Medicare Advantage Options Shrink Across Many Counties for 2027
A KFF analysis of CMS data shows Medicare Advantage prescription drug plan availability varies widely by county for 2027. About 20% of beneficiaries can choose from more than 40 plans, down from 27% in 2026. In 193 counties, no such plans will be offered for general enrollment, affecting roughly 638,000 people.
For 2027, the counties with the most Medicare Advantage prescription drug plan choices remain concentrated in Pennsylvania, Ohio, Michigan, and Los Angeles County, California. Lancaster, Pennsylvania, has the largest selection nationwide, with 66 plans. Meanwhile, 193 counties across 16 states and territories will offer no such plans for general enrollment, up from 123 counties in 2026.
Those zero-option counties cover about 638,000 beneficiaries, or 1% of all Medicare beneficiaries, compared with 399,000 in 2026. Alaska has no general enrollment plans in any county, affecting roughly 110,000 people. Six counties in Nebraska and South Dakota offer a plan without drug coverage; the other 187 have no Medicare Advantage plans at all for general enrollment.
Beneficiaries in counties with fewer or no Medicare Advantage prescription drug plan options may need to compare traditional Medicare or other coverage, potentially increasing shopping burdens. Reduced insurer competition could affect premiums, supplemental benefits, or provider networks, though outcomes are uncertain. The roughly 638,000 people in counties without general enrollment plans, along with those in areas where major carriers are exiting, could face fewer alternatives and greater reliance on traditional Medicare.