Two of the country’s largest health insurers have each stopped offering Medicare Advantage in more than 100 counties, a retreat that reshaped where older Americans could buy the plans for 2026. Elevance dropped out of 181 counties and Centene left 104, according to an analysis of federal plan data. Both companies also moved into some new markets, but the scale of their withdrawals underscores that the pullback across Medicare Advantage is an industry-wide shift, not the choice of a single carrier trimming a few unprofitable corners.
How far Elevance and Centene pulled back
The county counts come from KFF’s review of the federal landscape files that set each year’s plans. Elevance was exiting 181 counties for 2026 while entering 45 new ones, a net decrease of 136 counties from the prior year. Centene left 104 counties but entered 63, the most new counties of any large insurer, giving it the smallest net contraction of the group even as its gross exits topped 100. Both figures describe where a carrier stopped selling plans entirely, not a reshuffling of options within a market. The corporate names can also obscure the exits for the people affected: Elevance markets its Medicare Advantage coverage largely under the Anthem and Wellpoint brands, while Centene sells its plans as Wellcare, so many enrollees experienced a withdrawal under those consumer labels rather than the parent-company names that appear in the federal filings.
Because each insurer chose its own counties to abandon, the withdrawals largely do not overlap, so the effect on retirees is scattered rather than concentrated in a handful of states. Elevance also went further than Medicare Advantage alone, exiting standalone Medicare drug plans in a separate retreat from the Part D market. For a beneficiary, the practical result is the same regardless of which carrier is leaving: a plan that existed one year may simply not appear on the menu the next.
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A market-wide retreat heading into 2027
Elevance and Centene are part of a broader withdrawal led by the two biggest carriers. For 2026, UnitedHealthcare exited 225 counties and Humana exited 198, the largest pullbacks of any insurers, and each ended up offering plans in roughly 80 percent of counties, down from close to 90 percent a year earlier. The cumulative effect was that about 2.6 million Medicare Advantage prescription drug enrollees were in a plan terminated for 2026 and not automatically moved to a replacement, roughly double the number a year before.
The retreat is carrying into the next plan year rather than leveling off. Humana is already set to exit plans covering about 600,000 members for 2027, and UnitedHealthcare has floated a preliminary map that would drop additional counties. Insurers blame medical costs rising faster than government payments, tighter risk-adjustment rules, and star-rating changes that reduce bonus revenue — pressures that make lower-margin counties the first to be cut when a carrier redraws its map. The stakes are wide because Medicare Advantage now covers more than half of all people on Medicare — over 34 million enrollees — so even scattered county-level exits ripple across a larger population than in the years when traditional Medicare still held the majority of beneficiaries.
What enrollees losing a plan can do
A terminated plan triggers a set of choices during the fall open enrollment period. A beneficiary can move to another Medicare Advantage plan if one is still offered in the county, or return to traditional Medicare. The termination is disclosed in the plan’s Annual Notice of Change, the document mailed before enrollment opens, which is why reading it rather than assuming a plan renews is the step that separates a smooth switch from a gap in coverage.
Returning to traditional Medicare carries a benefit that is easy to miss. Someone pushed off a terminated Medicare Advantage plan generally gains guaranteed-issue rights to buy a Medigap policy, so an insurer cannot deny coverage or raise the price because of pre-existing conditions during that window. In most states, Medigap insurers can otherwise use medical underwriting, so the window opened by a plan exit can decide whether affordable supplemental coverage is available at all. A handful of states go further than the federal baseline: Connecticut and New York require Medigap insurers to guarantee issue year-round, and Maine and Massachusetts run annual guaranteed-issue windows, so where a retiree lives can shape how much the timing of a plan exit truly matters. Because the loss is involuntary, affected enrollees also receive a special enrollment period running from December 8 through the end of February, a bridge past the standard December 7 deadline for locking in a replacement.
The through-line across Elevance, Centene, UnitedHealthcare, and Humana is that Medicare Advantage maps are being redrawn every year, and the counties dropped are disproportionately rural and lower-margin. A retiree who has held the same plan for years cannot assume it will survive the next filing cycle. The county-level exits rarely make national headlines, yet they land in individual mailboxes as an Annual Notice of Change — and the households that read that notice, rather than wait to discover the gap at the pharmacy counter, are the ones that keep a plan and a Medigap option within reach.
This article was produced with AI assistance and reviewed against primary sources by The Money Overview editorial team.
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