Medicare decisions can feel deceptively familiar. If your current coverage worked reasonably well this year, it is tempting to simply let it roll into 2027. But plans can change premiums, drug coverage, provider networks, pharmacies, and other benefits from year to year, so the fine print is worth a closer look before making that decision.
For 2027, Medicare Open Enrollment will again run from October 15 through December 7, with changes taking effect on January 1. Before enrollment begins, pay close attention to the Annual Notice of Change from your current plan. It can highlight changes that might otherwise be easy to miss.
Prescription coverage deserves extra attention this year. Under the standard Part D benefit, the deductible will increase from $615 in 2026 to $700 in 2027, while the annual out-of-pocket threshold will increase from $2,100 to $2,400. Once that threshold is reached, beneficiaries continue to owe no cost sharing for covered Part D drugs during the catastrophic phase.
Premiums are another area where the headline number may not tell the whole story. The national base beneficiary premium for Part D will be $41.33 in 2027, but that is not necessarily what you will pay.
A plan that worked well in 2026 may still be the right choice for 2027. The important thing is to make that decision intentionally rather than assume nothing has changed.
When it is time to compare your options, consider:
- Prescription coverage: Are all of your medications still on the plan's formulary, and what tier does each medication fall into?
- Doctors and hospitals: Are your preferred physicians and hospitals still in network?
- Pharmacies: Are your preferred pharmacies still included, and are there differences in pricing or preferred pharmacy networks?
- Out-of-pocket costs: How do deductibles, copays, coinsurance, and maximum out-of-pocket costs compare?
- Benefits: Are the supplemental benefits included with the plan ones you expect to use?
Medigap Birthday Rule
If you have Medicare Supplement (Medigap) coverage, there may be another opportunity worth understanding. Some states have a Medigap "birthday rule," which allows eligible enrollees to switch to a different Medigap plan with equal or lesser benefits around their birthday without undergoing medical underwriting. During the applicable window, insurance companies generally cannot deny coverage, charge more based on health, or exclude coverage because of pre-existing conditions.
The details, however, vary by state. The birthday-rule window can range from 30 to 63 days, depending on where you live, and the rule is not available nationwide. In states that offer this protection, you generally can move to a plan with the same or fewer benefits but upgrading to more comprehensive coverage may require medical underwriting. Because these rules are state-specific, it's important to understand the provisions that apply where you live before making a change. For more information on states with a Medigap Birthday Rule please be sure to contact our Medicare Specialist, Bill Stolow, at 609-216-7440.
As you review your 2027 Medicare coverage, Bill is also available to help you evaluate your existing plan, understand your options, and avoid costly Medicare mistakes. Taking the time to review your coverage now can help you enter the new year with greater confidence in your Medicare choices.