Millions of seniors could lose their Medicare Advantage plan next year and 193 counties will have none at all

If you or a parent counts on a Medicare Advantage plan, now is the time to check your mail. A wave of these private plans will not be offered next year in many parts of the country. Some seniors will have no Advantage option at all where they live.

An analysis of federal data by a health policy research group found 193 counties that will have zero Medicare Advantage plans for next year. Most of them are rural. A year ago the number was closer to 120.

Big cities are feeling it too. Dallas, Houston, Minneapolis, Seattle and Portland will each see roughly a quarter to a third fewer plans to choose from.

Who is affected

Medicare Advantage lets private insurers run Medicare benefits for people who pick it over the traditional government program. More than half of the roughly 70 million people on Medicare use it, about 35 million in all. Many like the extra perks such as dental and vision care, lower premiums and drug coverage rolled into one plan.

The catch is that insurers decide where to sell. When a market does not pay off, they can pull out. Research published in a major medical journal found 2.9 million seniors were in plans that shut down last year. Early estimates for this round run from about 2 million to as many as 5 million people.

What to do before Dec. 7

Open enrollment began Oct. 15 and ends Dec. 7. If your plan is going away and you do nothing, your insurer may move you into another of its Advantage plans or you could land in traditional Medicare with no supplemental or drug coverage. That could leave you paying far more for prescriptions.

There is one silver lining. If your plan is ending and you want to switch to traditional Medicare, you get a guaranteed chance to buy a supplemental Medigap policy without the usual hurdles. That can be a big deal for people whose health conditions kept them out of Medigap before.

Do not wait until the last week. This year insurers are allowed to cap how many people can join some plans, so a plan you like could fill up. They are supposed to take people in the order they apply and cannot pick customers based on health, age or background. With so many people shopping, help lines may also be slower than usual.

Make a list of your doctors, your pharmacy and every drug you take, then compare plans on the official Medicare website or with a free local counselor before you sign up.