The Medicare Advantage Exit Leaves a 63-Day Medigap Door

Medicare open enrollment runs October 15 through December 7, 2026, and 638,000 people live in 193 counties with no general Medicare Advantage drug plan for 2027. KFF, the health policy research group, drew those figures from CMS Landscape files and found the empty-county count up from 123 counties and 399,000 people a year earlier. Health technology firm Duos estimates roughly 5 million people will have to switch because a plan was canceled or left their county.

The cancellation letter is also a legal door. Federal rules let many of those members buy a Medigap policy with no health questions, but only if they go back to Original Medicare, and only inside a short window. Joining a replacement Advantage plan closes that door in most states.

193 Counties Have No General Medicare Advantage Drug Plan

KFF’s county reading is the hard map. Beneficiaries in the 193 counties with no general-enrollment drug plan are 1% of people with Medicare. The same files still give the average beneficiary 28 Medicare Advantage prescription drug plans, down from 32 in 2026, and 20% of beneficiaries, packed into 4% of counties, still face more than 40 options. Lancaster County, Pennsylvania, tops the list at 66.

THE 2027 AVAILABILITY SNAPSHOT

• Empty counties: 193 have no general-enrollment MA-PD, up 70 from 123 in 2026, a rise of 239,000 people to 638,000.
• Truly blank spots: 187 of those counties have no general Medicare Advantage plan at all; 6 have an MA plan with no drug benefit.
• Choice at the mean: 28 MA-PD options for the average beneficiary, while 20% still see more than 40.
• Who still grows: Devoted Health is entering 342 counties and exiting none.

The national average hides the exits. UnitedHealth Group is leaving 228 counties and entering 9, and now offers plans in about 70% of counties, down from nearly 80% in 2026. Humana is leaving 62 and entering 4, and still reaches about 80% of counties. Health Care Service Corporation is leaving 498 and entering none, the largest footprint cut KFF recorded.

COUNTY EXITS BY INSURER FOR 2027

Group 1001, sold as Clear Spring Health, and Molina Healthcare are leaving the MA-PD market outright, though Molina is still offering special needs plans in many counties. Blue Cross Blue Shield of Michigan, which had sold MA-PDs in Iowa, Michigan, North Dakota, South Dakota, and Wyoming, will sell them only in Michigan and Wyoming. Dan Weissmann, who hosts the health-cost podcast An Arm And A Leg, said more than 40 states will lose some Medicare Advantage plans for 2027.

CMS Calls the 2027 Market Stable

The Centers for Medicare & Medicaid Services used a different lens on September 28, 2026, when it put out the 2027 landscape. It counted 5,532 Medicare Advantage plans nationally, down 21 from 5,553, and said more than 99% of beneficiaries will have access to at least one Medicare Advantage plan, while 97% will have 10 or more. About 8 in 10 Medicare Advantage members, CMS said, will be able to stay in their current plan with the same or a lower premium. Projected enrollment is 34 million, about 47.4% of people in Medicare.

The weighted average monthly premium across all MA plans, including special needs plans, is projected to fall from $14.37 in 2026 to $12.00 in 2027, a 16.5% drop. After rebates, the average Part D premium inside Medicare Advantage drug plans is projected to fall from $11.32 to $7, which is $4.32, or 38%. Stand-alone Part D is projected to rise from $35.09 to $36. CMS also said hearing, dental, and vision extras should hold steady.

By slashing handouts to big insurance companies, CMS is keeping premiums stable while ensuring that 97% of Medicare beneficiaries have access to 10 or more MA plans and that 93% of non-low-income beneficiaries can get an enhanced Part D plan for less than $6 a month.

Dr. Mehmet Oz, CMS Administrator, September 28, 2026 CMS press release

Those national averages and the county holes can both be true, because they count different products. CMS is counting all Medicare Advantage access, including special needs plans that restrict who can enroll. KFF is counting MA-PDs open to general enrollment. A person who does not qualify for a special needs plan, and who lives in one of the 187 counties with no general Medicare Advantage at all, does not have the menu CMS is describing.

The 63-Day Medigap Window Most Letters Skip

Medicare Advantage is the private version of Medicare. Original Medicare is the federal program, Parts A and B, and it still has no cap on out-of-pocket spending for those services. Medigap is the supplement that pays a share of those bills, and it does not work with Advantage. In 2024, 12.9 million people, 46% of those in traditional Medicare, held a Medigap policy, KFF found.

Federal law gives guaranteed issue rights if a plan terminates in your area, leaves Medicare, or stops covering where you live. During that window an insurer must sell certain standardized policies, cannot use your health history to say no, and cannot charge extra because you are sick. Medicare.gov states you must apply as early as 60 days before coverage ends and no more than 63 days after it ends, and that you have the right only if you switch to Original Medicare rather than joining another Medicare Advantage plan. Medigap cannot start until the Advantage plan ends.

For a plan that ends December 31, 2026, that window opens November 1, 2026, and closes March 4, 2027. The federal list is Plans A, B, C, D, F, G, K, or L sold in your state. Plans C and F are closed to people who first became eligible for Medicare on or after January 1, 2020. Plan N is not on the federal guaranteed list, so an insurer can still underwrite it.

FEDERAL TRIGGERS FOR A MEDIGAP GUARANTEED ISSUE RIGHT

• Plan leaves Medicare: The contract is not renewed and you return to Original Medicare.
• Service area ends: The plan stops covering the county where you live.
• You move: You leave the plan’s service area and can no longer use it.
• Fraud or rule breaks: Medicare finds the plan misled you or failed to follow the rules.
• First-year trial: You joined Advantage when you first got Medicare and leave within 12 months, which is a broader right than a termination.

Keep the nonrenewal notice. Medicare.gov says you may need copies of letters, emails, or claim denials with a new Medigap application. Plan Finder will compare remaining Advantage and Part D plans; it will not flash a banner that a supplement is now for sale with no health questions. That gap is how people walk past the only easy on-ramp back to traditional Medicare they may ever get.

What Happens If You Join Another Advantage Plan?

Many carriers will try to slide members into a sister HMO or PPO in the same county. KFF notes that if a contract still has another plan of the same type in that county, people can be moved automatically. That keeps dental extras and an out-of-pocket cap, and it can keep a familiar card. It also uses up the event that opened guaranteed issue. You only have the Medigap right if you switch to Original Medicare.

Outside a guaranteed issue period, Medigap insurers in most states may deny a policy or raise the price for pre-existing conditions. KFF, using 2023 Advantage encounter data and insurer applications, found 74% of Medicare Advantage enrollees, 20.9 million people, had a condition that could trigger a denial. At least one in five had peripheral vascular disease (25%), chronic kidney disease (24%), coronary artery disease (21%), or diabetes with complications (21%). Among enrollees 85 and older, the share was 88%. Florida sat at 82%; Alaska sat at 59%.

Four states, Connecticut, Massachusetts, Maine, and New York, require continuous or annual guaranteed issue for people 65 and older, so the federal trap is weaker there. Minnesota added annual guaranteed issue for ages 65 to 70, effective August 1, 2026. Delaware, Illinois, and Rhode Island also go past the federal floor, though not as far as those four. In the rest of the country, a person who has been on Advantage for years, then tries to leave without a qualifying event, can be turned down.

Doing nothing has a different landing. Medicare.gov says that if you do not pick another Advantage plan during yearly open enrollment, you are enrolled in Original Medicare. That is Parts A and B with 20% coinsurance on most doctor services and no out-of-pocket cap, unless you separately buy Medigap and a stand-alone Part D plan. The drug plan still has to be chosen in the October 15 through December 7, 2026 window if you want it in place on January 1.

Alaska, the Dakotas, and 187 Empty Counties

The counties with no general-enrollment MA-PD sit in 16 states, Alaska, California, Colorado, Idaho, Kansas, Minnesota, Montana, Nebraska, Nevada, New Hampshire, North Dakota, Oklahoma, Oregon, South Dakota, Utah, and Vermont, plus U.S. territories other than Puerto Rico. New Hampshire, North Dakota, and Oklahoma join that list for 2027. Alaska again has no general-enrollment Medicare Advantage drug plan in any county, which covers about 110,000 beneficiaries.

Six counties still have a Medicare Advantage plan without drug coverage: Boyd County, Nebraska, and Aurora, Beadle, Bon Homme, Brown, and Charles Mix Counties in South Dakota. In the other 187, there is no general Medicare Advantage, with or without drugs. Some of those places still have special needs plans or cost plans, which are not open to everyone.

The exits are not only prairie ZIP codes. KFF flags Miami-Dade County, Florida, where Health Care Service Corporation is dropping MA-PDs, and Monroe County, New York, around Rochester, where Humana left. In four Minnesota counties, Brown, Lake of the Woods, Morrison, and Renville, three insurers that sold MA-PDs in 2026 are gone for 2027. Weissmann’s county-level read of the same federal files found about a third of Twin Cities Advantage plans shutting down, and more than a quarter in Dallas-Fort Worth, Houston, and Seattle.

Rural hospitals and clinics already work with thin specialist benches. When the last PPO leaves, the extra dental and vision pitch leaves with it, and the remaining path is Original Medicare plus whatever Medigap and Part D a person can still buy. That is a workable path if the letter is used on time. It is a worse path if the letter sat unopened.

After the Payment Squeeze, Carriers Chose Counties

Insurers did not hide the motive. Medical costs ran hotter than the bids they filed, and CMS has been tightening the coding games that had padded Advantage payments. The Calendar Year 2027 Rate Announcement, issued April 6, 2026, projected a net 2.48% raise, more than $13 billion in additional Advantage payments, which the industry still called tight against clinic and drug trend. CMS also finalized limits on unlinked chart reviews, the diagnoses added from paper files with no matching visit.

Matthew Fiedler, interim director of the Center on Health Policy at the Brookings Institution, said policymakers have taken steps to rein in payments to Advantage plans that had run far above what the law intends, and that one would expect some cut in extra benefits. The county file is that cut in geographic form. Carriers kept dense markets where they still like the odds, and they walked away from thin ones. Devoted Health’s 342-county expansion is the exception that proves the screen: a smaller plan adding territory while the largest parents subtract it.

CMS can say the national plan count barely moved, because special needs plans and a handful of growers filled slots that general PPOs abandoned. A person shopping in Lancaster County still sees 66 MA-PDs. A person shopping in a North Dakota county that just went blank sees Original Medicare. Star ratings released October 8, 2026, which steer bonus money a year later, will shape the next round of those bets, not this one. The 2027 cards are already printed.

Minnesota’s Two-Hour Hold Is a Preview

Last year’s version of this story is already measured. KFF found 2.6 million people in individual MA-PDs had that coverage terminated at the end of 2025, 13% of those enrollees, up from 6% the year before. Almost all of them, 98.9%, still had at least one MA-PD in 2026. Minnesota was not as lucky on the phones. Hundreds of thousands of people there had to find new plans, and more plans are shutting for 2027.

I don’t know any other way to describe it other than total chaos. We had wait times of two hours. Nobody wants to wait for even 10 minutes, let alone two hours.

Kelli Jo Greiner, Minnesota Medicare hotline administrator, in an interview with Dan Weissmann

When people got through last year, Greiner said, the plans that had not shut down often covered less and charged higher monthly premiums. Minnesota now has that extra Medigap rule for ages 65 to 70, which was not in place for the last scramble. The hotline load does not shrink just because the legal menu got a little wider. The nation’s 54 State Health Insurance Assistance Programs offer free, unbiased counseling, and the SHIP Technical Assistance Center says volume spikes from October 15 through December 7. Its locator line is 1-877-839-2675. CMS also staffs 1-800-MEDICARE around the clock.

THE 2027 COVERAGE CALENDAR

1. October 15, 2026: Open enrollment starts. Compare 2027 Advantage, Original Medicare, Medigap, and Part D on Medicare.gov.
2. November 1, 2026: Earliest day to apply for Medigap under the federal 60-day-before rule if coverage ends December 31.
3. December 7, 2026: Open enrollment ends. Advantage and Part D choices made by this date take effect January 1.
4. December 31, 2026: Non-renewed Advantage coverage ends.
5. January 1, 2027: New coverage starts. Medigap, if issued, can begin the same day the Advantage plan ends.
6. March 4, 2027: Last day to apply for Medigap with federal guaranteed issue after a December 31 ending date.

IF YOUR ADVANTAGE PLAN IS ENDING

• Open the letter: Greiner is still hearing from people who missed last year’s notice. The envelope is the proof a Medigap insurer will ask for.
• Price both paths: A remaining Advantage plan versus Original Medicare plus Medigap plus a stand-alone Part D plan, including doctors, drugs, and extras.
• Watch the two clocks: Open enrollment for Advantage and Part D ends December 7, 2026. The Medigap guaranteed-issue clock runs to March 4, 2027, for a year-end termination.
• Call SHIP early: Free counselors will not sell a plan. They will tell you whether your state adds rights on top of the federal floor.

The 2027 cards that remain will still sell extras that Original Medicare does not include. The 193 counties on KFF’s blank map will not. Anyone who got the shutdown letter has a dated right that most comparison tools never mention, and the date on that letter is the one that counts.

Disclaimer: This article is news reporting and analysis of Medicare Advantage plan availability and federal Medigap rules. It is informational only and is not medical, insurance, or legal advice, and it is not a recommendation to enroll in, keep, or leave any plan. Readers should confirm their county’s 2027 options on Medicare.gov, keep any nonrenewal notice, and consult a licensed insurance counselor, a SHIP counselor, or 1-800-MEDICARE before changing coverage. Figures and plan lists reflect CMS and KFF data published for the 2027 plan year and can change as contracts, appeals, and special-needs offerings are updated.