KFF counts 193 counties where no Medicare Advantage drug plan will be open to general enrollment in 2027. About 638,000 people on Medicare live in them, 1% of all beneficiaries, and the group includes all of Alaska.
The figures come from a KFF analysis by Meredith Freed, Jeannie Fuglesten Biniek, Nancy Ochieng and Juliette Cubanski, published October 9. A year earlier the count was 123 counties and 399,000 people, so 239,000 more people are in counties without a Medicare Advantage drug plan, known as an MA-PD, than in 2026.
Which counties and states lose out
KFF says the counties with no MA-PD for general enrollment are 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 are new to the list this year.
Alaska is the whole-state case. KFF says no MA-PDs for general enrollment are offered in any Alaska county in 2027, which affects about 110,000 beneficiaries, the same as in 2026.
Anyone on Medicare in one of these counties now has a concrete question to answer before the year ends: what to do instead of a Medicare Advantage drug plan. One alternative is Original Medicare with a stand-alone Part D drug plan, and the annual enrollment period for choosing one opened October 15.
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The Centers for Medicare & Medicaid Services says annual enrollment runs October 15 through December 7, 2026, and that the Medicare Plan Finder on Medicare.gov shows premiums, costs and benefits for 2027 plans. CMS projects the average monthly premium for a stand-alone Part D plan at $36 in 2027, up from $35.09 in 2026.
What the count does and does not cover
The 193 counties are defined narrowly. KFF counts MA-PDs offered to general enrollment, and notes that some counties without them still have other private options, including cost plans and special needs plans, which restrict enrollment to people who meet specific criteria. Six counties, Boyd in Nebraska and Aurora, Beadle, Bon Homme, Brown and Charles Mix in South Dakota, have a Medicare Advantage plan without drug coverage. The other 187 have no Medicare Advantage plan of either kind for general enrollment.
That is why the number sits far below the share of people who can reach some Medicare Advantage plan. CMS says in its 2027 outlook that more than 99% of beneficiaries will have access to at least one Medicare Advantage plan, a count that is not limited to drug plans open to general enrollment. The agency adds that 97% of beneficiaries have access to 10 or more options, while KFF finds Lancaster, Pennsylvania has the most offerings of any county, 66 MA-PDs, against none in the 193 counties.
The average person on Medicare still has a deep field to choose from. KFF puts the average at 28 MA-PDs per beneficiary in 2027, and says one in five beneficiaries, 20%, can choose from more than 40, down from 27% in 2026.
Which insurers pulled out
KFF names two companies leaving the MA-PD market entirely: Molina Healthcare and Group 1001, which markets plans as Clear Spring Health and offered them in Colorado, Georgia and Illinois. Molina still offers special needs plans in many counties.
Other insurers are trimming their maps. KFF’s county tally shows Health Care Service Corporation leaving 498 counties with no entries, Centene leaving 359 and entering 15, UnitedHealth Group leaving 228 and entering 9, CVS Health leaving 186 and entering 63, Blue Cross Blue Shield of Michigan leaving 177 and entering 1, Elevance Health leaving 66 and entering 10, and Humana leaving 62 and entering 4. Devoted Health is expanding, entering 342 counties and leaving none.
Options for people left without a drug plan
KFF’s analysis does not lay out alternatives, so the options come from Medicare itself. Medicare.gov says people who have Medicaid or get Extra Help can change coverage once a calendar month, including joining a stand-alone drug plan to return to Original Medicare.
Full Medicaid coverage, a Medicare Savings Program or Supplemental Security Income brings Extra Help automatically, according to Medicare.gov’s page on drug costs. Others can apply through Social Security, which describes Extra Help as a program for people with limited income and resources that helps lower or cut Part D costs, and takes applications online or at 1-800-772-1213.
Original Medicare leaves gaps, and a Medigap policy covers part of them. Medicare.gov’s Medigap timing page says the best time to buy is the six-month window that starts the first day of the month a person is 65 or older and signed up for Part B. Outside it, there is no federal guarantee an insurer will sell a policy, and it may cost more because of health problems.
The open question for the 638,000 is what is actually on offer in each county. The Medicare Plan Finder shows the 2027 plans that serve a given address, and a household in one of the 193 counties can see there whether a special needs plan, a cost plan or only Original Medicare with a drug plan is available before the December 7 close.
In a county with no Medicare Advantage drug plan for 2027?
A county with no Medicare Advantage drug plan turns the 2027 decision into a different one: a stand-alone drug plan, a possible Medigap policy, and a December 7 enrollment deadline that arrives quickly.
The 2027 Medicare Open Enrollment Decision Kit includes a cost calculator spreadsheet that compares plans on cost, drugs and doctors, along with the Open Enrollment calendar. It covers the plans that remain when a Medicare Advantage drug plan is not an option.
Get the cost calculator and Open Enrollment calendar in the Decision Kit before December 7 →
More Financial Reading
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- 21 Ways Retirees Can Raise $1,000 Fast Without a Job
This article was produced with AI assistance and edited for accuracy against the sources linked above.
