When Medicare Advantage insurers began sounding alarms about payment system changes last year, few could have predicted the scope of what followed. As 2025 drew to a close, more than 2.6 million Americans found out that the Medicare Advantage plan they’d chosen and come to rely on would no longer exist in the new year.
A new KFF analysis takes a close look at the scale of these terminations, what options affected enrollees actually had going into 2026, and which communities were hit hardest.
A Sharp Jump in Plan Terminations
The numbers tell a striking story. In 2025, plan terminations affected 13% of all Medicare Advantage enrollees with prescription drug coverage — more than double the 6% affected the year before. Insurers have pointed to recent and prospective changes to the Medicare Advantage payment system as the driving force behind both the terminations and reductions in plan benefits.
Most Enrollees Still Had Options
Despite the disruption, the picture for most affected beneficiaries wasn’t as dire as it might seem. According to the KFF analysis, nearly all enrollees whose plans were terminated had at least one Medicare Advantage plan with drug coverage available to them in 2026. On average, they had more than two dozen plans to choose from in their area.
For enrollees who had previously enjoyed a zero-premium plan option, most were able to find a comparable zero-premium option for 2026 as well.
A Small but Vulnerable Group Left Behind
Still, not everyone landed safely. Just under 30,000 people — about 1.1% of those whose plans were terminated — had no Medicare Advantage option with drug coverage available in their area for 2026. For this small but vulnerable group, the plan terminations meant navigating a fundamentally different coverage landscape.
Rural Communities Bore a Disproportionate Burden
The impact of terminations wasn’t evenly distributed across the country. The KFF analysis found that rural states were hit harder than their share of overall Medicare Advantage enrollment would suggest. While these states represent a small slice of the national Medicare Advantage market, their enrollees faced outsized disruption — a pattern that reflects the longstanding challenges of maintaining robust plan competition in less densely populated areas.
What This Means Going Forward
For most of the 2.6 million affected enrollees, the end result was an inconvenient but manageable transition — a forced re-enrollment process that ultimately led to comparable coverage. But the sharp year-over-year increase in termination rates, and the geographic inequities in who bears the brunt of that disruption, are worth watching closely as the Medicare Advantage market continues to evolve.