The Medicare Advantage market is being redrawn — and providers are caught in the middle.
For 2027, Humana is exiting Medicare Advantage plans covering 600,000 members. Molina Healthcare is discontinuing its Medicare Advantage prescription drug product entirely. Presbyterian Health Plan in New Mexico is ending most of its MA plans, affecting roughly 30,000 members. UnitedHealthcare is reviewing exits from 34 additional counties across 12 states. And Clear Spring Health already departed the Medicare Advantage market entirely in mid-2026.
These exits follow a brutal 2026 in which over 25 major health systems dropped Medicare Advantage contracts — including Mayo Clinic, Mount Sinai, Mass General Brigham, UNC Health, and Providence — citing inadequate reimbursement, prior authorization burdens, and unsustainable administrative costs.
What does this mean for providers, physicians, and hospitals entering AEP 2026? It means disruption is coming whether you plan for it or not. The providers who come through this period intact are the ones who act now — before October 15.
Humana members losing MA plans for 2027
Major health systems that dropped MA contracts in 2026
Counties exited by top 5 carriers, 2025–2026
AEP opens — the window providers cannot afford to miss
The Scale of the 2027 Medicare Advantage Exits
The exits heading into 2027 are not isolated or random. They represent a structural reckoning in the Medicare Advantage market — driven by years of rising medical costs, benchmark payment rates that trail inflation, and a care utilization surge that caught insurers significantly off-guard.
Carriers Reducing or Exiting for 2027
| Carrier | 2027 Action | Members Affected | Status |
|---|---|---|---|
| Humana | Exiting MA plans covering ~600,000 members; narrowing to 46 states and 85% of U.S. counties | ~600,000 | Confirmed |
| Molina Healthcare | Discontinuing MA-PD product entirely for 2027 due to underperformance | N/A | Confirmed |
| Presbyterian Health Plan (NM) | Discontinuing most MA plans for 2027 | ~30,000 | Confirmed |
| Clear Spring Health | Full MA market exit — IL, GA, CO plans discontinued June 2026 | — | Exited |
| UnitedHealthcare | Reviewing exits from 34 additional counties in 12 states for 2027 (preliminary as of Aug 5, 2026) | ~20,000+ | Preliminary |
These are on top of the already staggering 2026 exits: UnitedHealthcare exited 109 counties affecting 180,000 members; Humana trimmed 500,000 members in 2025 and narrowed from 89% to 85% of U.S. counties for 2026; Aetna exited 100 additional counties; and Elevance/Anthem exited 181 counties, according to industry analysis via LinkedIn.
— MarketWatch / Morningstar, August 15, 2026
Why Carriers Are Exiting — The Root Causes
Understanding why carriers are leaving is essential context for providers navigating this period. The exits are not arbitrary. They reflect a structural imbalance between what Medicare Advantage pays and what care actually costs.
Reimbursement Rates That Trail Medical Inflation
CMS finalized a 2.48% average benchmark increase for Medicare Advantage plans for 2027 — up from the initial 0.09% proposal but still significantly below medical inflation, according to Insurance News Net. Medicare Advantage plans typically reimburse providers at roughly 90% of what traditional Medicare pays. With that gap widening as costs rise, health systems increasingly find MA contracts financially untenable.
Prior Authorization Burden and Claim Delays
Providers cite prior authorization denials and administrative friction as the leading operational reason for dropping MA contracts. Health systems ranging from Mayo Clinic to Mass General Brigham and UNC Health have publicly cited these pressures. When a hospital must spend significant resources fighting denials for medically necessary care, the math on an MA contract changes fast.
Higher-Than-Expected Utilization
After the COVID-19 pandemic suppressed care utilization for years, a significant backlog of deferred care hit Medicare Advantage populations simultaneously. Carriers priced plans based on historical utilization that no longer reflected post-pandemic demand — and the resulting losses are driving the pullbacks.
Profitability Pressure in Rural and PPO Markets
Exits are concentrated in rural counties and PPO plan structures. PPO plans, which allow members to see providers outside the network, are more expensive to operate and harder to manage medically. As Reuters reported, UnitedHealthcare’s exits are “largely comprised of preferred provider organizations.”
CMS had proposed 2027 rules that would have given beneficiaries stronger protections when providers leave Medicare Advantage networks mid-year. According to the New York Times, CMS retracted those proposed protections in April 2026 — leaving members and providers with fewer safeguards heading into this turbulent period.
How Provider Networks Are Breaking Down: The Health System Exodus
Carrier exits are only one half of the disruption. The other half is the accelerating exodus of health systems from Medicare Advantage networks — driven by the same underlying economics.
According to Becker’s Hospital Review, at least 25 major health systems dropped Medicare Advantage contracts in 2026. The list includes institutions that are cornerstones of their regional markets:
- Mayo Clinic (MN, WI, IA) — exited most UnitedHealthcare and Humana individual MA plans, January 2026
- Mass General Brigham (MA) — primary care providers left UnitedHealthcare and BCBS MA networks, January 2026
- UNC Health (NC) — ended contracts with Humana, WellCare, and HCSC MA plans, January 2026
- Mount Sinai (NYC) — exited Anthem MA network, 2026
- Providence (CA) — left UnitedHealthcare MA for 15 hospitals, January 2026
- Fairview Health Services (MN) — stopping UnitedHealthcare MA scheduling effective January 1, 2027
- University of Miami Health System — out of network with UnitedHealthcare MA, with full exit planned for 2027
- Presbyterian Healthcare Services (NM) — discontinuing most MA plans for 2027, affecting ~30,000 members
- MultiCare (WA), St. Luke’s Health System (ID), Centra Health (VA), Kettering Health (OH) — all exited Humana MA
— KFF Health News
How Provider Revenue Is Directly Threatened
For a physician practice or hospital system, a Medicare Advantage carrier exit or contract termination is not an abstract industry event. It has immediate, measurable financial consequences.
Patient Panel Attrition
When a carrier exits your market, the patients enrolled in that plan face a disrupted AEP. Many will select a new plan — and the new plan may not include your practice in its network. Even patients who intend to stay with you may inadvertently enroll in a plan where you are out-of-network, discovering the problem only at their next appointment.
Out-of-Network Cost Shock for Patients
According to Yahoo Finance, when a hospital exits a Medicare Advantage network, a PPO member’s out-of-pocket ceiling can nearly double — from approximately $5,421 in-network to $9,825 combined. When patients face those costs, many defer care, delay procedures, or avoid follow-up visits entirely. That deferred care becomes bad debt and volume loss for providers.
Revenue Cycle Disruption
Mid-year network exits — whether the carrier exits the market or a health system drops an MA contract — create administrative havoc. Claims submitted under an old contract while the patient is technically out-of-network generate denials, billing rework, and collection delays that strain revenue cycle operations for months.
Value-Based Contract Collapse
For provider groups participating in value-based care arrangements with Medicare Advantage plans, a carrier exit can terminate the entire contract mid-performance period — wiping out shared savings potential and orphaning care management infrastructure that was built for a specific population.
Provider Revenue Risk Summary
- Patient panel attrition when members select plans where you are out-of-network
- Volume declines as cost-shocked patients defer care or switch providers
- Claims denial spikes from network transition billing errors
- Revenue cycle disruption and collection delays for 3–6 months post-transition
- Value-based contract termination and loss of shared savings opportunity
- Administrative burden from fielding patient calls and coordinating plan transitions
What Patients Experience — And Why Providers Must Lead the Communication
When a Medicare Advantage plan exits, members do not always understand what it means or what they need to do. CMS requires plans to notify members when their plan is discontinued — and when a primary care provider or behavioral health specialist leaves the network, plans must provide at least 45 days’ notice, per federal regulations. But notification does not equal comprehension.
Many beneficiaries receive an Annual Notice of Change (ANOC) letter in September that contains buried language about network changes or plan discontinuation. They may miss it, misunderstand it, or assume their doctor will still be covered under whatever plan they are auto-enrolled into.
The result, according to KFF Health News: patients show up for appointments in January only to learn they are out-of-network — and either face a large unexpected bill or go without care. For practices, this is a scheduling, billing, and patient trust crisis rolled into one.
A provider leaving a Medicare Advantage network mid-year does not automatically create a Special Enrollment Period. Members may be locked into their current plan until AEP, even if their doctor is no longer covered. Proactive provider communication before October 15 is the only reliable way to prevent this scenario.
What Providers Should Do Right Now — Before October 15
AEP 2026 opens October 15. That is the window during which your Medicare Advantage patients can make plan changes that take effect January 1, 2027. Here is a concrete action plan for providers who want to protect their patient panel and revenue through this period.
Step 1: Audit Your Patient Panel by Medicare Advantage Carrier
Pull a report of all active Medicare Advantage patients segmented by carrier. Identify which patients are enrolled in plans that have announced exits or network changes in your market. This is the foundation of every other action item.
Step 2: Verify Your Network Status Across Remaining Carriers
If a major carrier is exiting your market, your patients will need to switch plans. Know before October 15 which remaining plans in your county include your practice in-network. Check each carrier’s provider directory directly — these directories are sometimes outdated, so call to verify if a patient’s intended new plan lists you as in-network.
Step 3: Communicate Proactively With Affected Patients Before AEP
Send a letter or secure portal message to every patient enrolled in an exiting plan well before October 15. Explain what is happening in plain language, which plans you remain in-network with, and that they must select a new plan during AEP (October 15 – December 7). This single step protects your patient relationship and reduces the volume shock that hits in January when unprepared patients discover coverage problems.
Step 4: Partner With a Licensed Medicare Broker or FMO
The most effective providers in this environment are those who establish a relationship with a licensed Medicare broker or Field Marketing Organization. A qualified broker can help your patients navigate plan selection, identify plans where your practice is in-network, and facilitate the enrollment process — all at no cost to the patient. This is not just a patient service; it is a retention strategy for your practice.
Step 5: Review Your Own MA Contracts
If you have not recently reviewed the reimbursement rates in your Medicare Advantage contracts against your actual cost structure, now is the time. The experience of 25+ health systems dropping MA contracts in 2026 reflects a calculation that every provider should be making annually. Know what each contract is actually worth before negotiating renewals in this environment.
Provider Action Timeline — Before October 15
- Now: Pull patient panel report segmented by Medicare Advantage carrier
- September: Verify your network participation with all major remaining carriers in your market
- By Oct 1: Send proactive communication to all patients enrolled in exiting plans
- Oct 15 – Dec 7: Support patients through AEP enrollment — partner with a licensed Medicare broker
- Q4 2026: Review all remaining MA contracts for reimbursement adequacy and renegotiate if warranted
The Opportunity Inside the Disruption
Market disruption on this scale creates as many opportunities as it does challenges. Providers and practices that position themselves correctly before AEP will emerge from this period with stronger patient relationships and cleaner payer mixes than those who wait passively.
When a carrier exits a market, it does not reduce the total number of Medicare beneficiaries in that area. It redistributes them. Members whose plans terminate must re-enroll somewhere — and the question is whether they land in a plan where their current provider is in-network.
Practices that are in-network with the plans that will absorb displaced members stand to gain new patients, not lose them. The key is knowing which plans are growing in your market and ensuring your participation is current before October 15.
Additionally, as large carriers exit rural and PPO markets, regional plans — including smaller carriers, CO-OPs, and regional Blue Cross plans — are actively expanding to fill the gaps. Providers in those markets may have new contracting options worth exploring for 2027.
— Value-Based Care Industry Analysis, 2026
How Affordable Care Agents Helps Providers Navigate This Moment
Affordable Care Agents is a national FMO and insurance brokerage that works with licensed Medicare brokers across the country. During market transitions like this one, provider organizations benefit from having a licensed Medicare broker partner who can:
- Help your Medicare Advantage patients identify plans where your practice remains in-network during AEP
- Facilitate enrollment for displaced patients during the Annual Election Period at no cost to the patient
- Provide educational materials for your front desk or patient portal explaining the 2027 carrier changes in plain language
- Connect provider-focused practices with brokers who specialize in Medicare Advantage enrollment in your specific market
- Keep your affiliated patients informed about their options through a compliant, CMS-rule-following enrollment process
The brokers who work with Affordable Care Agents are contracted with multiple carriers — including the regional and growing plans that are filling the gaps left by UnitedHealthcare, Humana, and others. That multi-carrier access means they can match your patients to a plan that includes your practice, rather than defaulting to a single-carrier option.
Questions & Answers: Medicare Advantage Carrier Exits 2027
Understanding the Full Coverage Landscape: MAPD, Medicare Supplement, and Under-65
When a Medicare Advantage carrier exits a market, displaced members don’t have just one replacement option — they have a full landscape of choices. Helping patients, providers, and the brokers who serve them understand those differences is one of the most practical things an FMO or agency can do heading into AEP 2026. Here is a clear breakdown of the three major coverage paths — and the broker opportunity inside each one.
Medicare Advantage + Prescription Drug Plans (MAPD)
A Medicare Advantage Prescription Drug plan (MAPD) — also called a Part C plan with Part D built in — combines hospital coverage (Part A), medical coverage (Part B), and prescription drug coverage (Part D) into a single private insurance plan. Most MAPD plans bundle extra benefits on top: dental, vision, hearing, fitness, and sometimes over-the-counter allowances.
What Is an MAPD Plan?
An MAPD plan replaces Original Medicare Parts A and B and adds drug coverage. Members pay the plan’s monthly premium (often $0 in competitive markets), continue paying their Part B premium, and use the plan’s network of physicians and hospitals. MAPD plans come in two main network structures:
- HMO (Health Maintenance Organization): Members must use in-network providers for all non-emergency care and typically need referrals for specialists. Lower cost-sharing but less provider flexibility.
- PPO (Preferred Provider Organization): Members can see out-of-network providers at a higher cost share. More flexibility, but typically higher premiums. Importantly, many of the 2026 carrier exits specifically targeted PPO plans — UnitedHealthcare’s exits were described by Reuters as “largely comprised of preferred provider organizations” — due to the higher cost of managing out-of-network utilization.
How Do MAPD Carrier Exits Affect Providers?
Every MAPD plan maintains its own provider network and pays its own reimbursement rates. When a displaced patient re-enrolls in a new MAPD plan during AEP, the critical question is whether their current physician, specialist, or hospital is in-network with the new plan. Providers who have already dropped certain carriers — as Mayo Clinic, Mass General Brigham, and UNC Health have done — face a compounding problem: if their patients re-enroll in those same carrier’s MAPD plans, those patients will face out-of-network costs even in a brand-new plan year.
The MAPD Broker Opportunity in AEP 2026
With Humana’s confirmed 600,000 member exits and UnitedHealthcare’s multi-year county withdrawals, MAPD brokers face the largest concentrated re-enrollment opportunity in recent Medicare history. The key advantage goes to brokers who are contracted across multiple carriers — particularly those with growing regional plans filling the county gaps left by national exits. According to Becker’s Payer, regional plans like Devoted and Clover are actively expanding into counties abandoned by larger national insurers.
MAPD Broker Takeaways
- Verify each client’s current providers are in-network with the replacement MAPD plan before enrollment — not after
- Check drug formularies — the exiting plan’s drug tiers and copays do not carry over automatically to a new MAPD
- Compare HMO vs. PPO structures for each displaced member based on their care patterns and existing provider relationships
- Identify regional and co-op plans expanding in exited counties — these often offer better in-network access for local providers than national alternatives
- Document every enrollment conversation thoroughly — CMS marketing rules require scope of appointment compliance and transparent plan comparison
Medicare Supplement Plans (Medigap): The Alternative to MAPD
For many displaced Medicare Advantage members — particularly those who have experienced prior authorization denials, unexpected out-of-pocket costs, or the loss of a longtime provider — the 2027 carrier exits represent a natural inflection point to consider Medicare Supplement insurance (Medigap) as an alternative path.
What Is a Medicare Supplement Plan?
A Medicare Supplement plan works alongside Original Medicare (Parts A and B) — not in place of it. While MAPD plans replace Original Medicare, Medigap plans pay the gaps that Original Medicare leaves: deductibles, coinsurance, and copayments. Members on Medigap retain full access to any provider in the country that accepts Medicare — with no network restrictions and no referral requirements.
Why Medicare Supplement Matters Especially After MA Network Disruptions
The pattern repeating across the country in 2026 — patients losing access to their longtime specialist or hospital when a health system drops a Medicare Advantage contract — does not occur under Medicare Supplement. A Medigap member with Original Medicare can see Mayo Clinic, Mass General Brigham, UNC Health, or any other provider that accepts traditional Medicare, regardless of which insurance company issued their Medigap policy. That guarantee of provider access has significant value for patients who have already experienced the instability of MA networks.
Plan G and Plan N: The Two Most Common Medigap Options
| Feature | Plan G | Plan N |
|---|---|---|
| Part A deductible | Covered | Covered |
| Part B deductible | Not covered — member pays (~$257 in 2026) | Not covered |
| Part B coinsurance | Covered in full | Covered with small office copay (up to $20) and ER copay (up to $50 if not admitted) |
| Part B excess charges | Covered | Not covered |
| Network restrictions | None — any Medicare-accepting provider nationwide | None — any Medicare-accepting provider nationwide |
| Prescription drugs | Not included — must add a standalone Part D plan | Not included — must add a standalone Part D plan |
| Best for | Members who want maximum coverage, predictable costs, and complete provider freedom | Members who want broad access at a lower premium and can absorb small office copays |
When a Medicare Advantage plan is discontinued by the carrier, affected members typically receive a guaranteed issue right — meaning they can enroll in certain Medigap plans without medical underwriting, even if they have pre-existing conditions. This window is time-limited and tied to the plan termination date. Brokers should verify the exact window with each Medigap carrier and ensure clients apply during that period. Missing it may require the client to answer health questions to qualify for Medigap in the future.
Medicare Supplement Broker Opportunity During AEP 2026
The wave of MA carrier exits creates a once-in-a-cycle opportunity for Medigap brokers. Members who have experienced prior authorization battles, surprise out-of-network bills, or the loss of a trusted doctor are highly receptive to the Medigap value proposition: predictable costs, no networks, no referrals. A broker who positions as a trusted advisor during AEP 2026 — not just a plan-switcher — can convert displaced MA members into long-term Medigap clients with much stronger retention profiles.
Medicare Supplement Broker Takeaways
- Identify MA clients whose plans are terminating — they may have a guaranteed issue right for Medigap
- Act fast — guaranteed issue windows are time-limited and tied to the plan’s termination date
- Pair Medigap Plan G or N with a standalone Part D plan for complete coverage
- Educate members on the trade-off: higher monthly premium vs. unrestricted provider access and zero prior auth surprises
- Multi-carrier Medigap contracting gives clients real price comparison — be appointed with at least 3 carriers in your market
- Members who have lost access to major health systems under MA are particularly strong Medigap prospects
Under-65 Health Insurance: The Overlooked Segment in This Disruption
The Medicare Advantage exit headlines are focused on seniors — but the market disruption is creating parallel pressure on the under-65 (U65) health insurance market that brokers cannot afford to miss. Every Medicare-disrupted household is a potential whole-family coverage review conversation.
Who Are the Under-65 Clients in This Context?
The most directly relevant U65 clients connected to the Medicare Advantage disruption include:
- Spouses of Medicare beneficiaries who are not yet 65 — often in the same household being disrupted by the Medicare carrier exit and in need of their own individual coverage
- Early retirees aged 62–64 who retired before Medicare eligibility and are on COBRA, ACA Marketplace plans, or temporary coverage
- Individuals approaching Medicare via SSDI — those within 24 months of Medicare eligibility through Social Security Disability Insurance who may be evaluating bridge coverage options
- Self-employed professionals and gig workers in the same communities where provider network exits are happening, who depend on ACA Marketplace plans to access the same health systems now reshuffling insurer relationships
The Provider Network Connection for U65 Patients
Here is the connection most providers and brokers overlook: the same health systems dropping Medicare Advantage contracts — Mayo Clinic, Mass General Brigham, UNC Health, Providence — may also be restructuring their participation in certain ACA Marketplace narrow-network plans offered by the same insurers experiencing MA profitability pressure. A 63-year-old on an ACA Marketplace plan receiving care at a system reshuffling its insurer relationships may face the same network disruption as their 67-year-old neighbor on Medicare Advantage.
Providers auditing their Medicare Advantage contracts should simultaneously review ACA Marketplace plan participation — particularly for plans offered by insurers under MA financial pressure.
ACA Marketplace Plans: Key Options for U65 Clients in 2027
The ACA Marketplace Open Enrollment Period for 2027 coverage runs November 1 through January 15, 2027 — overlapping with the tail end of Medicare’s AEP window (which closes December 7). Brokers managing households with both Medicare-age and under-65 members will be in simultaneous open enrollment for two different markets during Q4 2026.
Key coverage options for under-65 clients include:
- ACA Marketplace metal-tier plans (Bronze, Silver, Gold, Platinum) — the primary source of subsidized individual health coverage for U65 clients. Premium tax credits are available based on household income and family size through Healthcare.gov or state-based exchanges. Members should verify provider network participation carefully — narrow-network Silver plans are common and may not include every health system.
- ICHRA (Individual Coverage HRA): Employers can fund tax-advantaged ICHRA accounts that reimburse employees for Marketplace premiums. For self-employed clients or small groups whose carriers are reshuffling networks, ICHRA can provide a more stable and flexible long-term coverage structure.
- Short-Term Limited Duration Insurance (STLDI): Available in some states as a bridge option. Coverage, duration limits, and availability vary significantly by state — brokers must always verify state rules and clearly disclose all limitations before enrolling a client in a short-term plan.
Brokers who want to write Medicare Advantage or Part D business during AEP 2026 must complete current AHIP Medicare certification. Affordable Care Agents provides brokers access to a discounted AHIP certification through the OIM link — complete your certification at ahipmedicaretraining.com/clients/oim before October 15.
The Whole-Household Strategy: The Real Broker Advantage
The brokers who thrive in AEP 2026 are the ones thinking in households, not policies. A Medicare carrier exit in a household often exposes the entire family’s coverage structure to review. A broker who arrives with a complete household strategy — Medicare Advantage or Supplement for the 67-year-old, ACA Marketplace guidance for the 62-year-old spouse, and ancillary products (dental, vision, critical illness, hospital indemnity) for both — delivers dramatically more value than a broker who only handles the Medicare replacement.
Under-65 Broker Takeaways
- Ask about household composition with every Medicare-affected client — there may be a U65 spouse or dependent who also needs coverage guidance
- ACA Marketplace OEP for 2027 opens November 1 — be ready to discuss Marketplace options alongside AEP Medicare conversations
- Verify premium tax credit eligibility for U65 household members — income thresholds and subsidy levels change annually; check Healthcare.gov for current figures
- Check provider network participation for ACA plans in markets where health systems are reshuffling insurer relationships
- Offer ancillary products — dental, vision, accident, critical illness, hospital indemnity — as standalone coverage that stays with the client regardless of which health plan they carry
- Be licensed and contracted in both Medicare and U65 markets — the most productive brokers in AEP 2026 will work both sides of every household
MAPD vs. Medicare Supplement vs. Original Medicare: Side-by-Side
| Feature | MAPD | Medigap + Part D | Original Medicare Only |
|---|---|---|---|
| Monthly premium | Often $0–$50 (plus Part B) | $100–$300+ (plus Part B + Part D) | Part B premium only (~$185/mo in 2026) |
| Provider network | Restricted to plan network (HMO or PPO) | Any Medicare-accepting provider — nationwide, no referrals | Any Medicare-accepting provider — nationwide |
| Out-of-pocket max | Yes — varies by plan (in-network cap) | Minimal — most cost gaps covered by Medigap | None — unlimited exposure |
| Drug coverage | Included in most MAPD plans | Requires separate standalone Part D plan | Requires separate standalone Part D plan |
| Extra benefits | Dental, vision, hearing, OTC, fitness | None — ancillary plans available separately | None |
| Prior authorization | Yes — varies by plan and procedure | Minimal — follows Original Medicare rules | Minimal — follows Medicare rules |
| Best for | Budget-conscious, network-flexible members who want extra benefits | Members who want predictable costs and unrestricted provider freedom | Very low utilizers — carries highest financial exposure |
More Questions & Answers: MAPD, Medigap, and Under-65 Options
Disclaimer: This article is provided for educational and informational purposes only and should not be considered legal, tax, financial, medical, insurance, or compliance advice. Insurance laws, Medicare and Medicaid regulations, Affordable Care Act Marketplace rules, carrier policies, commissions, plan availability, eligibility requirements, and state regulations may change and may vary by jurisdiction. Readers should verify current information through official sources such as CMS, Medicare.gov, Healthcare.gov, IRS.gov, state Departments of Insurance, and applicable insurance carriers before making insurance or business decisions. Affordable Care Agents is a national FMO, IMO, and insurance brokerage. Publication does not constitute an offer of insurance or a guarantee of coverage, contracting, compensation, eligibility, or regulatory compliance.
