KFF Analysis: Medicare Advantage Plan Availability Varies Widely by County for 2027

As the private plan alternative to traditional Medicare prepares for the upcoming plan year, a newly released analysis shows that 20 percent of Medicare beneficiaries can choose from more than 40 Medicare Advantage prescription drug plans for 2027 coverage, down from 27 percent in 2026. Medicare plan data from the Centers for Medicare & Medicaid Services examined by KFF reveals significant geographic variation in plan availability, alongside insurer footprint reductions across the country.

Key Clinical Takeaways:
• One in five Medicare beneficiaries can choose from over 40 Medicare Advantage prescription drug plans for 2027, representing a decrease from 27 percent in 2026.
• Beneficiaries residing in 193 counties across 16 states and U.S. territories will have zero Medicare Advantage prescription drug plans available for general enrollment in 2027.
• Major insurers including UnitedHealth Group and Humana are exiting significantly more counties than they are entering for the 2027 plan year.

County-Level Concentration of Plan Options

The 20 percent of Medicare beneficiaries who have access to more than 40 plan options are heavily concentrated in just 4 percent of U.S. counties. This marks a contraction from 2026 figures, where 27 percent of beneficiaries residing in 6 percent of counties had access to that volume of choices. The counties offering the highest number of plan selections remain clustered predominantly in Pennsylvania, Ohio, and Michigan, alongside Los Angeles County in California. Lancaster, Pennsylvania leads the nation with 66 different Medicare Advantage prescription drug plans available to local residents.

Expansion of Counties Lacking General Enrollment Options

For the 2027 plan year, Medicare beneficiaries living in 193 counties will have no Medicare Advantage prescription drug plans available for general enrollment. This represents an increase from 123 counties in 2026. These affected individuals comprise 1 percent of all Medicare beneficiaries, totaling approximately 638,000 people—up from 399,000 beneficiaries who lacked these options in 2026. The counties with zero general enrollment options span 16 states, which now include New Hampshire, North Dakota, and Oklahoma alongside Alaska, California, Colorado, Idaho, Kansas, Minnesota, Montana, Nebraska, Nevada, Oregon, South Dakota, Utah, and Vermont, plus U.S. territories outside Puerto Rico. Alaska continues to feature no general enrollment plans in any county, affecting roughly 110,000 beneficiaries. Six specific counties in Nebraska and South Dakota offer a plan without prescription drug coverage, while the remaining 187 counties feature no Medicare Advantage plans of any kind for general enrollment.

Major Carriers Scale Back County Footprints for 2027

Major carriers are scaling back their county footprints for 2027. UnitedHealth Group plans to exit 228 counties while entering nine new ones, and Humana is exiting 62 counties while entering four. Despite these exits, Humana maintains the largest reach by offering plans in approximately 80 percent of all U.S. counties, matching its 2026 coverage. UnitedHealth Group offers plans in about 70 percent of counties, down from nearly 80 percent the previous year. Health Care Service Corporation is executing the largest reduction by leaving 498 counties without entering any new ones, followed by Centene, which is exiting 359 counties and entering 15. Blue Cross Blue Shield of Michigan Mutual Ins. Co. is dropping 177 counties to focus exclusively on Michigan and Wyoming. Elevance Health is exiting 66 counties and entering 10. Group 1001 and Molina Healthcare are completely withdrawing from the prescription drug plan market, though Molina continues offering special needs plans.

Contrasting Insurer Expansion Strategies

Amid widespread exits, select insurers are actively growing their market presence. Devoted Health is expanding its footprint by entering 342 counties without exiting any. CVS Health is entering 63 new counties while simultaneously exiting 186. Kaiser Foundation Health Plans is holding its footprint stable by entering three counties and exiting three. Insurer exits touch both rural and urban territories, with multiple carriers leaving smaller rural populations in states like Minnesota, as well as specific urban markets such as Miami-Dade County, Florida, and Monroe County, New York. These divergent corporate decisions reflect shifting local market dynamics, cost pressures, and individual profitability assessments by each carrier.

Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.