This is No Time to 'Set It and Forget It' During Medicare Annual Open Enrollment

If you are enrolled in a Medicare Advantage (MA) plan, you will want to pay extra close attention to your plan materials for changes to your plan coming in 2027. Not doing so could mean that you no longer have access to your doctor or the pharmaceuticals you need if your insurer makes changes.

Rising medical costs, regulatory shifts, and squeezed MA insurers' margins are driving many companies to cut back on perks, raise your share of costs, and reshape networks. Additionally, insurers are seeing higher-than-expected medical spending from enrollees, while navigating regulatory changes that limit how much they can offset costs. 

As a result, this year you'll need to take extra time to thoroughly review your plan materials and plan options during the Annual Open Enrollment period.

Here's what you need to know and watch out for:

Watch for network changes

Some insurers are exiting certain counties entirely, with analysts estimating that over one million MA enrollees may lose access to their current plan because their insurer is ending that product or pulling out of their service area. 

MA insurers are also pulling back on preferred provider organization designs in favor of more restrictive health maintenance organization (HMO) models. 

HMO plans tend to restrict outside-network care much more than PPOs do. With HMOs, you usually must see providers in the plan's network (unless it's an emergency), and you may need a referral to see a specialist.

PPOs typically allow more flexibility to see out-of-network providers — though often with higher cost-sharing. If your plan shifts from PPO to HMO, or if your preferred doctors switch networks, you could face unexpected costs.

Changes in Part D coverage

It's not just health benefits that are changing — Medicare prescription drug (Part D) plans are also undergoing reshaping. 

Fewer plans —The number of standalone Part D plans continues to shrink, dropping down to 360 stand-alone Part D plans nationwide in 2026 (down from 464 in 2025 and 709 in 2024). The official nationwide total for 2027 will be released by CMS in late September, but market consolidation continues. That means fewer choices and less room for shopping around.

Deductible changes —Also, the maximum deductible allowed for 2027 is being raised to $700 (up from $615 in 2026). Some plans may waive deductibles or set lower ones, but many will push toward the maximum.

Cost-sharing changes — Many plans are also shifting from flat copayments to coinsurance for drugs before you reach the out-of-pocket maximum. That means you pay a percentage of the drug cost rather than a flat fee. As a result, a high-cost prescription might cost you far more. 

Out-of-pocket cap — The Part D plan out-of-pocket spending cap will rise to $2,400 in 2027, up $300 from 2026. Once you hit that amount, the plan pays all covered drugs for the rest of the year.

Trimming perks

In recent years, Medicare Advantage plans have enticed enrollees with various "extras" beyond standard medical benefits. These might include:

• Meal delivery,

• Gym memberships (SilverSneakers or similar),

• Over-the-counter allowances,

• Transportation benefits,

• Healthy food,

• Home repair budgets.

But in 2027, those perks are being pared back. Under new rules issued by the Centers for Medicare and Medicaid Services, supplemental benefits offered by MA plans are now more tightly regulated, and some categories are explicitly excluded (for instance, "non-healthy food" benefits are no longer allowed) 

If you've come to rely on these extra benefits that go above and beyond what Medicare is obliged to cover, you'll want to read your current plan documents to make sure they are still being offered.

The takeaway

There is a lot to consider this year. Most importantly, review the following in your plan materials and compare them to this year:

• Annual maximum out-of-pocket — Even though the maximum allowed out-of-pocket limit for in-network services under Medicare Advantage is slightly lower in 2027 than in 2026, many individual plans are increasing their own caps.

• Copays — What you pay after you have met your deductible (for example, you might pay 20%, 30%,

  or more of the cost).

• Deductibles — Some plans require you to pay a certain amount before coverage begins.

• Premiums — Sometimes higher charges kick in for out-of-area or non-preferred providers. 

• Network — Check to see if your doctor and preferred hospital are still in-network in your current plan.

• Drug formulary — Check your Part D plan drug formulary to make sure that the medicines you rely on to manage your health are still covered.

If you're feeling overwhelmed or unsure of how to proceed, give us a call. We can help you decide whether it's best to stay with your current plan or make a change.