Every fall, Medicare tells beneficiaries to review their coverage instead of letting it roll over. Most years, plenty of people skip it and come out fine. This year, a string of reports and federal actions, many published in the past two weeks, suggests that doing nothing could cost far more than usual.
With open enrollment ending Dec. 7, here is how the pieces fit together, and why the stakes are higher for 2027.
Why is this year’s Medicare open enrollment different?
Three things are happening at once. Plans are disappearing, stand-alone drug plan premiums are set to jump for people who stay put, and Medicare Advantage choices are shrinking in parts of the country. At the same time, some changes work in beneficiaries’ favor, including new negotiated prices on 15 widely used drugs. The right move depends heavily on where you live and what you take.
How many people are losing their plan?
About 4.3 million people will have their Medicare Advantage or stand-alone Part D plan terminated at the end of 2026, according to a KFF analysis published Oct. 27: 3.1 million in Medicare Advantage plans with drug coverage and 1.2 million in stand-alone drug plans. Medicare Advantage members who do nothing are moved to traditional Medicare without drug coverage, KFF noted, and Part D members get no automatic replacement. HNC covered the details in our report on the 4.3 million plan terminations.
KFF projects the average monthly premium for stand-alone prescription drug plans will rise 50%, from $34 to $51, if current enrollees keep the same plan. About 10.4 million enrollees without low-income help, 76%, would pay more, and 2.4 million would see increases of more than $50 a month, compared with 38,000 people this year. There will be no zero-premium stand-alone plans in 2027, so 4.1 million people now in $0 plans would start paying.
KFF ties the jump to the end of the Part D Premium Stabilization Demonstration after 2026, which had provided extra subsidies to plan sponsors and capped premium increases at $50 for 2026. By contrast, KFF projects the average drug premium in Medicare Advantage plans at $9 a month, because those plans can use rebate dollars to lower premiums.
Where are Medicare Advantage choices shrinking?
The average beneficiary can still choose from 28 Medicare Advantage drug plans in 2027, but a KFF county analysis released Nov. 5 found 193 counties in 16 states with no such plan for general enrollment, up from 123. About 638,000 people live in those counties, up from 399,000. HNC’s county-by-county report lists the states.
What is getting better for 2027?
Negotiated Medicare prices for 15 more Part D drugs take effect Jan. 1, 2027, according to Medicare’s 2027 What’s New and Changing guide, which advises beneficiaries to contact their plan about how the prices affect them. On Nov. 5, CMS also made the negotiation program’s rules permanent and said it will pick up to 20 more drugs by Feb. 1, 2027. The same Medicare guide describes a new GLP-1 Bridge that offers certain GLP-1 drugs for a $50 monthly copay to people with Part D who meet the requirements.
People who leave Medicare Advantage often want a Medigap supplement policy to cover traditional Medicare’s deductibles and coinsurance. But outside protected windows, federal law lets Medigap insurers deny coverage or charge more based on health history, and KFF estimates 74% of Medicare Advantage enrollees have at least one condition that could lead to a denial.
There is an important exception this year. People whose Medicare Advantage plan is terminated, or stops covering their area, get federal guaranteed issue rights to buy a Medigap policy, according to KFF’s review of federal and state rules, and people 65 and older generally have 63 days to apply after a qualifying event. KFF does not count people whose plan is merging with another plan from the same insurer as losing coverage; they are moved automatically to the other plan, though their benefits, costs and networks may change.
What should seniors do before Dec. 7?
The common thread is that this year rewards people who check. Read the Annual Notice of Change or termination letter, enter every prescription into Medicare’s Plan Finder at Medicare.gov, and compare total yearly costs, not just premiums. Free, unbiased help is available at 1-800-MEDICARE and from State Health Insurance Assistance Programs at shiphelp.org. HNC’s open enrollment checklist walks through each step. Changes made by Dec. 7 take effect Jan. 1.
Key Takeaways
- KFF counts 4.3 million people whose Medicare Advantage or Part D plan ends Dec. 31.
- Stand-alone drug plan premiums could average $51 a month in 2027, up from $34, for people who keep their plan; no $0 plans remain.
- 193 counties will have no Medicare Advantage drug plan for general enrollment in 2027.
- Negotiated prices for 15 more Part D drugs start Jan. 1, 2027.
- A terminated Medicare Advantage plan triggers federal guaranteed issue rights to buy a Medigap policy.
- Open enrollment ends Dec. 7.
Frequently Asked Questions
When does Medicare open enrollment end?
Open enrollment ends Dec. 7, and changes made by then take effect Jan. 1, 2027.
Why are Part D premiums going up so much in 2027?
KFF links the increase to the end of the Part D Premium Stabilization Demonstration after 2026, which had subsidized plan sponsors and capped premium increases at $50 for 2026.
Can I be denied a Medigap policy if I leave Medicare Advantage?
Outside guaranteed issue periods, federal law allows Medigap insurers to deny coverage or charge more based on health history. If your Medicare Advantage plan is terminated or leaves your area, you have guaranteed issue rights.
Where can I get free help choosing a plan?
Call 1-800-MEDICARE or your State Health Insurance Assistance Program, which you can find at shiphelp.org, and use Medicare’s Plan Finder at Medicare.gov.
Featured image: A pharmacist uses an automated pill counter to fill prescriptions. (U.S. Air Force photo by Senior Airman Jessica Sanchez-Chen, public domain, via Wikimedia Commons)
