Medicare Advantage plan availability varies dramatically across U.S. counties, shaping how beneficiaries access private Medicare options with prescription drug coverage for 2027.
Where choices are plentiful
About 20% of Medicare beneficiaries can select from more than 40 MA-PD plans, but those options are confined to roughly 4% of counties. In 2026, the share was 27% of beneficiaries in 6% of counties, indicating a modest contraction.
Counties with the richest selections cluster in Pennsylvania, Ohio, Michigan and Los Angeles County, California. Lancaster, Pennsylvania tops the list, offering 66 MA-PD plans—the highest count in the nation.
Nearly 13 million beneficiaries enjoy over 40 choices in 2027, down from 16.6 million the year before. Meanwhile, about 7 million people have only 1 to 10 plans available, up from 4.8 million in 2026.
Limited options and gaps
For 2027, 193 counties will have no MA-PD plans for general enrollment, an increase of 70 counties from the prior year. The affected counties represent about 1% of all Medicare beneficiaries, or roughly 638,000 individuals.
These counties span 16 states and U.S. territories, adding New Hampshire, North Dakota and Oklahoma to the list that already included Alaska, California, Colorado, Idaho, Kansas, Minnesota, Montana, Nebraska, Nevada, Oregon, South Dakota, Utah and Vermont.
Alaska remains without any MA-PD options, leaving about 110,000 beneficiaries without a plan in that state.
Six counties—Boyd, Nebraska; Aurora, Beadle, Bon Homme, Brown and Charles Mix in South Dakota—still have Medicare Advantage plans that lack prescription drug coverage. The remaining 187 counties offer no Medicare Advantage options at all.
The average beneficiary can choose from plans offered by seven firms in 2027, one fewer than in 2026.
Twenty percent of beneficiaries in 68 counties can pick from MA-PDs offered by ten or more firms, down from 29% in 131 counties the year before.
About 9% of beneficiaries in 679 counties face only two or three firm options, an increase from 7% the prior year. In 259 counties, a single firm provides the only MA-PD, up from 180 counties.
UnitedHealth Group is exiting 228 counties while entering just nine, and Humana is withdrawing from 62 counties and adding four new ones.
Health Care Service Corporation cuts its footprint the most, leaving 498 counties without any MA-PD offerings and adding no new locations. Centene follows, exiting 359 counties and entering 15.
Blue Cross Blue Shield of Michigan Mutual Ins. Co. reduces its presence by 177 counties, keeping only a single new county, while Elevance Health drops out of 66 counties and adds ten.
Group 1001 (Clear Spring Health) and Molina Healthcare are fully exiting the MA-PD market, though Molina continues to offer SNPs in many areas.
Devoted Health expands dramatically, entering 342 counties with no exits, and CVS Health adds 63 new counties while withdrawing from 186.
Kaiser Foundation Health Plans maintains a stable footprint, exiting three counties and entering three new ones for 2027.
Market entry and exit trends
Overall, the 2027 environment shows a net contraction, with more insurers withdrawing from the Medicare Advantage market than adding new footprints. Four firms have launched into the market for the first time, while ten existing participants have discontinued their offerings, and four have seen their contracts assumed by other companies.
Among the newcomers, three are introducing only health maintenance organization (HMO) products, whereas a single entrant is providing a mix of HMO and chronic-condition special needs plans (C-SNPs). These additions modestly offset the broader retreat of established carriers.
Several organizations that previously participated have transferred their contracts to larger affiliates. Notable examples include Community Care, Inc., Marshfield Clinic Health System, Inc., and Renown Health, whose plans are now operated under the umbrellas of their parent insurers. Additionally, Summa Health’s contracts have been taken over by General Catalyst Group Management Holdings LP, marking the latter’s entry into the Medicare Advantage arena.
County-Level Availability and Market Contraction in 2027
The Medicare Advantage market remains fluid, with an average beneficiary facing 28 prescription-drug plans in 2027. Plan offerings differ by county, and this analysis draws on CMS environment data to map that variation. The study excludes cost, benefit, or other plan characteristic changes and focuses solely on availability. Findings show a wide geographic spread and a modest drop in the share of enrollees with more than 40 options. Several large insurers withdrew from more counties than they added, and overall more firms exited than entered the market.
The 2026 data set excludes SNPs, EGHPs, HCPPs, PACE, cost plans, MMPs, and MA-only plans, and Connecticut is omitted because of FIPS code differences. KFF analyzed CMS environment files for 2026 and the June 2025 Medicare Enrollment Dashboard to produce these figures. Approximately 12.8 million beneficiaries have 31 to 40 plan choices in 2027, a slight decline from 13.2 million in 2026.
Nearly 7 million people face only 1 to 10 plans in 2027, up from 4.8 million the prior year. In 2026, UnitedHealthcare and Humana together accounted for about 46% of Medicare Advantage enrollment. Ten firms that participated in 2026 are not offering any plans in 2027. Some cited cost pressures, regulatory uncertainty, or a changing market, while others gave no reason.
Co-branded and specialty plan developments
Beyond the shifting carrier map, several insurers are expanding the scope of their offerings through partnerships that embed additional benefits into Medicare Advantage plans. Alignment Health continues its collaboration with Instacart in California and Nevada, allowing qualifying beneficiaries with chronic conditions to receive grocery deliveries.
