Every October, Medicare's Annual Enrollment Period (AEP) gives beneficiaries a six-week window between Oct. 15 through Dec. 7 to reconsider their coverage. Most years, that's a matter of choice: People can shop around if they want to. But this year, in a growing number of states, it isn't optional. Their current plan may simply no longer exist, insurance marketplace MediaAlpha reports.
Medicare Advantage insurers are pulling back sharply for 2026. Nationally, the number of non-special-needs Medicare Advantage plans fell 10% year-over-year, from 3,719 plans in 2025 to 3,373 in 2026, as major carriers including UnitedHealthcare, Humana, Aetna, CVS Aetna, and Elevance scaled back their footprints in hundreds of counties. The result: The average Medicare beneficiary now has 39 plan choices at the county level, down from 42 the year before.
For some states, that pullback isn't a modest trim but a near-total collapse of the private Medicare market.
The states with the biggest forced disruption
Research from Johns Hopkins Bloomberg School of Public Health found that forced disenrollment, which means beneficiaries are losing their Medicare Advantage plan because the insurer exited their area, hit a historic high for 2026. The forced disenrollment rate, which averaged just over 1% annually between 2018 and 2024, climbed to 6.9% in 2025 and is projected to reach 10% in 2026, a tenfold jump in two years. Twelve states saw disenrollment rates above 20% this year, and several crossed 40%.
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In Vermont, 92.2% of Medicare Advantage enrollees lost their plan for 2026, effectively wiping out private Medicare options statewide for most residents. Vermont's collapse followed a familiar pattern: When carriers began exiting in 2025, remaining plans absorbed a wave of higher-cost enrollees, eroding profitability until the last insurers pulled out entirely.
Wyoming, South Dakota, Idaho, New Hampshire, Maryland, and North Dakota each experienced forced disenrollment rates at or above 40% of enrollees in 2026. Maryland's case stands out because, unlike the other states on this list, it's a largely urban market – proof that plan exits aren't only a rural, low-density phenomenon.
In the case of New Hampshire, the disruption traces to specific carrier decisions: Anthem and Martin's Point are exiting the state's individual Medicare Advantage market entirely for 2026, and Aetna is withdrawing from most counties, affecting an estimated 77,000 residents. Some counties, like Coos County, will be left with just two insurers offering plans.
Where plan choice is shrinking the most
A separate KFF analysis of 2026 plan offerings found New Hampshire and Minnesota saw the steepest drops in the number of plans available to the average beneficiary, with 13 fewer plans in New Hampshire and 11 fewer in Minnesota. In Minnesota, UCare, the state's second-largest Medicare Advantage insurer, exited the market completely, while UnitedHealthcare and Humana trimmed offerings, particularly in lower-enrollment rural counties.
Not every state is losing ground, though. In six states – Alabama, Hawaii, Kansas, Missouri, Utah, and West Virginia – the average beneficiary actually has more plan choices for 2026 than in 2025, a reminder that this disruption isn't a uniform national retreat so much as a reshuffling that hits some states harder than others.
Why this matters for Annual Enrollment
Rural counties, plans rated below four stars, and smaller regional carriers have been disproportionately affected by the 2026 exits, according to the Johns Hopkins researchers, leaving some seniors with few or no local alternatives once their plan disappears. For beneficiaries anywhere, but especially in the states above, this AEP isn't a "check in case something changed" formality; it may be the only way to find out whether their current plan still exists at all.
"The states seeing the sharpest plan losses are exactly where we'd urge people to start comparing early, rather than waiting until their plan cancellation notice arrives," said Sarah Graves, VP of demand partnerships at MediaAlpha. "Beneficiaries in states like Vermont, New Hampshire, and Minnesota have the least room for a wait-and-see approach this year."
With AEP running through Dec. 7, beneficiaries in every state have a limited window to confirm their plan is still available and to compare alternatives if it isn't.
This story was produced by MediaAlpha and reviewed and distributed by Stacker.
