Pennsylvania Medicare

Medicare Advantage Plans in Pennsylvania for 2027: What's Ending and What's Available

51 Pennsylvania Medicare plans end or leave counties for 2027, per CMS; 283,486 people must choose a new plan. Another 12 were merged or renumbered, so those members move automatically. If yours is on the list, a licensed agent can help at no cost to you.

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Which Pennsylvania Medicare plans are ending in 2027?

The biggest plans ending: Aetna (160,923 members), UPMC Health System (83,776 members), Blue (18,925 members). CMS's 2027 Plan Crosswalk says 51 Pennsylvania Medicare Advantage and Part D plans end or leave counties for 2027, with at least 283,486 people enrolled who must choose a new plan. Another 12 plans (80,581 people) were merged into other plans or given new plan numbers; CMS moves those members automatically, and their letter names the new plan. A plan that ends stops on December 31, 2026. It does not mean you lose Medicare. Your plan's own letter is the final word.

63 Pennsylvania plans on CMS's 2026 list but not its 2027 list: plans that end come first, then plans CMS merged or renumbered
PlanPlan IDCountiesMembersWhat CMS says for 2027
SilverScript Choice (PDP)
Aetna
S5601-012Statewide (Part D drug plan)156,649Ends December 31, 2026. Members must choose a new plan. 156,649 of them are in counties where this company has no 2027 plan at all.
UPMC for Life PPO Rx Choice (PPO)
UPMC Health System
H5533-015Allegheny, Armstrong, Beaver, Butler and 26 more34,450Leaves these counties for 2027. Members here must choose a new plan.
UPMC for Life HMO Rx Choice (HMO)
UPMC Health System
H3907-057Butler, Cambria, Cameron, Clarion and 3 more14,144Leaves these counties for 2027. Members here must choose a new plan.
UPMC for Life HMO Premier Rx (HMO)
UPMC Health System
H3907-059Bedford, Blair, Butler, Cambria and 7 more13,144Leaves these counties for 2027. Members here must choose a new plan.
UPMC for Life PPO Premier Rx (PPO)
UPMC Health System
H5533-011Cumberland, Dauphin, Lancaster, Lebanon and 5 more8,634Ends December 31, 2026. Members must choose a new plan.
Blue Rx PDP Complete (PDP)
Blue (Highmark Health)
S5593-003Statewide (Part D drug plan)6,459+Ends December 31, 2026. Members must choose a new plan. 6,459 of them are in counties where this company has no 2027 plan at all.
Blue Rx PDP Plus (PDP)
Blue (Highmark Health)
S5593-002Statewide (Part D drug plan)6,417+Ends December 31, 2026. Members must choose a new plan. 6,417 of them are in counties where this company has no 2027 plan at all.
Capital Blue Cross Complete (PPO)
CAPITAL BLUE CROSS
H3923-047Adams, Franklin, York5,343Leaves these counties for 2027. Members here must choose a new plan.
UPMC for Life HMO Deductible Rx (HMO)
UPMC Health System
H3907-037Bradford, Butler, Cambria, Cameron and 20 more5,335+Leaves these counties for 2027. Members here must choose a new plan.
UPMC for Life HMO Rx (HMO)
UPMC Health System
H3907-058Cambria, Cameron, Clearfield, Huntingdon and 1 more3,559Leaves these counties for 2027. Members here must choose a new plan.
Found your plan on this list?A licensed agent reads your letter with you and goes over your options. No cost, 8 AM to midnight ET.
UPMC for Life PPO Premier Rx (PPO)
UPMC Health System
H5533-013Bedford, Blair, Butler, Cambria and 8 more3,524Leaves these counties for 2027. Members here must choose a new plan.
Capital Blue Cross Enhanced (PPO)
CAPITAL BLUE CROSS
H3923-046Northampton, Schuylkill3,294Leaves these counties for 2027. Members here must choose a new plan.
Complete Blue PPO Distinct (PPO)
Blue (Highmark Health)
H3916-059Blair, Cambria, Cameron, Clarion and 11 more2,879+Ends December 31, 2026. Members must choose a new plan.
Community Blue Medicare HMO Signature (HMO)
Blue (Highmark Health)
H3957-042Franklin, Fulton, Monroe, Schuylkill and 2 more2,708Leaves these counties for 2027. Members here must choose a new plan.
Jefferson Health Plans Flex Pro (PPO)
Thomas Jefferson University
H1619-003Adams, Berks, Bradford, Bucks and 16 more2,497+Ends December 31, 2026. Members must choose a new plan.
Personal Choice 65 Plus Rx (PPO)
Personal (Independence Health Group)
H3909-018Bucks, Chester, Delaware, Montgomery and 1 more2,180Ends December 31, 2026. Members must choose a new plan.
AARP Medicare Advantage from UHC PA-0011 (PPO)
Erickson (UnitedHealthcare)
H2406-072Adams, Beaver, Blair, Bradford and 21 more2,024+Leaves these counties for 2027. Members here must choose a new plan.
Aetna Medicare Premier (HMO-POS)
Aetna
H3931-004Bucks, Chester, Delaware, Montgomery and 1 more1,893Ends December 31, 2026. Members must choose a new plan.
HumanaChoice H5525-086 (PPO)
Humana
H5525-086Adams, Bradford, Montgomery, Susquehanna1,845Leaves these counties for 2027. Members here must choose a new plan.
Erickson Advantage Signature (HMO-POS)
Erickson (UnitedHealthcare)
H5652-001Bucks, Delaware1,153Ends December 31, 2026. Members must choose a new plan.
Found your plan on this list?A licensed agent reads your letter with you and goes over your options. No cost, 8 AM to midnight ET.
Aetna Medicare Enhanced (PPO)
Aetna
H5521-122Adams, Allegheny, Armstrong, Beaver and 63 more1,092+Ends December 31, 2026. Members must choose a new plan.
Aetna Medicare PinnacleHealth Prime (HMO-POS)
Aetna
H3931-091Cumberland, Dauphin, Juniata, Perry and 1 more773+Ends December 31, 2026. Members must choose a new plan.
Aetna Medicare PinnacleHealth Prime (PPO)
Aetna
H5522-029Cumberland, Dauphin, Juniata, Perry and 1 more516+Ends December 31, 2026. Members must choose a new plan.
Complete Blue PPO Merit (PPO)
Blue (Highmark Health)
H3916-057Blair, Cambria, Cameron, Clarion and 11 more462+Leaves these counties for 2027. Members here must choose a new plan.
UPMC for Life PPO High Deductible Rx (PPO)
UPMC Health System
H5533-003Butler, Cambria, Cameron, Carbon and 4 more383+Leaves these counties for 2027. Members here must choose a new plan.
UPMC for Life PPO Rx Enhanced (PPO)
UPMC Health System
H5533-005Butler, Cambria, Cameron, Carbon and 4 more331+Leaves these counties for 2027. Members here must choose a new plan.
UPMC for Life PPO Essential Care Rx (PPO)
UPMC Health System
H5533-017Cambria, Cameron, Clearfield, Indiana246+Leaves these counties for 2027. Members here must choose a new plan.
HumanaChoice Giveback H5525-085 (PPO)
Humana
H5525-085Tioga220Leaves these counties for 2027. Members here must choose a new plan.
Jefferson Health Plans Flex Plus (PPO)
Thomas Jefferson University
H1619-002Adams, Berks, Bradford, Bucks and 16 more214+Ends December 31, 2026. Members must choose a new plan.
Humana Gold Choice H8145-055 (PFFS)
Humana
H8145-055Adams, Berks, Bradford, Carbon and 20 more206+Ends December 31, 2026. Members must choose a new plan.
Found your plan on this list?A licensed agent reads your letter with you and goes over your options. No cost, 8 AM to midnight ET.
HealthSpring Preferred (HMO)
Cigna HealthSpring
H3949-049Crawford, Mercer, Venango172Ends December 31, 2026. Members must choose a new plan.
Humana Gold Choice H8145-052 (PFFS)
Humana
H8145-052Franklin, Susquehanna162Leaves these counties for 2027. Members here must choose a new plan.
Humana Gold Choice H8145-163 (PFFS)
Humana
H8145-163Adams, Allegheny, Armstrong, Beaver and 59 more111+Ends December 31, 2026. Members must choose a new plan.
Erickson Advantage Freedom (HMO-POS)
Erickson (UnitedHealthcare)
H5652-006Bucks, Delaware100Ends December 31, 2026. Members must choose a new plan.
Erickson Advantage Liberty (HMO-POS)
Erickson (UnitedHealthcare)
H5652-008Bucks, Delaware98Ends December 31, 2026. Members must choose a new plan.
Wellcare Patriot Giveback (HMO-POS)
Wellcare / Ambetter
H2915-013Adams, Allegheny, Armstrong, Beaver and 59 more86+Ends December 31, 2026. Members must choose a new plan.
Erickson Advantage Liberty no Rx (HMO-POS)
Erickson (UnitedHealthcare)
H5652-002Bucks, Delaware46Ends December 31, 2026. Members must choose a new plan.
Provider Partners Pennsylvania Community Plan (HMO I-SNP)
Provider Partners Pennsylvania (Rifkin Managed Care Holding)
H4093-004Allegheny, Armstrong, Beaver, Bucks and 14 more34+Ends December 31, 2026. Members must choose a new plan.
UPMC for Life HMO Rx Enhanced (HMO)
UPMC Health System
H3907-006Cambria, Cameron, Clearfield26+Leaves these counties for 2027. Members here must choose a new plan.
Erickson Advantage Guardian (HMO-POS I-SNP)
Erickson (UnitedHealthcare)
H5652-003Bucks, Delaware24Ends December 31, 2026. Members must choose a new plan.
Found your plan on this list?A licensed agent reads your letter with you and goes over your options. No cost, 8 AM to midnight ET.
HumanaChoice SNP-DE H5216-227 (PPO D-SNP)
Humana
H5216-227Potter21Leaves these counties for 2027. Members here must choose a new plan.
Erickson Advantage Champion (HMO-POS C-SNP)
Erickson (UnitedHealthcare)
H5652-004Bucks, Delaware20+Ends December 31, 2026. Members must choose a new plan.
HealthSpring True Choice (PPO)
Cigna HealthSpring
H7849-106Crawford, Mercer, Venango12+Leaves these counties for 2027. Members here must choose a new plan.
Aetna Community HealthChoices (HMO D-SNP)
Aetna
H3959-069Cameron, Clarion, Clearfield, Crawford and 9 more10 or fewerEnds December 31, 2026. Members must choose a new plan.
Aetna Community HealthChoices (HMO D-SNP)
Aetna
H3959-070Bucks, Chester, Delaware, Montgomery and 1 more10 or fewerEnds December 31, 2026. Members must choose a new plan.
Aetna Community HealthChoices (HMO D-SNP)
Aetna
H3959-071Allegheny, Armstrong, Beaver, Bedford and 10 more10 or fewerEnds December 31, 2026. Members must choose a new plan.
Aetna Community HealthChoices (HMO D-SNP)
Aetna
H3959-072Bradford, Carbon, Centre, Clinton and 18 more10 or fewerEnds December 31, 2026. Members must choose a new plan.
Aetna Community HealthChoices (HMO D-SNP)
Aetna
H3959-073Adams, Berks, Cumberland, Dauphin and 9 more10 or fewerEnds December 31, 2026. Members must choose a new plan.
HealthSpring TotalCare Plus (HMO D-SNP)
Cigna HealthSpring
H3949-009Crawford, Mercer, Venango10 or fewerLeaves these counties for 2027. Members here must choose a new plan.
Provider Partners Pennsylvania Essential Plan (HMO I-SNP)
Provider Partners Pennsylvania (Rifkin Managed Care Holding)
H4093-008Allegheny, Armstrong, Beaver, Bucks and 14 more10 or fewerEnds December 31, 2026. Members must choose a new plan.
Found your plan on this list?A licensed agent reads your letter with you and goes over your options. No cost, 8 AM to midnight ET.
UHC Nursing Home Plan EX-F002 (PPO I-SNP)
Erickson (UnitedHealthcare)
H0710-017Clarion, Jefferson, Mifflin, Northumberland10 or fewerLeaves these counties for 2027. Members here must choose a new plan.
UPMC for Life Complete Care (HMO D-SNP)
UPMC Health System
H4279-001Adams, Allegheny, Armstrong, Beaver and 44 more36,215+Merged into UPMC for Life Complete Care (HMO D-SNP) (H4279-007) for 2027. Members are moved automatically and can still switch.
HealthSpring Extra Rx (PDP)
Cigna HealthSpring
S5617-356Statewide (Part D drug plan)16,687+Merged into HealthSpring Assurance Rx (PDP) (S5715-027) for 2027. Members are moved automatically and can still switch.
HealthSpring Assurance Rx (PDP)
Cigna HealthSpring
S5617-215Statewide (Part D drug plan)12,890+Merged into HealthSpring Assurance Rx (PDP) (S5715-027) for 2027. Members are moved automatically and can still switch.
Complete Blue PPO Merit (PPO)
Blue (Highmark Health)
H3916-066Adams, Berks, Bradford, Carbon and 21 more5,644+Continues for 2027 as Complete Blue PPO Merit (PPO) (H3916-069). Members keep their plan.
Complete Blue PPO Signature (PPO)
Blue (Highmark Health)
H3916-038Erie, Lawrence, Mercer4,885Merged into Complete Blue PPO Signature (PPO) (H3916-041) for 2027. Members are moved automatically and can still switch.
UPMC for Life Complete Care (HMO D-SNP)
UPMC Health System
H4279-004Berks, Carbon, Lackawanna, Lehigh and 8 more1,207Merged into UPMC for Life Complete Care (HMO D-SNP) (H4279-007) for 2027. Members are moved automatically and can still switch.
Capital Blue Cross Value (HMO)
CAPITAL BLUE CROSS
H3962-004Adams, Berks, Centre, Columbia and 17 more1,161+Continues for 2027 as Capital Blue Cross Value (HMO) (H3962-023). Members keep their plan.
Wellcare Assist (HMO-POS)
Wellcare / Ambetter
H2915-011Adams, Allegheny, Armstrong, Beaver and 59 more534+Merged into Wellcare Simple (HMO-POS) (H2915-003) for 2027. Members are moved automatically and can still switch.
HealthSpring Preferred (HMO)
Cigna HealthSpring
H3949-045Lehigh, Northampton513Merged into HealthSpring Preferred (HMO) (H3949-052) for 2027. Members are moved automatically and can still switch.
Found your plan on this list?A licensed agent reads your letter with you and goes over your options. No cost, 8 AM to midnight ET.
Wellcare Simple (HMO-POS)
Wellcare / Ambetter
H2915-003Blair, Cambria, Crawford, Erie and 2 more368Merged into Wellcare Simple (HMO-POS) (H2915-003) for 2027. Members are moved automatically and can still switch.
DEVOTED CHOICE PREMIUM 002 PA (PPO)
Devoted Health
H6018-002Berks, Bucks, Chester, Delaware and 4 more364Merged into DEVOTED CHOICE 007 PA (PPO) (H6018-007) for 2027. Members are moved automatically and can still switch.
Capital Blue Cross Basic (PPO)
CAPITAL BLUE CROSS
H3923-048Adams, Berks, Columbia, Franklin and 8 more113+Continues for 2027 as Capital Blue Cross Basic (PPO) (H3923-049). Members keep their plan.

Full detail by company and county: Pennsylvania Medicare plan changes for 2027. CMS hides county counts of 10 or fewer, so totals are at least the number shown.

Medicare Advantage plans available in Pennsylvania for 2027

338 Medicare Advantage plans are offered in Pennsylvania for 2027 by 20 companies. 200 are HMO plans and 137 are PPO plans, with 1 private fee-for-service. 71 are special needs plans, which only people who qualify (for example, people who also have Medicaid or a chronic condition) can join, so 267 are open to most people with Medicare. Depending on the county, you can choose from between 46 and 111 plans.

Compared with 2026: 350 plans were offered in Pennsylvania in 2026, so the count is down by 12 for 2027. Listed in CMS's 2026 files but not its 2027 files: Cigna HealthCare (13 plans in 2026), Wellcare By Allwell (5 plans in 2026). A company can also appear to leave because it changed its name, so check your own plan's letter.

Plans by company, 2026 and 2027

CompanyPlans in 2026Plans in 2027Change
Highmark Blue Cross Blue Shield or Highmark Blue Shield7675−1
Aetna Medicare3940+1
Capital Blue Cross3035+5
Devoted Health2635+9
Humana2728+1
UPMC for Life3228−4
UnitedHealthcare2522−3
Independence Blue Cross1717no change
Geisinger Gold1314+1
HealthSpring1311−2
Jefferson Health Plans98−1
UPMC for Life Complete Care35+2
Highmark Wholecare Medicare Assured44no change
Perennial Advantage33no change
Provider Partners Health Plans33no change
Wellcare53−2
Clover Health22no change
Peak Health22no change
VISTA Health Plan Inc.22no change
American Health Advantage of Pennsylvania11no change
Cigna HealthCare130not listed
Wellcare By Allwell50not listed

Plans offered by county, 2026 and 2027

CountyPlans in 2026Plans in 2027Change
Adams9690−6
Allegheny9695−1
Armstrong8992+3
Beaver9192+1
Bedford7578+3
Berks105106+1
Blair8482−2
Bradford8490+6
Bucks107104−3
Butler9186−5
Cambria8071−9
Cameron7571−4
Carbon9290−2
Centre7271−1
Chester99102+3
Clarion8676−10
Clearfield8674−12
Clinton7576+1
Columbia5761+4
Crawford9286−6
Cumberland10397−6
Dauphin10399−4
Delaware10095−5
Elk7065−5
Erie8686no change
Fayette7977−2
Forest7168−3
Franklin8281−1
Fulton7680+4
Greene8586+1
Huntingdon8887−1
Indiana6761−6
Jefferson7676no change
Juniata8888no change
Lackawanna7575no change
Lancaster114111−3
Lawrence8890+2
Lebanon109107−2
Lehigh103105+2
Luzerne7779+2
Lycoming8076−4
McKean7164−7
Mercer8782−5
Mifflin8483−1
Monroe8084+4
Montgomery9194+3
Montour8293+11
Northampton102103+1
Northumberland5355+2
Perry106105−1
Philadelphia9798+1
Pike4646no change
Potter7568−7
Schuylkill8687+1
Snyder8485+1
Somerset8787no change
Sullivan7579+4
Susquehanna8079−1
Tioga6571+6
Union8991+2
Venango8477−7
Warren7979no change
Washington9290−2
Wayne8285+3
Westmoreland9186−5
Wyoming8384+1
York105103−2

Counts include special needs plans. A plan can be offered in only part of a state, so the plans you can choose depend on your county. Which plans keep your doctors and cover your medicines is not in the CMS files; a licensed agent checks that for you.

Ready to enroll in a Pennsylvania plan?

No cost. No obligation. Not the government. Speak with a licensed insurance agent (TTY 711).

Will a 2027 plan keep your doctors and cover your prescriptions?

The public plan sites can't tell you that without a lot of clicking, and some 2027 plans aren't on them until October 15. Give us your doctors and your prescriptions and a licensed agent checks every 2027 plan in your county against your list, then calls you with the two or three that fit. No cost, no obligation.

We call back 8 AM to midnight ET, every day. We use the details you provide to respond to your coverage help request. Do not submit Medicare numbers, Social Security numbers, payment information, or medical records through this form.

Got a letter saying your Medicare plan is leaving or won't renew?

A non-renewal letter means your specific plan won't continue in your county after December 31, 2026. It doesn't mean you lose Medicare, and it usually doesn't mean your insurance company is leaving Medicare altogether. You can choose a new Medicare Advantage plan, or move to Original Medicare with a Medigap plan and a Part D drug plan.

Medicare Advantage in Pennsylvania today

My Medicare Advantage plan is ending. What are my deadlines?

What happens if I do nothing when my plan is cancelled?

You don't lose Medicare. If you don't choose a new plan, you're moved to Original Medicare (Parts A and B) on January 1, 2027. Original Medicare doesn't include prescription drug coverage, so you'd need to join a separate Part D plan. Going 63 days or more without creditable drug coverage can mean a permanent late-enrollment penalty.

Can I switch to a Medicare Supplement (Medigap) plan without health questions?

Usually yes. When a Medicare Advantage plan leaves your area or stops offering coverage, federal law gives you a guaranteed issue right: a Medigap company must sell you Plan A, B, D or G (or C or F if you were eligible for Medicare before January 1, 2020), can't charge more for past or present health problems, and can't refuse you, as long as you switch to Original Medicare. Some states add more rights than this. Keep your non-renewal letter; it can serve as proof.

How Medigap guaranteed issue works when your plan ends

Losing your Advantage plan this year? Moving to Medigap | Medigap or another Advantage plan? | Moving to Medigap, step by step

What to check before choosing a replacement plan

Free Medicare tools

Questions about Pennsylvania Medicare plans ending

Which Medicare Advantage plans are ending in Pennsylvania for 2027?

The list on this page comes straight from CMS's 2027 plan files: every plan that won't renew, or won't be offered in a county, in Pennsylvania. It covers several carriers.

Is my Medicare Advantage plan being cancelled in Pennsylvania?

If your plan won't continue, you'll get a non-renewal letter by October 2, 2026. Your Annual Notice of Change (ANOC) lists what's changing if your plan does continue. Your plan stays in force through December 31, 2026 either way.

How many people in Pennsylvania lost their Medicare Advantage plan last year?

For 2026, CMS's files show 69 Medicare Advantage plans ended or dropped counties in Pennsylvania, affecting about 179,764 members across 67 counties.

What happens if I don't pick a new plan after my Medicare Advantage plan ends?

You don't lose Medicare. If you don't choose anything, you're moved to Original Medicare (Parts A and B) on January 1, 2027. Original Medicare doesn't include drug coverage, so you'd need to join a separate Part D plan, and going 63 days or more without creditable drug coverage can mean a late-enrollment penalty.

How long do I have to switch after my Medicare Advantage plan is discontinued?

You can switch during Open Enrollment, October 15, 2026 to December 7, 2026, for coverage starting January 1. Because your plan is ending, you also get a Special Enrollment Period from December 8, 2026 through February 28, 2027. An enrollment request received December 8-31 is effective January 1; received in January, effective February 1; received in February, effective March 1. Choosing by December 7, 2026 avoids any gap.

Can I get a Medicare Supplement (Medigap) plan without health questions if my plan is ending?

Usually yes. When a Medicare Advantage plan leaves your area or stops offering coverage, you have a guaranteed issue right to buy Medigap Plan A, B, D or G (and C or F if you were eligible for Medicare before January 1, 2020) without medical underwriting, as long as you move to Original Medicare. You can apply as early as 60 days before your coverage ends and no later than 63 days after (March 4, 2027). Some states give more rights than this.

Why did I get a letter saying my Medicare plan won't renew?

Plans that won't continue next year must mail members a non-renewal notice by October 2, 2026. It means your current plan ends December 31, 2026, not that you lose Medicare. Keep the letter: it shows which plan is ending and helps prove your enrollment rights.

Will my doctors still be covered on a new plan in Pennsylvania?

It depends on the plan you choose. Before switching, check that your doctors, specialists and hospitals are in the new plan's network, your prescriptions are on its drug list, and your pharmacy is covered. With Original Medicare plus Medigap, you can see any provider that accepts Medicare.

Which Medicare Advantage plans are available in Pennsylvania for 2027?

CMS's 2027 files list 338 Medicare Advantage plans offered in Pennsylvania by 20 companies: Highmark Blue Cross Blue Shield or Highmark Blue Shield (75 plans), Aetna Medicare (40 plans), Capital Blue Cross (35 plans), Devoted Health (35 plans), Humana (28 plans), and others. 71 of them are special needs plans, which only people who qualify can join. Which plans you can actually choose depends on your county.

I just found out my plan is ending. Do I need to decide right away?

No. Your plan works through December 31, 2026. You can choose a new plan from October 15 to December 7, and because your plan is ending you also get a Special Enrollment Period from December 8 through February 28, 2027. Deciding earlier just means your new plan is settled before January 1.

Will I get pressured into a sales call if I ask for help?

No. A licensed agent looks at the plans available where you live in Pennsylvania, explains what changes for you, and you decide. There is no cost to you and no obligation to enroll in anything. Calls are recorded, as Medicare requires.

How do I know my plan is on this list?

Type your plan name or the plan ID from your member card into the box above the table. The list comes from CMS's own 2026 and 2027 plan files. Your plan's written notice is the final word; if the two disagree, trust the letter and have a licensed agent check it with you.

Is your Pennsylvania Medicare plan ending?

Call to check your plan and compare what's available where you live, with licensed Medicare help.

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GetFastRates.com is not connected with or endorsed by the U.S. government or the federal Medicare program. Calling connects you with licensed insurance help. Plan availability, costs, benefits, and enrollment rules can vary by state, carrier, and individual situation.

Sources

Last updated 2026-10-06. Plan counts come from CMS files; CMS doesn't publish county counts of 10 or fewer members, so totals are at least the number shown.