The number CMS leads with is 99 percent. More than 99 percent of Medicare beneficiaries will have access to at least one Medicare Advantage plan in 2027. The number that tells the real story is 57. That is how much the count of counties with no Medicare Advantage prescription drug plan for general enrollment increased between 2026 and 2027 -- from 123 counties to 193.
The Number CMS Leads With, and the One It Doesn't
When CMS announced the 2027 Medicare Advantage landscape in early October, its official messaging emphasized stability. More than 99 percent of beneficiaries have access to at least one MA plan. About 8 in 10 enrollees can keep their current plan at the same or lower premium. The average monthly MA premium is projected to fall 16.5 percent, from $14.37 to $12 a month.
All of that is technically accurate. None of it captures what is happening at the county level.
A KFF analysis published October 9 using CMS 2027 landscape data found that 193 counties will have no Medicare Advantage prescription drug plan available for general enrollment. In 2026, that number was 123. The one-year increase is 70 counties -- a 57 percent jump in a single plan year.
About 638,000 beneficiaries live in those 193 counties. In 2026, 399,000 people were in that position. The gap widened by 239,000 people in one year.
The 99 percent figure and the 57 percent figure coexist. They are not contradictory. What they measure is different. CMS counts whether a plan exists somewhere in a county. KFF counts whether a plan with prescription drug coverage exists for people who aren't in a special needs population. Those two measurements answer different questions, and the one that matters for daily medication access is the second one.
The counties joining the no-plan list in 2027 are in 16 states plus U.S. territories other than Puerto Rico: Alaska, California, Colorado, Idaho, Kansas, Minnesota, Montana, Nebraska, Nevada, New Hampshire, North Dakota, Oklahoma, Oregon, South Dakota, Utah, and Vermont. Three states -- New Hampshire, North Dakota, and Oklahoma -- are newly affected compared with 2026.
Alaska is the sharpest single-state example. No county in Alaska offers a general-enrollment Medicare Advantage prescription drug plan in 2027. That affects about 110,000 beneficiaries. Six counties in Nebraska and South Dakota have a Medicare Advantage plan without drug coverage, meaning residents can enroll in an MA plan but must buy a separate Part D plan for their medications. The other 187 counties in the no-plan list have nothing -- no MA plan, with or without drug coverage.
The Insurer Exit Map, by the Numbers
The county-level picture is the product of decisions made by individual insurers. The KFF analysis tracks county entries and exits for each company. The pattern is not uniform.
Health Care Service Corporation -- which owns Blue Cross Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma, and Texas -- is exiting 498 counties and entering zero. That is the largest single-insurer reduction of any major carrier. HCSC acquired Cigna's Medicare business in 2025. In 2027, its Blue plan footprints are contracting sharply: Texas fell from 229 counties to 47, Illinois from 100 counties to 7, Oklahoma from 58 counties to 6. The company is exiting Connecticut, Kansas, Montana, New York, Oregon, Utah, and Washington D.C. entirely.
Centene is exiting 359 counties and entering 15. The company is leaving Hawaii, Oklahoma, and Tennessee, and moving to SNP-only status in Nevada and Ohio. Its total plan count falls from 303 to 210 -- a reduction of nearly one-third.
UnitedHealth Group is exiting 228 counties and entering 9. UHG's presence falls from nearly 80 percent of U.S. counties in 2026 to about 70 percent in 2027. The company is pulling standard plans from 140 counties and exiting 34 counties entirely, including all of Wyoming.
Humana is exiting 62 counties and entering 4. It is leaving Minnesota entirely. Its plan exits affect approximately 600,000 members -- notable context given that it added more than 1.2 million members during the previous enrollment period.
CVS Health's Aetna business is exiting 186 counties and entering 63. Aetna is pulling standard plans from 123 counties, exiting Maryland and New Hampshire, and is down from 2,139 counties to 2,072.
Blue Cross Blue Shield of Michigan Mutual is exiting 177 counties and entering 1. It will offer Medicare Advantage prescription drug plans only in Michigan and Wyoming, down from five states.
Group 1001 -- which operates through Clear Spring Health -- and Molina Healthcare are exiting the general Medicare Advantage prescription drug market entirely. Molina will continue to offer special needs plans in many counties, but its general-enrollment MA-PD presence ends.
In total, 12 payers offering Medicare Advantage in 2026 will not offer it in 2027, eight of them health system-owned plans (including Providence, Memorial Hermann, and Christus Health). Wellmark, BCBS North Dakota, and BCBS Mississippi are also among the exits.
On the other side: Devoted Health is expanding, entering 342 counties with no exits -- the largest expansion of any insurer in the 2027 landscape. Devoted is adding chronic condition plans in 30-plus states and more than doubling its C-SNP count from 122 to 255. Four organizations are entering the MA market for the first time in 2027, including St. Luke's Health Plan in Idaho and MultiCare Health System in Washington state.
The national plan count moves from 5,553 to roughly 5,532 -- a minimal net change. That figure is the headline. The geographic churn behind it is the story.
What's Driving the Exits: The Payment Math
The proximate cause is the same across nearly every exit announcement: CMS payment rates are not covering costs.
CMS published its final 2027 payment rule in April 2026, setting a 2.48 percent rate increase for Medicare Advantage. That increase equals approximately $13 billion in additional plan payments. When risk score trends are included, the effective rate increase is closer to 4.98 percent.
Insurers and provider groups said it wasn't enough.
The American Medical Group Association stated that the update "fails to keep pace" with the costs of delivering Medicare care. AMGA cited 1.8 million MA enrollees in 2024 whose plans were unavailable in 2025 as evidence of a structural underpayment pattern. Industry groups had pushed back hard on the original proposal -- CMS initially proposed a 0.09 percent increase, then raised it to 2.48 percent after comment.
UnitedHealthcare President Bobby Hunter said in a September 2026 briefing that MA funding "has not kept pace with medical and pharmacy costs." He cited "funding pressures, rising medical costs, rising drug costs, and increased utilization" as drivers of the company's county pullbacks. He also noted that "more than 95% of our non-special needs plan members never reach" the out-of-pocket limit -- a reference to the cap introduced under the Inflation Reduction Act, which limited what beneficiaries pay in a year but shifted costs onto plans.
The Inflation Reduction Act's Part D redesign changed the financial architecture of Medicare drug coverage. Before the redesign, a portion of catastrophic drug costs was covered by the federal government's reinsurance program. After the redesign, more of those costs shifted to plans directly. For carriers with a high proportion of members on expensive medications, that shift changed the underlying economics of the product.
The V28 risk adjustment changes have also pressured plans. CMS has been transitioning to a new risk adjustment model (V28) that generates lower risk scores for many beneficiaries, reducing per-member payments to plans. CMS delayed further changes to the V28 approach for 2027 to let the existing changes "settle," but the delay is described as indefinite, not permanent.
The result is a market in which the carriers best able to absorb cost pressure are maintaining or expanding their footprints. Those with thinner margins or less geographic diversification are pulling back. HCSC's Texas compression -- from 229 counties to 47 -- is a visible version of that pattern. CVS/Aetna is entering 63 counties while exiting 186; it is not retreating uniformly, but repricing where it can and withdrawing where it can't.
The Part D Standalone Collapse
The counties with no Medicare Advantage prescription drug plan are not necessarily without any options. Beneficiaries can use traditional Medicare and buy a standalone Part D prescription drug plan. But the standalone Part D market is also contracting.
KFF found that the average number of standalone Part D plans available per beneficiary falls from 11 in 2026 to 9 in 2027. The total plan count drops from 360 to 316 nationally.
The more significant change: no zero-premium standalone Part D plan will be available in 2027 to people who don't qualify for low-income assistance. In 2026, some zero-premium standalone Part D plans existed. They are gone.
Approximately 4 million Part D enrollees who paid no premium in 2026 will pay one in 2027, regardless of whether they stay or switch plans. KFF found that AARP Medicare Rx Preferred -- a widely enrolled plan -- is raising premiums by $50 or more per month in every state. The CMS estimate of the average standalone Part D premium moves from approximately $35 to $36 monthly. That average includes the cheapest plans: Wellcare Value Script at $5.30 a month in 45 states and Wellcare Classic at $7.30 in 33 states. The average will be higher for most people in practice because the cheapest plans limit their formularies to keep premiums low.
New York's standalone Part D floor is $37.30 per month -- seven times the national floor. In Wyoming, the highest average MA premium of any state is $69.23. These are not national averages. They are what specific beneficiaries in specific geographies will actually pay.
The Part D stabilization program that CMS operated during the IRA transition is ending after 2026. The program subsidized premiums during the phase-in. Its expiration means the full cost of the IRA's Part D redesign flows through to enrollees and plans beginning in 2027.
What Beneficiaries Actually Have Left
The loss of a Medicare Advantage plan does not mean the loss of Medicare coverage. Every beneficiary in a county with no MA-PD for general enrollment retains access to traditional Medicare -- Parts A and B. They can buy a standalone Part D prescription drug plan. They can, if they choose, also purchase a Medigap supplemental policy.
The enrollment protections for people in exiting markets are meaningful. Enrollees whose MA plan leaves their area get a special enrollment period that can extend past the December 7 open enrollment deadline. Those switching from MA to traditional Medicare may have a time-limited guaranteed-issue right to buy certain Medigap policies without medical underwriting. That right is not unlimited and varies by state -- some states have protections that extend it, many do not.
The practical barrier is not legal. It is logistical and financial.
A beneficiary in a rural county who loses their MA plan must navigate the transition during a period (October 15 to December 7) while still managing their health. They need to confirm that their medications are covered by whatever Part D plan they select. They need to understand whether their physicians and specialists are in-network under any remaining MA option or, if switching to traditional Medicare, to verify that their providers accept Medicare assignment. They may need to purchase a Medigap policy -- whose monthly premium is separate from Part D -- to limit their exposure to traditional Medicare's cost-sharing.
CMS Administrator Dr. Mehmet Oz urged beneficiaries to use open enrollment as "an opportunity to review their coverage." The 1-800-MEDICARE hotline and the Medicare Plan Finder tool are available resources. Each state's State Health Insurance Assistance Program offers free, unbiased counseling. These resources exist and are genuinely helpful. They do not eliminate the burden of transition for people who are already managing chronic conditions or limited transportation.
There is also the enrollment cap problem. Fifteen insurers have enrollment caps on 65 plans across 11 states in 2027, with caps ranging from 410 to 56,345 members. Capped plans are closed to new enrollees until membership falls. A plan that technically exists in a county but refuses new enrollment does not function as an option for someone whose prior plan exited.
The Rural Pattern and Why It Persists
The geography of the exits is not random. Rural counties absorb disproportionate reductions because the economics of rural MA delivery are structurally different from urban markets.
Urban MA markets feature higher enrollment concentration, more in-network providers competing for contracts, and shorter travel distances that make specialist care tractable within an HMO model. Rural markets feature lower enrollment, fewer competing providers, and geographic spread that makes network construction expensive and narrow-network plan design impractical.
The four Minnesota counties that lose all three of their Medicare Advantage insurers simultaneously -- Brown, Lake of the Woods, Morrison, and Renville -- are a concrete version of this pattern. Three separate insurers, operating under independent business decisions, reached the same conclusion about the same four counties in the same year. That is not a coincidence. It is the market's pricing of rural risk.
Health Care Service Corporation leaving Miami-Dade County and Humana exiting Monroe County, New York -- which includes Rochester -- shows that urban markets are not immune. But the magnitude of urban exits is bounded by competing plans that fill the space. In Miami-Dade, other carriers remain. In rural Brown County, Minnesota, they don't.
The 28-plan national average obscures this. KFF notes that the national average is heavily shaped by urban markets. Lancaster County, Pennsylvania, has 66 Medicare Advantage prescription drug plans available. That figure pulls up a national average that includes zero-plan counties. The median -- what a typical rural beneficiary experiences -- is lower than the mean.
The relationship between the MA market and rural healthcare access is not new. The National Rural Health Association has tracked Medicare Advantage penetration in rural areas for years, noting that rural beneficiaries have historically had fewer options and have relied more heavily on traditional Medicare. The 2027 exits are an acceleration of an existing pattern, not a new one.
The 193-county figure will likely rise. The underlying conditions -- payment rate pressure, risk adjustment changes, the IRA's Part D redesign costs flowing to plans -- are not resolved for 2028. Insurers that are currently trimming to profitable geographies will continue to assess where their margins hold. Counties that currently have one or two options are at higher risk of joining the no-plan list in future years than counties with ten.
What This Means for Lung Cancer Screening
Medicare Advantage plans and lung cancer screening have a specific relationship that makes the exit map more than an abstract policy problem for Oatmeal Health.
The U.S. Preventive Services Task Force recommends annual low-dose CT screening for adults aged 50 to 80 with a significant smoking history. Medicare -- both traditional and MA -- covers the scan at no cost-sharing for eligible beneficiaries. The coverage rule is the same in both programs. The access gap is not in the coverage rule. It is in the counseling, the navigation, and the follow-through.
Medicare Advantage plans are required to cover a shared decision-making visit before a lung cancer screening can be ordered for most beneficiaries. That visit is also covered under traditional Medicare. But in practice, the visit completion rate is low. Research has found that the counseling conversation that unlocks access to screening happens at well under 20 percent of the rate it should for eligible patients.
The communities where MA exits are concentrating -- rural, lower-income, with thinner healthcare infrastructure -- are also the communities where lung cancer incidence and mortality rates are highest, where primary care access is most constrained, and where the gap between eligible patients and screened patients is widest.
A beneficiary in a no-plan county who transitions to traditional Medicare does not lose their legal right to a low-dose CT scan. They lose the care coordination infrastructure, however limited, that an MA plan may have provided -- the reminder letters, the care management programs, the navigator calls. In rural markets where Oatmeal Health operates, that infrastructure was already thin. Its further erosion through plan exits is a meaningful headwind for screening access.
Oatmeal Health's approach to this problem is not to replace the insurance infrastructure. It is to operate at the community level -- partnering with rural health systems, community health centers, and primary care practices to identify high-risk patients and connect them to screening. The MA exit map is a background condition, not a barrier to that work. But it is a reminder that the coverage map and the access map are not the same thing, and in rural America the gap between them tends to be widest precisely where the need is greatest.
About
Jonathan Govette is Co-Founder and CEO of Oatmeal Health, a company focused on expanding lung cancer screening access for underserved populations. Oatmeal Health partners with health systems, community health centers, and primary care practices to identify high-risk patients and connect them to low-dose CT screening. Learn more at oatmealhealth.com.
Key References
KFF. "Medicare Advantage Plan Availability Varies Widely by County for 2027." October 9, 2026. https://www.kff.org/medicare/medicare-advantage-plan-availability-varies-widely-by-county-for-2027/
Becker's Hospital Review / Becker's Payer. "Medicare Advantage Looks Stable for 2027. Underneath, It's Shifting." October 2026. https://www.beckershospitalreview.com/finance/medicare-advantage-looks-stable-for-2027-underneath-its-shifting/
Fierce Healthcare. "CMS Gives Medicare Advantage Rates a 2.48% Bump for 2027 Plan Year in Final Rule." April 2026. https://www.fiercehealthcare.com/regulatory/cms-gives-medicare-advantage-rates-248-bump-2027-plan-year-final-rule
Medical Daily. "638,000 Medicare Beneficiaries in 193 Counties Will Have No General Medicare Advantage Drug Plan for 2027." October 2026. https://www.medicaldaily.com/medicare-advantage-no-plan-193-counties-2027-kff-479856
Becker's Hospital Review. "Humana to Exit Medicare Advantage Plans Covering 600,000 Members in 2027." 2026. https://www.beckershospitalreview.com/finance/humana-to-exit-medicare-advantage-plans-covering-600000-members-in-2027/
Goodsurance. "KFF: Number of Counties With No Medicare Advantage Plan Rises 57 Percent for 2027, With UnitedHealth Group Exiting 228 Counties." October 9, 2026. https://www.goodsurance.com/news/2026-10-09-kff-ma-county-availability-2027-rural-uhc-humana-exits
Oatmeal Health. "Medicare Advantage Mass Exit 2027." October 17, 2026. https://oatmealhealth.com/medicare-advantage-mass-exit-2027/
CMS. "2027 Medicare Advantage and Part D Final Rule." April 2026.