How to Get a Medicare Advantage Plan: State-by-State

Key Takeaways: Medicare Advantage in 2026 💡

Can I enroll anytime? No — the main enrollment window is October 15 through December 7 each year (Annual Enrollment Period). Outside of that, you’ll need a qualifying life event for a Special Enrollment Period.

What are the 4 types of Medicare? Part A (hospital), Part B (medical), Part C (Medicare Advantage, which bundles A + B through a private insurer), and Part D (prescription drugs).

What’s the biggest disadvantage? Restricted provider networks — if your doctor or hospital is out-of-network, you could pay significantly more or get no coverage at all.

Are plans the same in every state? Absolutely not. Texas added 44 new plans for 2026, while Minnesota lost 11. Alaska still has zero Medicare Advantage plans available.

How much will it cost? The average Medicare Advantage monthly premium dropped to $14.00 in 2026. About 63% of plans still charge $0 in additional premiums beyond the standard Part B premium of $202.90.

What about prescription drug costs? The annual out-of-pocket cap for Part D drugs is $2,100 in 2026, with a monthly installment payment option available.

Which plans should I avoid? Plans rated below 3 stars by CMS consistently — 23 plans received sub-3-star ratings for 2026, including contracts from Wellcare, Humana, Aetna, and UnitedHealthcare.

Is Florida a good state for Medicare Advantage? Florida has one of the most competitive markets with 5.1 million Medicare enrollees and ultra-low average premiums, though rates rose from $12 to $18 monthly from 2025 to 2026.

What about Texas? Texas saw the largest increase in plan offerings for 2026 — 44 additional plans — and is also part of a new prior authorization pilot program starting January 2026.

What changed for 2026? Major changes include tighter rules on plan denials and appeals, 10 drugs with newly negotiated lower prices, improved provider directory accuracy in Plan Finder, and automatic renewal for the Prescription Payment Plan.

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🏥 Medicare Advantage Is Not “Free Medicare” — Here’s What It Really Is

Medicare Advantage (Part C) is not a government program in itself — it’s Original Medicare (Parts A and B) delivered through a private insurance company that contracts with CMS. These companies receive a per-member payment from the federal government, then manage your benefits through their own provider networks, drug formularies, and cost-sharing structures.

The appeal is clear: bundled coverage, often with extras like dental, vision, and hearing, sometimes for no premium beyond your standard Part B payment. But it comes with trade-offs that matter more than most advertisements let on.

🔍 Feature	✅ Medicare Advantage (Part C)	⚕️ Original Medicare (Parts A + B)
💰 Monthly premium	Often $0 beyond Part B ($202.90)	Part B premium + Medigap (varies widely)
🏥 Provider networks	HMO/PPO — restricted to network	Any Medicare-accepting provider nationwide
💊 Drug coverage	Usually included	Requires separate Part D plan
🦷 Dental/vision/hearing	Typically included	Not covered
📋 Prior authorization	Required for many services	Historically minimal (changing in 2026)
🔒 Out-of-pocket max	$9,250 max in 2026 (many plans set lower)	No annual cap without Medigap
🌍 Travel coverage	Limited to plan service area	Nationwide provider access

💡 Pro tip: That $0 premium looks attractive, but the real cost surfaces when you need care. The enrollment-weighted average maximum out-of-pocket for Medicare Advantage rose to $5,950 in 2026, up from $5,688 in 2025 — a 5% increase.

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⚠️ The Biggest Disadvantage of Medicare Advantage Isn’t What You Think

Most people assume the biggest downside is cost. It’s not. The single most impactful disadvantage is the combination of restricted networks and prior authorization requirements that can delay or deny care exactly when you need it most.

Here’s why this matters more in 2026 than ever before: major insurers including UnitedHealthcare, Humana, and Aetna have narrowed their networks and reduced plan offerings to recover profit margins after post-pandemic utilization surged. According to CMS data, approximately 2.9 million enrollees could face forced disenrollment in 2026 due to plan exits — up from about 1% historically to a projected 10%.

⚠️ Disadvantage	📊 2026 Reality	🛡️ How to Protect Yourself
🏥 Network restrictions	Plans narrowing networks to cut costs	Verify every provider in Plan Finder before enrolling
📋 Prior authorization delays	Some services require approval before treatment	Ask your doctor which procedures need pre-auth
🔄 Plans change yearly	346 fewer plans available nationally vs. 2025	Review your Annual Notice of Change every September
🚗 Limited travel coverage	No coverage outside service area (except emergencies)	Consider Original Medicare + Medigap if you travel frequently
💸 Hidden out-of-pocket costs	$0 premium plans can still cost thousands in copays	Compare total estimated annual costs, not just premiums
🚫 Forced disenrollment	~2.9 million enrollees may lose their plan in 2026	Have a backup plan; know your switch options during open enrollment

💡 Pro tip: CMS now requires Medicare Advantage plans to submit provider directory data directly to Medicare Plan Finder for 2026, with updates required within 30 business days of changes. If you enroll based on Plan Finder data and discover your doctor isn’t actually in-network, you may qualify for a special enrollment period to switch plans — a brand new protection for 2026.

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📋 The 4 Types of Medicare Plans Explained (and How Part C Fits In)

Understanding the four parts of Medicare is essential before deciding whether Medicare Advantage is right for you.

🏷️ Part	📄 What It Covers	💰 2026 Cost Snapshot
🅰️ Part A (hospital insurance)	Inpatient hospital stays, skilled nursing, hospice, some home health	$0 premium for most (if you paid Medicare taxes 10+ years); $518/month if not
🅱️ Part B (medical insurance)	Doctor visits, outpatient care, preventive services, durable medical equipment	$202.90/month standard premium (higher with IRMAA surcharges)
🅲️ Part C (Medicare Advantage)	Bundles Part A + B through a private insurer; usually adds Part D + extras	Average $14/month premium; 63% of plans are $0
🅳️ Part D (prescription drugs)	Outpatient prescription medications	Average standalone premium $34.50/month; $2,100 annual OOP cap

There’s also Medigap (Medicare Supplement Insurance), which isn’t technically a “part” of Medicare but works alongside Original Medicare to cover gaps like copayments, coinsurance, and deductibles. Medigap is a separate private policy and cannot be combined with Medicare Advantage.

💡 Pro tip: If you’re healthy, travel frequently, and want maximum provider flexibility, Original Medicare plus Medigap plus a standalone Part D plan often provides better long-term value than Medicare Advantage — despite the higher monthly premiums. But if you’re budget-conscious and your doctors are in-network, a well-rated Medicare Advantage plan can save thousands annually.

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🗓️ When to Enroll — And the Windows You Can’t Afford to Miss

You cannot enroll in Medicare Advantage at just any time. There are specific enrollment periods, and missing them can leave you stuck for an entire year.

📅 Enrollment Period	🕐 Dates	📝 What You Can Do
🆕 Initial Enrollment Period (IEP)	7-month window around your 65th birthday (3 months before, birthday month, 3 months after)	Sign up for Parts A, B, and/or Medicare Advantage for the first time
📂 Annual Enrollment Period (AEP)	October 15 – December 7 each year	Switch between MA and Original Medicare, change MA plans, add/change Part D
🔄 Medicare Advantage Open Enrollment	January 1 – March 31 each year	Switch MA plans or drop MA and return to Original Medicare + Part D
⚡ Special Enrollment Periods (SEP)	Varies by qualifying event	Move, lose employer coverage, plan exits your area, qualify for Medicaid, or other qualifying events
📋 General Enrollment Period (GEP)	January 1 – March 31 each year	Enroll in Part A and/or Part B if you missed your IEP (late penalties may apply)

💡 Pro tip: If your Medicare Advantage plan is exiting your area for 2026, you automatically qualify for a Special Enrollment Period. Don’t wait — proactively research alternatives before December 7 to avoid being auto-enrolled into a replacement plan that may not include your preferred providers.

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🗺️ How to Get Medicare Advantage Plan by State — Where You Live Changes Everything

Medicare Advantage availability is approved on a county-by-county basis, so two people in the same state might have vastly different options. Here’s what the 2026 landscape looks like for some key states and regions.

🏛️ State	📊 Plan Availability Trend (2026 vs. 2025)	💰 Average Premium Notes	🔍 Key Considerations
🤠 Texas	+44 new plans (largest increase nationally)	Competitive pricing; large insurer presence	Part of new WISeR prior authorization pilot for Original Medicare starting 2026
🌴 Florida	+18 new plans	Average rose from $12 to $18/month	5.1M+ Medicare enrollees; most competitive market nationally
🌞 California	Slight decrease in plans	Higher premiums reflecting urban costs	Rural counties may have very limited options
🏙️ New York	-25 plans	Varies widely by region	Significant plan contraction, especially upstate
🌾 Minnesota	-26 plans (largest decrease nationally)	Above average	UCare exited the market almost entirely
🏔️ Wyoming	Stable but very limited	Average premium surged 88% ($51 to $96/month)	Only 3 MA-PD plans available on average
🌲 Vermont	1 MA-PD plan available	Limited options	92.2% of enrollees projected to face forced disenrollment
❄️ Alaska	Zero plans available	N/A	No Medicare Advantage plans for general enrollment, same as 2025

💡 Pro tip: Don’t just look at your state-level averages. Enter your specific zip code into Medicare Plan Finder to see exactly which plans are available in your county, what they cost, and which providers are in-network.

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🌴 How to Get Medicare Advantage in Florida

Florida is the gold standard for Medicare Advantage competition, and for good reason. With over 5.1 million Medicare enrollees and a massive senior population, insurers compete aggressively for Florida enrollees.

Here’s what makes Florida’s market unique for 2026: the state gained 18 additional plan offerings, premiums remain among the lowest nationally despite a slight increase, and plan choices are abundant in virtually every county. Major carriers including UnitedHealthcare, Humana, Florida Blue (GuideWell Health), Devoted Health, and Freedom Health all maintain a strong presence.

Notably, Florida Blue (GuideWell Health) shifted nearly 24% of its membership from 3-star plans to 4-star plans for 2026 — one of the most significant quality improvements among any insurer nationally.

📋 Florida Medicare Advantage Snapshot	📊 2026 Data
🏛️ Total Medicare enrollees	5,196,218
💰 Average MA premium trend	Rose from $12 to $18/month
⭐ Notable quality improvement	Florida Blue shifted 24% of members into 4-star plans
🦷 Extra benefits	Most plans include dental, vision, hearing, and fitness
🔍 Best approach	Compare plans by county; Miami-Dade has 50+ options while rural Panhandle counties have fewer

💡 Pro tip: Florida’s competitive market means insurers differentiate through extra benefits. Look beyond the $0 premium — compare OTC allowances, meal delivery benefits, transportation services, and gym memberships across plans in your county.

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🤠 How to Get Medicare Advantage in Texas

Texas is experiencing a Medicare Advantage boom. The state added more plans than any other state for 2026 — 44 additional offerings — making it one of the best markets for seniors looking for choice and competition.

Texas is also part of something new and controversial: CMS’s WISeR (Wasteful and Inappropriate Service Reduction) Model, a six-year pilot starting January 1, 2026 that introduces prior authorization into Original Medicare in six states. This doesn’t directly affect Medicare Advantage enrollees (who already deal with prior authorization), but it’s worth noting because it may influence how doctors practice and accept patients across both programs in Texas.

📋 Texas Medicare Advantage Snapshot	📊 2026 Data
📈 Plan availability trend	+44 new plans (highest gain nationally)
💰 Average premiums	Competitive; many $0 premium options
🏥 Major carriers	UnitedHealthcare, Humana, Aetna, HealthSpring, BCBS of Texas
⚕️ New for 2026	WISeR prior authorization pilot for Original Medicare
🌆 Urban vs. rural	Houston, Dallas, San Antonio have 40+ options; West Texas is far more limited

💡 Pro tip: HealthSpring (now under Health Care Service Corporation, which acquired Cigna’s Medicare business) launched as a new brand for 2026 and offers Medicare Advantage in Texas. It’s worth comparing their plans against established carriers, as new market entrants sometimes offer competitive introductory benefits to attract members.

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⭐ The Worst Medicare Advantage Plans in 2026 — and How to Spot Them

CMS rates every Medicare Advantage plan on a scale of 1 to 5 stars, measuring quality of care, customer service, chronic disease management, and overall member experience. For 2026, 23 plans were rated below 3 stars — meaning they fall short of acceptable quality benchmarks.

Plans that received the lowest ratings of 2 stars for 2026 include contracts from El Paso Health, Aetna Medicare, Clear Spring Health, American Health Advantage of Mississippi, a BCBS plan under Health Care Service Corporation, and a UnitedHealthcare contract in New York.

On the other end, 34 plans earned a perfect 5-star rating, including five Kaiser Permanente plans and four Longevity Health plans.

⭐ Star Rating	📊 What It Means	🔍 2026 Facts
⭐⭐⭐⭐⭐ (5 stars)	Outstanding quality; enrollees can switch in anytime via a SEP	34 plans earned 5 stars in 2026 (up from 7 in 2025)
⭐⭐⭐⭐ (4+ stars)	High quality; plan receives quality bonus payments from CMS	64% of enrollees are in 4+ star plans
⭐⭐⭐ (3 stars)	Average performance	Majority of plans fall in the 3 to 3.5 range
⭐⭐ (2 stars) or below	Poor quality; may face CMS sanctions or contract termination	5 plans rated just 2 stars for 2026 (up from 1 in 2025)

🚩 Red Flags to Watch For	💡 What to Do Instead
Plan rated below 3 stars	Choose a 4+ star plan in your area
Plan exiting counties or states	Proactively switch before you’re auto-enrolled elsewhere
Frequent annual benefit cuts	Compare your plan’s ANOC against competitors
High prior authorization denial rates	Ask your doctor’s office about their experience with the plan
Very narrow specialist network	Verify every specialist you see is in-network for 2026

💡 Pro tip: Nineteen states have at least one 5-star Medicare Advantage plan available for 2026. If one is offered in your area, it’s worth serious consideration — and enrollees in 5-star plans can switch plans at any time of year through a Special Enrollment Period, giving you maximum flexibility.

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💸 Why Medicare Advantage Plans Can Be “Bad” — The Overpayment Problem

Here’s something most articles won’t tell you: Medicare Advantage plans are projected to be overpaid by approximately $76 billion in 2026, largely due to a practice called “upcoding” where insurers document patients as sicker than they actually are to receive higher per-member payments from CMS.

This means taxpayers effectively subsidize the “free” extra benefits that make Medicare Advantage so appealing in advertisements. When insurers face pressure to reduce these overpayments (as CMS has been gradually doing through risk adjustment changes), the result is benefit cuts, plan exits, and forced disenrollments — exactly what’s happening across the market right now.

For individual enrollees, this plays out as the frustrating cycle of signing up for a plan that offers great benefits, only to see those benefits shrink or the plan disappear entirely the following year.

📊 Market Reality	🔢 2026 Numbers
Total MA enrollment	35+ million (as of February 2026)
Year-over-year growth	Slowing to 3% (down from historical 9% average)
Plans available nationally	~5,600 (down slightly from 5,633 in 2025)
Individual plans for enrollment	3,373 (9% decrease from 2025)
Projected overpayment to insurers	~$76 billion
Forced disenrollment rate	Projected 10% of enrollees (up from ~1% historically)

💡 Pro tip: When evaluating a Medicare Advantage plan, don’t just look at this year’s benefits. Research whether the insurer has a track record of maintaining stable offerings in your area, or if they’ve been cutting plans and exiting markets. A plan that saves you money this year but disappears next year creates disruption that can be more costly than paying slightly more for stability.

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🔄 What’s Actually New for Medicare Advantage in 2026

The CMS finalized its Contract Year 2026 MA and Part D final rule on April 4, 2025, bringing several meaningful protections and changes.

🆕 2026 Change	✅ What It Means for You
🏥 Plans must honor approved inpatient stays	MA plans can no longer retroactively deny a previously approved hospital admission (except for fraud or obvious error)
📋 Appeals loopholes closed	Stronger protections when you appeal a coverage denial
💊 $2,100 Part D out-of-pocket cap	Your prescription costs can’t exceed $2,100 annually (up from $2,000 in 2025)
💉 $0 vaccines	ACIP-recommended adult vaccines covered at zero cost-sharing
🩺 Behavioral health cost-sharing	MA plans must match or beat Original Medicare’s cost-sharing for mental health and substance use services
📱 Provider directories in Plan Finder	Plans must submit directory data to CMS for centralized display, updated within 30 days
🔄 Prescription Payment Plan auto-renewal	If you enrolled in 2025’s monthly installment program, it renews automatically for 2026
💊 10 drugs with negotiated prices	First round of Medicare price negotiations now in effect, projected to save $1.5 billion in enrollee costs

💡 Pro tip: The 10 drugs with newly negotiated prices include widely used medications for blood thinners, heart failure, diabetes, and blood cancers. Check whether any of your medications are on this list — the savings could be substantial even if your plan’s formulary hasn’t changed.

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❓ Frequently Asked Questions

Can I enroll in a Medicare Advantage plan at any time?

No. Your primary enrollment windows are your Initial Enrollment Period (around your 65th birthday), the Annual Enrollment Period (October 15 – December 7), and the Medicare Advantage Open Enrollment Period (January 1 – March 31, for those already in an MA plan). Outside these windows, you need a qualifying life event — such as moving, losing employer coverage, or qualifying for Medicaid — to access a Special Enrollment Period. One important exception: if you’re enrolled in a 5-star-rated plan, you can switch plans at any point during the year.

What if my Medicare Advantage plan is leaving my area in 2026?

If your plan exits your county or state, you’ll receive a notice and qualify for a Special Enrollment Period. Don’t simply accept the replacement plan you’re auto-enrolled into — use Plan Finder to compare all available options in your area, checking networks, drug formularies, and total estimated costs. You can also switch back to Original Medicare with a standalone Part D plan.

Is Medicare Advantage better than Original Medicare?

It depends entirely on your health needs, financial situation, and where you live. Medicare Advantage works well for generally healthy people who want bundled coverage with extras like dental and vision, stay local, and prefer lower premiums. Original Medicare with Medigap is typically better for people who see many specialists, travel frequently, or want unrestricted access to any Medicare-accepting provider without prior authorization hurdles.

How do I find out which Medicare Advantage plans are available in my state?

Go to Medicare Plan Finder and enter your zip code. This is the only reliable way to see exactly which plans serve your county, their star ratings, premiums, drug formulary details, and in-network providers. You can also call 1-800-MEDICARE (available 24/7) or contact your state’s free SHIP (State Health Insurance Assistance Program) counselor for unbiased guidance.

Why are so many Medicare Advantage plans disappearing?

Insurers are pulling back from less profitable markets as post-pandemic healthcare utilization increased and CMS tightened risk-adjustment payment models to address overpayments. The result is a contraction — 346 fewer individual plans nationally for 2026, with some states like Vermont and Minnesota hit especially hard. This trend is expected to continue into 2027.

Do Medicare Advantage plans cover prescriptions?

Most do. Approximately 32 Medicare Advantage prescription drug (MA-PD) plans are available to the average beneficiary in 2026. These plans include Part D drug coverage with the same $2,100 annual out-of-pocket cap that applies to standalone Part D plans. However, formularies vary significantly between plans, so always check that your specific medications are covered — and at what tier — before enrolling.

What are Special Needs Plans (SNPs)?

SNPs are a category of Medicare Advantage plans designed for specific populations: D-SNPs serve people dually eligible for Medicare and Medicaid, C-SNPs serve people with specific chronic conditions (like diabetes or heart failure), and I-SNPs serve people living in institutional settings. SNP enrollment grew significantly in 2026, with 1,721 SNPs available nationally — a 19% increase from 2025. These plans often offer enhanced benefits like transportation, in-home support, and caregiver assistance.

Can I have both Medicare Advantage and Medigap?

No. Federal law prohibits Medigap policies from paying for services covered under a Medicare Advantage plan. If you want Medigap coverage, you must be enrolled in Original Medicare (Parts A and B) — not Medicare Advantage. Switching from Medicare Advantage back to Original Medicare to buy Medigap can be complicated because Medigap insurers may apply medical underwriting (except during your initial Medigap open enrollment period or guaranteed issue situations).

How do I know if a plan is actually good?

Start with the CMS star rating — aim for 4 stars or above. Then look at the plan’s specific prior authorization requirements, its network of doctors and hospitals in your area, its drug formulary, and its maximum out-of-pocket limit. Read your Annual Notice of Change carefully each September. And don’t underestimate the value of talking to your own doctors’ billing staff — they deal with these plans daily and know which ones consistently approve care and which ones create hurdles.