For 15 consecutive years, Medicare Advantage enrollment moved in only one direction: up. Every year since 2010, more seniors chose the privately run alternative to traditional Medicare, drawn by low premiums, bundled benefits, and relentless marketing from insurers competing for federal dollars. That streak is now breaking.
Nearly three million Medicare Advantage enrollees are projected to lose access to their current plans in 2026, based on KFF’s analysis of early insurer filings and CMS plan crosswalk data reviewed ahead of the 2026 coverage year. If those losses are not fully offset by new sign-ups elsewhere, the program could record its first net enrollment decline in more than a decade. The disruption is landing alongside what should be welcome news: the Centers for Medicare and Medicaid Services projects that average monthly premiums will fall from $16.40 in 2025 to $14.00 in 2026, saving the typical enrollee roughly $29 a year.
Cheaper on paper, but harder to find in practice: that is the emerging reality for millions of seniors as 2026 coverage takes effect.
Why insurers are pulling back
The pullback traces directly to payment policy changes CMS finalized in its 2026 Rate Announcement. The agency tightened risk-adjustment coding rules that had allowed some insurers to inflate the health-risk scores of their enrollees, boosting federal payments beyond what the actual cost of care justified. CMS also recalibrated the county-level benchmarks that determine how much the government pays per enrollee, slowing the growth of those payments across the board.
CMS framed both moves as necessary to protect taxpayers and shore up the long-term sustainability of a program that now covers more than half of all Medicare-eligible Americans. The Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare spending, has for years flagged the gap between what the federal government pays MA plans and what the same care would cost under traditional Medicare. In its March 2025 report to Congress, MedPAC reiterated that MA payments have consistently exceeded fee-for-service costs, a dynamic the 2026 adjustments are designed to narrow.
But for insurers operating in counties where medical costs run high and the new benchmarks compress margins, the math no longer works. Plans that cannot maintain viable medical loss ratios in a given service area have a straightforward option: stop offering coverage there. Major carriers including Humana, which has the second-largest MA enrollment nationally, disclosed in earnings calls that they would exit select counties and reduce supplemental benefits in others to stabilize finances under the new payment structure.
Where the impact will hit hardest
The plan exits are expected to concentrate in counties where competition is already thin. Rural communities often have just one or two Medicare Advantage options, so a single insurer’s departure can leave thousands of people with no private plan available. Urban and suburban markets with five or more competing plans are far more likely to absorb exits without stranding beneficiaries.
Dual-eligible seniors, those who qualify for both Medicare and Medicaid, face particular risk. Many are enrolled in Dual Eligible Special Needs Plans (D-SNPs) designed to coordinate benefits across both programs. If a D-SNP exits a service area, finding a comparable replacement is not as simple as picking the next cheapest option. These plans handle complex care coordination that standard MA plans typically do not replicate.
CMS maintains detailed plan-level enrollment data that will eventually show exactly which counties lost coverage and how many people were affected. But those datasets lag behind insurer decisions by months. As of late spring 2026, the full picture has not yet materialized in federal records, even as affected members have already received non-renewal notices and had to make coverage decisions.
What the lower premiums actually mean
The projected drop in average premiums to $14 per month sounds like unqualified good news, and for many enrollees who keep their current plans, it is. But averages can mask what individual seniors experience. A beneficiary whose $0-premium plan disappeared may have found that the only remaining option in their county charges $45 a month, carries a higher deductible, or excludes their preferred doctors and hospitals from its network.
The $14 figure also reflects competitive pricing among plans that chose to stay in the market, not the experience of people forced to switch. Seniors who landed in a new plan may now face different prior-authorization requirements, unfamiliar formularies for prescription drugs, and narrower provider networks. Financial savings on the premium line can be offset by higher out-of-pocket costs elsewhere in the plan’s design.
For those who could not find a suitable Medicare Advantage replacement, the fallback is traditional Medicare. It has no network restrictions, but it also lacks the out-of-pocket spending cap that MA plans are now required to offer (capped at $2,000 for prescription drugs under the Inflation Reduction Act’s Part D redesign, with a separate medical out-of-pocket maximum set by each plan). Adding a Medigap supplemental policy and a standalone Part D drug plan can fill those gaps, but the combined monthly cost is typically far higher than what most MA enrollees were paying.
What affected seniors should do now
The Annual Election Period for 2026 coverage closed on December 7, 2025, but seniors who lost their MA plan or want to make a change still have options. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31, 2026, allowing current MA enrollees to switch to a different MA plan or drop MA and return to traditional Medicare with a standalone Part D plan. Here is what matters most right now:
- Check what is available in your area. Use Medicare’s Plan Finder tool to see which plans are currently offered in your ZIP code for 2026. If your plan was discontinued, you may have already been auto-enrolled in a new plan; verify that it meets your needs.
- Compare total costs, not just premiums. A $0-premium plan with a $5,000 out-of-pocket maximum may cost more over the year than a $25-per-month plan with a $3,000 cap, depending on how much care you use.
- Verify your doctors and prescriptions. Every MA plan maintains its own provider network and drug formulary. Confirm that your physicians, specialists, and medications are covered before committing to a new plan.
- Contact your State Health Insurance Assistance Program (SHIP). These federally funded counseling programs offer free, unbiased help comparing Medicare options. Counselors can walk through the specifics of what is available in your county and help you evaluate whether traditional Medicare plus a supplement might be a better fit.
- Watch for the fall 2026 AEP. The next Annual Election Period, for 2027 coverage, opens October 15, 2026. Given the pace of plan exits, seniors should plan to review their options again this fall rather than assuming their current coverage will carry forward unchanged.
How the 2026 shakeout reshapes Medicare Advantage going forward
Medicare Advantage has grown from covering about 24% of Medicare beneficiaries in 2010 to more than half today, an expansion fueled by generous federal payments, aggressive insurer marketing, and genuine appeal to seniors who prefer the simplicity of an all-in-one plan. The 2026 payment adjustments do not reverse that trajectory overnight, but they signal that the era of unchecked growth may be ending.
For policymakers, the tension is direct: paying insurers less per enrollee saves federal dollars but risks reducing access, particularly in areas where margins were already razor-thin. Some members of Congress have pushed back on the CMS rate changes, arguing they will destabilize coverage in vulnerable communities. Others, aligned with MedPAC’s long-standing recommendations, say the overpayments were unsustainable and the correction is overdue.
For the nearly three million seniors whose plans may be disappearing, the policy debate is far less abstract. They need workable coverage, and the window to secure it for 2026 closes at the end of March. The full scope of the disruption will become clearer as CMS publishes updated enrollment figures later this year and as insurers finalize their service area decisions for 2027. Until then, this is an enrollment season that demands closer attention than any in recent memory.
