About 2.6 million Medicare Advantage enrollees were forced to find new coverage this year after insurers terminated or consolidated plans across the country. Researchers at Johns Hopkins Bloomberg School of Public Health estimate that as many as 2.9 million beneficiaries face the same disruption heading into 2027, meaning roughly one in ten people enrolled in Medicare Advantage could lose their current plan two years running. The scale of these exits, driven by shifting federal payment benchmarks and tightening insurer margins, is creating real coverage gaps for seniors who depend on the supplemental benefits that Medicare Advantage plans typically bundle with standard Medicare.
Forced disenrollment is accelerating, not stabilizing
The federal government tracks every plan that is renewed, consolidated, or terminated through annual crosswalk files published by the Centers for Medicare and Medicaid Services. The CMS crosswalk files for 2026 document widespread terminations that triggered automatic reassignments or left beneficiaries shopping for entirely new coverage. When a plan ID disappears from the crosswalk without a direct successor, the enrollee either lands in a different plan chosen by the insurer or reverts to traditional Medicare, often losing dental, vision, hearing, and prescription drug benefits that had been packaged into the terminated plan.
A JAMA research letter summarized by Johns Hopkins researchers found that one in ten Medicare Advantage enrollees faced forced disenrollment in 2026, with as many as 2.9 million people affected. State-level data in that analysis showed that smaller, more rural states like Vermont bore a disproportionate share of plan losses. That pattern raises a pointed question for 2027: whether counties with below-average payment benchmarks, which cluster heavily in rural areas, will see exit rates far exceeding those in urban markets once the next round of crosswalk files is released.
For affected beneficiaries, the disruption is more than an administrative nuisance. Forced disenrollment can abruptly separate patients from long-standing primary care physicians or specialists who are out of network in replacement plans. It can also reset prior authorizations for services like home health, durable medical equipment, or chemotherapy, forcing clinicians and families to navigate new paperwork in the middle of treatment. Even when beneficiaries are automatically mapped into a different plan, formularies and cost-sharing rules often change, leading to higher out-of-pocket costs or new coverage denials.
CMS payment rules and the 2027 ratebook shape insurer math
Insurers decide whether to offer or exit a county based largely on the per-member payment rates CMS sets each year. The agency has already distributed the 2027 benchmark ratebook, which contains county-level payment ceilings that determine how much the federal government will pay plans for each enrollee. Where benchmarks fall below the cost of delivering care plus a margin, insurers pull out or sharply narrow their offerings. In low-benchmark rural counties, that can mean going from multiple competing plans to a single option or none at all.
CMS has also proposed 2027 payment policies that emphasize what the agency describes as “payment accuracy and sustainability.” A recent CMS payment proposal outlines technical changes to risk adjustment and other formulas that determine how plans are paid. While those adjustments are aimed at limiting overpayments and aligning rates with beneficiaries’ actual health status, they also tighten the financial room plans have to fund supplemental benefits, particularly in markets where benchmarks are already low.
At the same time, the proposed rule for contract year 2027 includes enrollment process changes and revisions to the Star Ratings measure set, according to a separate CMS fact sheet. Star Ratings matter because plans rated four stars or above receive quality bonus payments that help fund extras such as dental, vision, and gym memberships. When CMS recalibrates the measures used to assign those stars, some plans can see their ratings – and therefore their bonus dollars – fall even if underlying performance has not dramatically worsened. For plans hovering around the four-star threshold, a downgrade can be the difference between staying in a marginal county and exiting it.
Industry analysts say the combined effect of lower benchmarks in some regions, stricter risk adjustment, and more demanding quality metrics is pushing insurers to retrench into counties where they can reliably earn bonuses and maintain scale. That dynamic helps explain why forced disenrollment is concentrating in smaller states and rural areas, where enrollee pools are thin and provider networks are harder to assemble. Large national carriers can sometimes offset losses in one market with gains in another, but smaller regional plans have less room to absorb payment shocks and are more likely to terminate contracts entirely.
Beneficiaries face complex choices with limited time
For older adults caught in these shifts, the challenge is making sense of new plan options under tight annual enrollment timelines. Notices of plan termination typically arrive in the fall, leaving only a few weeks for beneficiaries – many with multiple chronic conditions – to compare premiums, networks, and drug coverage across unfamiliar alternatives. Advocates warn that people with cognitive impairment, limited English proficiency, or poor internet access are especially vulnerable to ending up in plans that do not meet their medical or financial needs.
Policy experts argue that CMS could mitigate some of the harm from forced disenrollment by strengthening outreach through State Health Insurance Assistance Programs, simplifying plan comparison tools, and tightening guardrails on how insurers reassign members when plans close. But unless payment benchmarks and bonus structures are adjusted in ways that make it financially viable to serve low-density and low-income counties, the underlying incentives driving exits are likely to persist. For millions of Medicare Advantage enrollees, that means plan stability may remain elusive well beyond the 2027 contract year.
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David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
