DC-MD-VA Medicare Advantage 2027: Nearly 1 in 5 Enrolled Seniors Faces a Plan Exit — Here Is the County-by-County Reality Check

Washington, D.C. is one of the most expensive Medicare Advantage markets in the United States. The per-capita cost of healthcare here — from Johns Hopkins in Baltimore to Inova Fairfax in Northern Virginia — is among the highest in the country. Carriers know this. And one by one, they are doing the math and walking out the door.

This is not a drill. This is not a "some plans may change" situation (that phrase makes me want to file a FOIA request on whoever wrote it). This is a documented, CMS-confirmed reshaping of the tri-state Medicare Advantage market that will affect hundreds of thousands of seniors before January 1, 2027 — and most of them do not know it yet.

Let's get into the data.

Why Are Carriers Leaving the DC-MD-VA Market in the First Place?

The answer is almost always money — specifically, the math between what CMS pays carriers (called the benchmark rate) and what it actually costs to care for seniors in an expensive metro market. The DC metro area has among the highest hospital chargemaster rates and specialist costs in the eastern United States. When CMS tightens rates, carriers in high-cost markets feel the squeeze first.

In April 2025, CMS finalized a 2026 rate notice that averaged a 5.06% increase across Medicare Advantage. That sounds generous — until you read the actuarial footnotes. CMS simultaneously tightened its risk adjustment model (V28 phase-in), which effectively reduces bonus payments to carriers for managing sicker patients. Carriers that built their DC-MD-VA book of business around high-acuity seniors with multiple chronic conditions suddenly found their margins collapsing.

Humana, which had been one of the three largest Medicare Advantage carriers in the DC metro area, publicly announced in late 2024 that it would exit "select markets" — a phrase that in CMS plan landscape files translated to the elimination of Humana's entire District of Columbia and suburban Maryland service area for plan year 2025, with Northern Virginia coverage reduced. The company posted a $741 million Medicare Advantage loss in Q2 2024 before announcing its restructuring. (Source: Humana Q2 2024 earnings release, investor.humana.com)

For 2027, the same pressure is building. The CMS 2027 advance notice (published February 2026) proposed further adjustments to the risk adjustment methodology. Carriers serving the DC metro — which includes Aetna/CVS Health, UnitedHealthcare, Elevance Health (formerly Anthem), CareFirst BlueCross BlueShield, and several smaller co-ops — are all evaluating whether individual county service areas remain financially viable.

Which Specific Counties in DC, Maryland, and Virginia Are Most at Risk for 2027 Plan Exits?

Not all counties face equal risk. Plan exits tend to cluster in areas where (1) beneficiary health acuity is higher than the benchmark rate accounts for, (2) hospital system consolidation has driven up in-network costs, or (3) plan enrollment is too small to justify the administrative overhead. Here's how the tri-state landscape breaks down:

What Happened When Humana Left — And What That Template Tells Us About 2027

The Humana exit is the case study everyone in this market should be reading. In late 2024, Humana sent termination notices to approximately 43,000 Medicare Advantage enrollees across DC, suburban Maryland, and Northern Virginia. (That's 43,000 people who had to find new coverage before January 1, 2025. During the holiday season. While managing their own health conditions.)

Humana's plans in this market had carried star ratings between 3.0 and 3.5 — not the highest, but not the cut line either. The decision wasn't about quality. It was about margin. Humana's DC-area contracts included H5216 (DC/MD) and H1951 (VA) service areas that the company determined were unprofitable given the V28 risk adjustment phase-in reducing payments for high-complexity patients. (Source: CMS Plan Landscape files; Humana 10-K FY2024, sec.gov)

Here's the template that matters for 2027: The carriers who stayed in 2025 — Aetna, UnitedHealthcare, Elevance Health, CareFirst — absorbed many of those 43,000 displaced enrollees. That influx of potentially sicker, higher-cost members has now flowed into their 2025-2026 claims experience. If their loss ratios are rising (and for several carriers, they are), the 2027 exit calculus changes again.

UnitedHealthcare reported a medical loss ratio of 86.7% in Q4 2025 — the highest in five years. (Source: UnitedHealth Group Q4 2025 earnings call, ir.unitedhealthgroup.com.) The CEO of UHC's parent, UnitedHealth Group, earned approximately $23.7 million in total compensation in 2024 while the company was simultaneously raising premiums and reducing benefits in several markets. I'm not editorializing. Those are just two numbers in the same paragraph. Draw your own conclusions.

Which Major Carriers Still Cover DC, Maryland, and Virginia — And Are Any Showing Early Warning Signs?

As of plan year 2025, the dominant carriers in the DC-MD-VA Medicare Advantage market are: