What's Happening?
For 2027, Medicare Advantage Prescription Drug (MA-PD) plan availability is set to decrease in several U.S. counties, with North Dakota being one of the states newly affected. According to a KFF analysis of CMS Landscape files, 193 counties nationwide
will have no MA-PD options for general enrollment, an increase from 123 counties in 2026. This change impacts approximately 638,000 Medicare beneficiaries, up from 399,000 in the previous year. The states newly added to the list of those with counties lacking MA-PD options are New Hampshire, North Dakota, and Oklahoma. Major insurers like UnitedHealth Group and Humana are exiting more counties than they are entering. Health Care Service Corporation is making the largest reduction, exiting 498 counties, while Blue Cross Blue Shield of Michigan Mutual Ins. Co., which previously offered MA-PDs in North Dakota, will only offer them in Michigan and Wyoming for 2027. Conversely, Devoted Health is expanding its footprint, entering 342 counties.
Why It's Important?
The reduction in Medicare Advantage plan availability, particularly in states like North Dakota, has significant implications for Medicare beneficiaries. Fewer plan options can limit choices, potentially leading to higher out-of-pocket costs, reduced access to preferred providers, or less comprehensive coverage for those in affected counties. This trend could force some beneficiaries to switch to traditional Medicare or other private plan options, which may not offer the same benefits or cost structures. The exit of major insurers from certain markets suggests a re-evaluation of profitability and market viability, which could indicate underlying challenges in providing MA-PD plans in less populated or more rural areas. This shift could exacerbate healthcare disparities, as beneficiaries in these counties may face greater hurdles in accessing affordable and suitable healthcare coverage, impacting their overall health and financial well-being.
What's Next?
Medicare beneficiaries in affected counties, including those in North Dakota, will need to carefully review their healthcare options during the upcoming enrollment period for 2027. They may need to explore traditional Medicare, Medicare Supplement plans, or other private plan options if MA-PDs are no longer available in their area. State and federal policymakers may face pressure to address these coverage gaps, potentially through incentives for insurers to offer plans in underserved areas or through adjustments to Medicare Advantage regulations. Insurers will continue to refine their market strategies, potentially leading to further shifts in plan availability in subsequent years. Beneficiaries should seek guidance from Medicare resources or local SHIP (State Health Insurance Assistance Program) counselors to understand their choices and ensure they have adequate coverage for 2027.
Beyond the Headlines
The shrinking availability of Medicare Advantage plans in certain regions points to deeper systemic issues within the healthcare market. It highlights the tension between insurer profitability and the need for comprehensive, accessible healthcare coverage for all Medicare beneficiaries. This trend could signal a growing divide in healthcare access between urban and rural areas, as insurers may find it less profitable to operate in less densely populated counties. The decisions by major insurers to withdraw from certain markets could also reflect increasing regulatory burdens, rising healthcare costs, or competitive pressures. This situation raises questions about the long-term sustainability of the Medicare Advantage program as a private alternative to traditional Medicare, and whether policy interventions are needed to ensure equitable access to plans across all geographic regions. The impact on beneficiaries' health outcomes and financial stability in these underserved areas will be a critical area to monitor.
