- The mean forced disenrollment rate for Medicare Advantage beneficiaries jumped from 1% in 2018-2024 to 6.9% in 2025, and then to 10% in 2026, after a spike in plans leaving the market.
- In Vermont, 92.2% of enrollees were subject to forced disenrollments, and at least 40% of enrollees were forced to disenroll from their plans in six other states.
- Beneficiaries facing forced disenrollment were more likely to be enrolled in preferred provider organization plans, non-special needs plans, smaller carrier plans, and lower star-rated plans, and to live in rural areas.
About one in 10 Medicare Advantage (MA) enrollees were forced to disenroll from their plan in 2026, following a spike in MA plans leaving the market, a study showed.
The mean forced disenrollment rate for MA beneficiaries jumped from 1% in 2018-2024 to 6.9% in 2025, and then to 10% in 2026, reported Mark K. Meiselbach, PhD, of the Johns Hopkins Bloomberg School of Public Health in Baltimore, and co-authors in a research letter in JAMA.
Meiselbach told MedPage Today that "the massive uptick in the past 2 years in plan exits relative to very infrequent plan exits over the prior 5+ years" was surprising, and "signals a changing landscape."
"It is also shocking to see the total or near-total collapse of MA in several states," he said.
In Vermont, 92.2% of enrollees were subject to forced disenrollments. In six other states -- Idaho, Wyoming, North Dakota, South Dakota, New Hampshire, and Maryland -- at least 40% of enrollees were forced to disenroll from their plans.
For Vermont, "major exits" occurred in 2025, Meiselbach noted. "When insurers exited in 2025, it was because they were unprofitable. So where did their enrollees, who for whatever reason were unprofitable, go? Many of them enrolled in the remaining MA plans, which likely made these remaining plans less profitable."
MA beneficiaries facing forced disenrollment in 2026 were more likely to be enrolled in preferred provider organization (PPO) plans, non-special needs plans, smaller carrier plans, and lower star-rated plans, and to live in rural areas and in markets with lower 2025 MA penetration.
Large carriers were often "more adept" at turning a profit, Meiselbach said. "The major carriers know how to do well with risk adjustment, how to maintain high star ratings that confer higher payments, and how to attract a more profitable enrollee population."
In an accompanying editorial, Hannah O. James, PhD, of the RAND Corporation in Boston, noted that forced disenrollments can disrupt care for beneficiaries.
"An older beneficiary with diabetes and heart disease who must switch plans may experience fragmented clinician relationships, interrupted specialist care, medication formulary changes, and disrupted care coordination that could ultimately lead to worse health outcomes," she wrote. "Beneficiaries living in rural areas face particular challenges: with fewer plan alternatives available, many may be required to revert to traditional Medicare, potentially losing supplemental benefits and additional financial protections if they cannot afford a supplemental insurance plan."
On the whole, "plan exits merit careful interpretation," James added.
When insurers leave certain markets in rural areas, that shift begs the question of whether reimbursement is sufficient. However, in this case, the Centers for Medicare & Medicaid services (CMS) signaled that net payment rates for MA plans would actually rise 5.06% in response to policy changes for the 2026 plan year. Still, plans continued to leave the market.
In addition, the Medicare Payment Advisory Commission (MedPAC) found that MA plans are already paid roughly 20% more than their peers in traditional Medicare plans, James pointed out. In other words, "plans serving unprofitable populations are exiting even after receiving payment increases on top of already higher payment rates relative to traditional Medicare."
"This pattern deserves serious examination of whether the capitated, for-profit model reliably delivers universal access or whether it inherently creates tension between beneficiary needs and plan incentives," she wrote.
From 2017 to 2025, there were 752,091 plan county observations representing 192,675,082 enrollee-years. The study sample included nonemployer health maintenance organization (HMO) and PPO plans across all 50 states and the District of Columbia.
The researchers leveraged publicly available data from CMS on enrollment and plan information from 2018 through 2026 to characterize the number of people forced to disenroll from plans each year. They then compared key features of the plans that exited in 2026 to the plans that did not.
A limitation of the study was that the "welfare implications" of disenrollments, which vary by enrollees based on their preference for other MA plans or traditional Medicare, were not investigated, Meiselbach and team noted.
Disclosures
This study was supported by funding from Arnold Ventures.
Meiselbach reported no disclosures. A co-author reported personal fees from Williams & Connelly.
James reported no conflicts of interest.
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