Will Your County Lose Medicare Advantage Coverage in 2026? Key Insights You Need to Know

People on Medicare Advantage (MA) need to pay careful attention this open enrollment season. Multiple insurers are significantly reducing the number of plans they offer and the markets in which they offer them in 2026. The Centers for Medicare & Medicaid Services (CMS) expects MA enrollment to decrease by nearly one million beneficiaries compared to 2025. 

The trend will force many Americans aged 65 and older to change health insurers. That said, some retirees will get hit much harder than others by the cuts, depending on where they live. Find out which areas of the U.S. are most affected—and what you can do if your plan gets canceled.     

Major Insurers Are Pulling Back on Medicare Advantage in 2026

Most major health insurers, including Aetna CVS Health, UnitedHealthcare, Blue Cross Blue Shield, and Anthem, have announced at least some cutbacks to their 2026 MA plan offerings in recent months. And several smaller insurers that play a big role covering select states or communities have followed suit. 

Notably, UCare, a nonprofit health plan that serves Minnesota and western Wisconsin, is terminating Medicare Advantage coverage beginning in 2026, a move that’s projected to affect 158,000 Americans.  

“Particularly with the UCare enrollees, there is a great deal of panic and uncertainty,” said Kelli Jo Greiner, director of Minnesota’s State Health Insurance Assistance Program (SHIP), given the plan has been around since 1998. “They’re not happy about it, and they don’t understand why it’s happening, and they don’t want to change.”

UCare did not immediately respond to a request for comment. However, insurers generally say they need to pull back because patients have been using benefits more than expected, and the government has lowered its reimbursement rate for insurer spending on patients. 

“Research shows new MA enrollees are sicker and have more chronic conditions than those in traditional Medicare, requiring more frequent care and driving higher costs,” said Blue Cross Blue Shield in a written statement. “Yet payment rates haven’t kept pace with rising drug and hospital prices. This results in fewer choices, reduced benefits, and higher costs for members.”

Where Are Cutbacks Happening?

Despite the challenges, not all markets are adversely affected. In fact, an Investopedia analysis of the MA marketplace found that, while 1,949 U.S. counties lost at least one MA plan in 2026, 798 counties gained at least one. 

Gaining counties tend to include major metros. For example, Dallas County, home to Dallas, Texas (population 1.3 million), added four MA plans for 2026. Alternatively, they’re home to a large percentage of older residents. In Alabama, for instance, where a few counties have added five MA plans or more, the over-65 population grew from about 861,000 in 2020 to nearly 956,000 in 2024.   

“Medicare advantage plans do better in environments like Florida with tons of population,” said Brian Cronin, a licensed Medicare broker and owner of The Cronin Agency in New Hampshire, where 77,000 residents are directly affected by plan reductions. Otherwise, health insurers see “mediocre enrollment and high use of the plan and that puts them in the red.”

That’s why less densely populated rural and suburban counties—like Grafton County, New Hampshire, which is losing 22 plans and has a low population density of only 54.5 people per square mile— tend to get short shrift. So do counties, like those in rural Minnesota, that aren’t eligible for a high federal reimbursement level .

In New Hampshire, “there’s just not a lot of choice,” Cronin said. “We will be able to get everybody into a plan, but that plan is not going to be as benefit-rich as their current year.”

Ultimately, whether your Medicare Advantage plan will continue,  and the number of 2026 options you have, highly depend on where you live. 

What You Can Do If Your Medicare Advantage Insurer Leaves

Here’s how to determine whether you’re affected by changes to the MA market and, if so, how to find affordable and adequate coverage after losing your current plan. 

Check Your Medicare Annual Notice of Change (ANOC) 

This letter from your health insurer, due each year by Sept. 30, outlines any changes to your current plan that’ll go into effect in January, including whether it’s no longer available.  

Bookmark Open Enrollment

If your plan is canceled, prepare to pick a new one during Medicare Open Enrollment, which runs from Oct. 15 to Dec. 7, 2025. Medicare Open Enrollment is your chance to join any MA plan available in your area, or to switch to Original Medicare. 

MA beneficiaries can also take advantage of a second enrollment period from Jan. 1 to March 31, 2026. If you sign up then, your new plan will take effect on the first day of the following month you enrolled.

Understand the Risks

If your MA plan is canceled and you miss open enrollment, you’ll get automatically enrolled in Original Medicare, which covers hospital and medical care. In that case, unless you have Medicare Part D, you could wind up without prescription drug coverage. You would have to pay full price without insurance help for your prescriptions until you can join a new plan in 2027. 

“We’re very concerned about those folks,” said Greiner.

You can circumvent any issues by picking a Medicare Part D plan or a new Medicare Advantage with prescription drug coverage during open enrollment.

Know Your Options

Determine which plans are available in your area by using the Plan Finder tool on Medicare.gov. It’s worth checking even if your current plan will continue in 2026.

“Most [people] should find that there are still multiple options available and spending some time understanding plan parameters may pay off this year in the form of more generous coverage and reduced out-of-pocket costs,” said Brandy Lipton, associate professor of health, society, and behavior at the University of California Irvine’s Joe C. Wen School of Population & Public Health.

Compare Medicare Advantage Plans

Look at out-of-pocket costs, including premiums, deductibles, and co-pays. But pay careful attention to drug formularies—the list of covered drugs for a particular plan—and provider networks, as they, too, are experiencing significant drawbacks and upheaval in certain areas. A plan’s coverage may be skimpier than what you had before, or your doctor may no longer be included, once you check the fine print.

“We have a number of providers pulling out of plans,” Greiner said of Minnesota’s market. “They didn’t like the process and procedures for getting approval” for treatment and claim reimbursement. 

Consider Medigap or a Medicare Cost Plan

Medigap is a private health insurance policy designed to bridge gaps in Original Medicare coverage. There are restrictions on applying for a Medigap plan, but you can do so without going through medical underwriting during open enrollment if your MA plan is canceled and you decide to switch back to Original Medicare. 

This could turn a frustrating situation into an opportunity. Typically, signing up for Medigap after you’re already on Medicare can be challenging due to the medical underwriting requirements, especially if you have pre-existing health conditions.    

Medicare Cost Plans are a hybrid between Medicare Advantage and Original Medicare that allow you to visit out-of-network providers at a reasonable cost. They’re an option if the remaining MA plans in your area have slim networks or exclude your preferred physicians. They are restricted to certain states, however.  

In Minnesota, “they’re very popular plans,” Greiner said.

Seek Assistance

If you’re feeling overwhelmed or unsure of how to proceed, reach out to your local SHIP or find a reputable Medicare insurance agent or broker in your area. Agents represent one insurance company while brokers sell plans from multiple insurers, giving you more options to choose from at once. You can check an insurance professional’s credentials on your state’s insurance department website.