A research letter published in JAMA on February 18, 2026, found that roughly 2.9 million Medicare Advantage enrollees, about one in ten people in non-employer HMO or PPO plans, faced forced disenrollment in 2026 after their plan exited their market entirely. Mark Meiselbach, an assistant professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, led the analysis and described the pattern as a sudden reversal after years of relatively stable Medicare Advantage enrollment. Twelve states saw more than one in five enrollees affected, with Vermont recording the most extreme share of any state in the study.
A JAMA research letter ties one in ten enrollees to 2026 plan exits
The letter, titled “Forced Disenrollments Among Medicare Advantage Beneficiaries Following 2026 Plan Exits,” examined which counties lost a Medicare Advantage contract for the 2026 plan year and how many enrollees those exits displaced nationwide. Meiselbach and his coauthors found the roughly 2.9 million affected enrollees represented about 10 percent of the non-employer Medicare Advantage population, a scale the letter describes as unusual after several years in which plan exits displaced far smaller shares of the market.
Meiselbach described the shift as “a substantial and sudden reversal” of a previously stable pattern, according to the Bloomberg School’s announcement of the findings, which quoted him saying millions of beneficiaries would need to actively navigate plan changes in 2026. The letter identified twelve states where more than one in five Medicare Advantage enrollees were affected, and it singled out Vermont as the most extreme case, where the analysis found 92 percent of enrollees lost their plan for 2026.
A plan exit of that scale is unusual because Medicare Advantage enrollment had grown steadily for more than a decade before 2026, with insurers expanding county footprints almost every year rather than retreating from them. The research letter’s central point is not simply that exits happened, but that the share of enrollees affected jumped well above the low single digits typical of prior years, a shift large enough that Meiselbach’s team treated it as worth a dedicated peer-reviewed letter rather than a routine enrollment update.
What the count leaves unanswered: The JAMA research letter behind this figure counts how many Medicare Advantage enrollees a 2026 plan exit displaced, not which replacement plan fits any single household’s prescriptions and doctors, a side-by-side comparison built into The 2027 Medicare Open Enrollment Decision Kit.
Why “forced disenrollment” is different from a voluntary plan switch
The research letter reserves the term “forced disenrollment” for enrollees whose plan itself exited a county, as distinct from a member who chooses to switch plans during Open Enrollment for cost or coverage reasons. A forced disenrollment is not optional: the current plan will not be sold in that county at all for the coming year regardless of how satisfied a member was with the coverage, which is why the letter treats it as a distinct category from ordinary annual plan-switching behavior.
Axios cited the same 10 percent figure in September 2026 coverage of the 2027 outlook, framing the 2026 exits as an early sign of a pattern insurers expect to continue. That same coverage reported nearly 70 percent of Medicare Advantage plan executives surveyed by HealthScape Advisors in January 2026 expect leaner 2027 benefit packages, tying Meiselbach’s count of displaced 2026 enrollees to the broader retrenchment plan leaders describe for the following year.
What a forced disenrollment requires of an affected member
A forced disenrollment carries its own federally guaranteed special enrollment period, separate from the standard fall Open Enrollment window. Medicare.gov’s guidance on special enrollment periods states that when a plan’s contract is not renewed, the window to switch to a new Medicare Advantage plan, a Medicare drug plan or Original Medicare runs from December 8 through the last day of February the following year; a member who takes no action by then is automatically returned to Original Medicare rather than left without any coverage.
That separate window does not by itself extend to buying a Medigap policy without medical underwriting; guaranteed-issue protection for Medigap runs on its own set of triggers tied to the date coverage actually ends, distinct from the special enrollment period that governs which replacement Medicare Advantage or Part D plan a member can select.
Meiselbach’s letter frames the 2.9 million figure as a floor rather than a ceiling, since it counts only enrollees whose plan exited a market entirely and does not include the separate, larger group whose plan stayed in place but cut benefits for 2027 the way HealthScape’s survey of plan executives described. Taken together, the JAMA finding on forced 2026 exits and the executives’ own forecast for 2027 point to the same underlying pressure moving through the market first as plan exits and next as benefit reductions.
The 2026 exits and the 2027 benefit trims stem from a related but not identical set of decisions: a plan exits a county when it decides the market cannot be served profitably at all, while a plan that stays trims dental allowances or Part B givebacks because it can still turn a profit at a thinner margin. Meiselbach’s data captures only the first kind of decision, which is why his 2.9 million figure and HealthScape’s nearly 70 percent figure measure two different, complementary slices of the same industry-wide retrenchment rather than the same underlying event counted twice.
A forced 2026 exit becomes a 2027 planning problem
Meiselbach’s research letter counts how many Medicare Advantage enrollees a 2026 plan exit displaced, and Axios’s reporting on the same finding connects it to a wider 2027 pullback plan executives describe. Neither source walks a displaced member through comparing what a replacement plan actually costs against the prescriptions and doctors already in use.
The 2027 Medicare Open Enrollment Decision Kit includes a cost calculator spreadsheet that compares plans on cost, drugs and doctors and a prescription-by-plan comparison, tools built for running that comparison once a replacement plan’s Annual Notice of Change or Summary of Benefits is in hand.
Run the plan comparison in The 2027 Medicare Open Enrollment Decision Kit.
This article was researched and drafted with the assistance of AI and reviewed by The Money Overview editorial team.
