KFF: Share of Medicare Beneficiaries With 40-Plus Advantage Drug Plans Falls to 20% for 2027, Down From 27%

Since the Oct. 5 look at insurers cutting Medicare Advantage plans and networks for 2027, new county-level data has sharpened the picture of where choice is shrinking. KFF published its analysis today, Oct. 9, using the CMS plan landscape files.

The national headline is calm. The county-by-county detail is not.

Where the choices are disappearing

The average Medicare beneficiary can pick from 28 Medicare Advantage drug plans (MA-PDs) in 2027, KFF found. One in five beneficiaries (20%) has more than 40 options, concentrated in 4% of counties. In 2026, 27% of beneficiaries in 6% of counties had that many.

Lancaster, Pennsylvania, tops the country with 66 MA-PDs. The counties with the most options are again mostly in Pennsylvania, Ohio and Michigan, plus Los Angeles County.

At the other end, 1% of beneficiaries have no MA-PD option at all. KFF also found that some major insurers are exiting a much larger number of counties than they are entering. Its analysis does not look at costs or benefits, and it leaves Connecticut out because of a data-coding mismatch.

CMS data shows the national plan count barely moved, from 5,553 in 2026 to 5,532 in 2027. Underneath that, options fall in 28 states and the District of Columbia. Wyoming drops from 14 plans to eight. More than a quarter of plans left Montana (28%), D.C. (25%) and Maryland (25%).

The insurer pullback by the numbers

Investment bank Stephens analyzed the major carriers and found every one of them cut the number of individual MA plans it offers. Centene is down about 3,000 unique plans, Humana about 2,400, UnitedHealthcare about 690 and Elevance about 150.

Humana says it will offer plans in more than 80% of U.S. counties next year, down from 85% in 2026. UnitedHealthcare says 66% of its members will be able to choose either an HMO or a PPO, down from 70%. Aetna is expanding HMO plans, which keep care inside a narrower set of providers.

UnitedHealthcare President Bobby Hunter framed the changes as a response to system strain: "We can't ignore the realities facing the healthcare system." Insurers have argued on earnings calls that federal reimbursement has lagged rising medical costs and heavier use of care.

The cuts are partly offset by continued growth in special needs plans, which serve people with long-term health conditions, dual Medicaid eligibility or institutional-level needs. Healthcare Dive reports insurers favor them in part because they generate higher per-enrollee margins.

What CMS says about prices

CMS projects the average monthly Medicare Advantage premium will fall to $12 in 2027 from $14.37 in 2026, a 16.5% decline. The agency also projects a 38% drop in premiums for MA drug plans. Standalone Part D premiums are expected to edge up by less than $1, to $36 from $35.09.

CMS says more than 99% of beneficiaries will have at least one MA option and 97% will have at least 10. The Trump administration has described the market as stable. CMS Administrator Dr. Mehmet Oz urged beneficiaries to "review their coverage, compare options, and pick the plan that best suits their needs and budget."

The averages hide real variation. Premiums rise in 19 states. Wyoming sees the biggest jump, from about $46 a month to more than $69. Idaho goes up roughly $10 to about $38, Connecticut up $8 to $25, and Vermont from $0 to $7.80.

The part a premium average does not capture

Healthcare Dive's analysis of the CMS data argues the stability message obscures turmoil, because major insurers cut plans while raising cost sharing in the plans that remain. Its reporting says some enrollees could lose their plan, lose a benefit or face a higher maximum out-of-pocket limit.

The tradeoff is built into the plan designs. A lower premium can come with a narrower network or higher charges for out-of-network care. The premium average says nothing about whether a given senior can keep a doctor.

Last year gives a reference point. About 10% of Medicare Advantage enrollees, roughly 2.9 million people, had to find new coverage for 2026 after plans were discontinued and insurers left markets, according to a February study in the Journal of the American Medical Association. Enrollment stood at 35.2 million in 2026, or 55% of Medicare beneficiaries, per KFF.

No agency has published a 2027 count of how many people will be forced off their current plan. Healthcare Dive says the figure could reach hundreds of thousands, if not millions. That number will not be firm until insurers send notices and enrollment plays out.

What happens next

Medicare open enrollment runs Oct. 15 through Dec. 7. Beneficiaries can compare 2027 premiums, out-of-pocket costs, benefits and networks at Medicare.gov.

The open question is whether a $2-a-month average premium drop survives contact with higher cost sharing and tighter networks once seniors start checking their own doctors against the new plan lists.