural area, in case you receive a notice of plan termination.
Talk to us soon! Don't wait until the last minute. If you receive a termination notice, or you see any changes in your ANOC that concern you, reach out to us for guidance. We can help you interpret the details as you check for changes to your current plan. As soon as plans are released, we can help you select a new plan if needed.
Know Your Options
If your plan does change or exit your area, remember this: you have guaranteed rights. If a Medicare Advantage plan terminates, you can enroll in any Medigap (Medicare Supplement) plan without being denied coverage based on pre-existing conditions, usually for up to 63 days after your coverage ends.
It's also helpful to keep in mind that the changes don't impact everyone. The majority of Medicare beneficiaries still have the same access to multiple Medicare Advantage plans with a range of benefits.
Moving Forward
The Medicare Advantage market has shifted. The days of predictable plans with expanding benefits may be behind us. But understanding the patterns of change and watching for communications puts you in control of your plan.
As 2027 plans are released this month, get in touch with us and we'll have a real conversation about what's changing and what's best for your healthcare needs. We're here to empower you to make informed decisions and stay ahead of change.
