Unprecedented Spike in Plan Exits Threatens Medicare Advantage Stability

The era of predictable growth for Medicare Advantage plans is fast approaching a significant roadblock, following 2 decades of continually increasing enrollment. By 2026, the program is expected to see an unprecedented spike in “forced disenrollment,” which is when private insurers may stop offering specific plans or choose to exit the market, leaving millions of older Americans potentially searching for new coverage.

This news was published online today in JAMA.¹

“We’ve recognized that we are probably overpaying for Medicare Advantage, and so efforts to reduce how much we pay are going to mean that some plans can no longer be profitable,” said lead author Mark Meiselbach, PhD, assistant professor at the Johns Hopkins Bloomberg School of Public Health, in an interview with The American Journal of Managed Care^®. “And if the plan is not profitable, the insurer is probably going to stop offering that plan. In some senses, this is a necessary consequence of correcting the market, but the distribution is not going to be even, and enrollees in some markets may be left without any Medicare Advantage plans to choose from.

Understanding the Market Shift

Traditional Medicare encompasses Part A and Part B, through which enrollees gain hospital insurance and medical insurance, respectively.² Medicare Advantage plans encompass Part C and Part D, and they are part of a program through which older individuals can enroll in private health plans to gain extra benefits they otherwise would not have access to through traditional Medicare.³ Part C plans combine hospital and medical coverage, and depending on the plan chosen, enrollees can also have access to prescription drug coverage (also a Part D option); vision, hearing, and dental services; and wellness options.⁴ Beyond the aforementioned drug coverage, Part D plans are separate prescription drug–only plans for out-of-pocket expenses with a yearly cap of $2100.⁵

The present study authors analyzed a massive data set comprising over 192 million enrollee-years, more than 752,000 plan county observations, and 28.6 million enrollees. They linked CMS county-level enrollment data in a previous year to annual Plan Crosswalk and Landscape files. The Crosswalk file tracks when contracts end or service areas shrink, and the Landscape file lists available plans per county; data for 2017 to 2025 and 2018 to 2026 were used, respectively. Focus areas were nonemployer health maintenance organization and preferred provider organization (PPO) plans across all 50 states and the District of Columbia. By tracking these movements, the team was able to pinpoint how many people would lose their current plans and what were the characteristics of those plans.

Data reveal a stark contrast between the historical stability of the program and its projected future. Forced disenrollment, whether enrolled in a special needs plan (SNP) or not, was a marginal issue between 2018 and 2024, at a mean 1.0%. In 2025, however, the rate jumped to almost 6.9%, and for 2026 is predicted to reach 10.0%—or approximately 2.9 million enrollees who could face coverage termination.

The impact is especially harsh for certain population segments:

• Non-SNPs face potential disenrollment of 12.4%
• PPO enrollees represent close to half of disenrolled individuals (49.35%), with only 30.88% retaining coverage
• Rural beneficiaries account for 28.04% of the disenrolled population, with just 15.07% retaining coverage
• Small carriers represent almost half of plan exits (48.82%) and 27.08% of retained coverage, whereas the top 3 carriers of UnitedHealthcare, Humana, and Elevance Health represent 24.23% of plan exits but 49.6% of plan retentions

There also are significant disparities state by state. Most states face a low forced disenrollment rate of less than 10%, followed by the next most common disenrollment rate of 10% to less than 20%, a very high rate of 40% of more, and a high rate of 20% to less than 40%. Vermont was an outlier. Part of the group of states facing the highest disenrollment, it came out on top, with 92.2% of Medicare Advantage enrollees projected to lose coverage in 2026.

“This is the second year in a row where there have been major exits from Vermont. Those plans were unprofitable, and that’s why they exited. When those plans exited, their enrollees went to the remaining plan, and then you’ve got a downward spiral that seems to have played out in Vermont,” Meiselbach said. “What’s not clear to me is whether the same sort of downward spiral might be occurring in other states, and we’ve just observed step 1 in 2026.”

Real-World Implications

“Drivers of higher plan exit may include changes to plan payments and risk adjustment, as well as unanticipated increases in health care use among Medicare Advantage enrollees,” the authors wrote, which when combined can make plans financially unstable for private insurers.

When a plan exits, its specific network of doctors and its unique benefits package disappear with it. Plan enrollees must then scramble to find another private plan that includes their existing physicians or decide if it is time to return to traditional Medicare. This choice is further complicated for those in rural areas or currently in plans with lower Star Ratings (less than 4 stars), as they are among the most likely to be searching for new options.

“Anything that makes it easier for enrollees to understand how the plans they might newly select compare to the plan they were on would help: tools to see whether provider networks will be disrupted, whether the drugs and medications they rely on will still be covered, and how supplemental benefits compare would be really valuable,” Meiselbach said. “And strengthening the outside option of traditional Medicare—making it a more viable product for all enrollees, with at a minimum an out-of-pocket maximum—would provide a stronger public fallback when markets destabilize.”

Ultimately, these findings signal a period of potential high volatility and a significant threat to care continuity, as well as the need for CMS to guide millions of vulnerable Americans through a rapidly shrinking private insurance market.

References

1. Meiselbach MK, Lavallee M, Zahn M, Xu J, Polsky D. Forced disenrollments among Medicare Advantage beneficiaries following 2026 plan exits. JAMA. Published online February 18, 2026. doi:10.1001/jama.2026.0028
2. Enrolling in Medicare Part A & Part B. CMS. Updated January 2018. Accessed February 16, 2026. https://www.medicare.gov/publications/11036-enrolling-medicare-part-a-part-b.pdf
3. What is a Medicare Advantage plan? How does it differ from traditional Medicare? KFF. September 1, 2025. Accessed February 16, 2026. https://www.kff.org/faqs/medicare-open-enrollment-faqs/medicare-advantage/what-is-a-medicare-advantage-plan-how-does-it-differ-from-traditional-medicare/
4. Everything you need to know about Medicare Advantage (Part C). HealthSpring. Accessed February 16, 2026. https://www.healthspring.com/medicare/understanding-medicare/what-is-part-c-medicare-advantage
5. What is Medicare Part D? National Council on Aging. February 13, 2026. Accessed February 16, 2026. https://www.ncoa.org/article/what-is-medicare-part-d/