Check Your 2027 Medicare Plans—You Have Until December 7 to Change
2027 changes to review during Medicare Open Enrollment
October 15, 2026
- Summary: 2027 Medicare Open Enrollment runs from October 15 to December 7, so review and make changes now
- Reading time: 7–10 minutes.
Medicare Open Enrollment runs from October 15 to December 7. That is the time to review your Medicare choices for next year and decide if you want to make changes. The coverage you select during the 2027 Open Enrollment takes effect on January 1, 2027.
If you received the Medicare & You 2027 book by mail, it should contain your personal options based on your zip code.
You can also go to the Medicare Plan Finder (Medicare.gov/plan-compare) to check your current Medicare insurance and compare plans available in your area for 2027. (If you already have a Medicare.gov login, you can use it; or, you can log in with ID.me, Login.gov, or CLEAR.)
Look for the Medicare Star Ratings shown for all plans when making plan comparisons.
If you don’t make changes by December 7, your current plans will be in effect for 2027.
Types of Medicare
There are two types of Medicare to choose from, Original Medicare and Medicare Advantage.
- Original Medicare (Parts A & B): This covers hospitalization and doctor visits, typically at 80%; thus, you have a co-pay of 20%. To cover that co-pay, you can purchase extra insurance, called a Medicare Supplement, or Medigap for short. Medigap plans may only be available when you’re first eligible for Medicare, as some may exclude you for having a pre-existing condition once the 6-month period has passed (this can vary by state). Learn more about Medigap plans (Medicare.gov/medigap-supplemental-insurance-plans). Additionally, since Original Medicare does not cover medications, you’ll need a Part D drug plan as well. Check your Medicare.gov account for options based on your zip code.
- Medicare Advantage (Part C): Medicare Advantage covers hospitalization, doctor visits, and medications, and often has extra benefits such as dental, vision, and even transportation. Premiums tend to be much lower for Medicare Advantage plans than for other options. There are many different types of Medicare Advantage plans (HMO, MSA, PPO, PFFS, and SNP), some of which overlap with Medicaid. With so many variables, checking your own account at Medicare.gov is the best way to find out your options for next year.
There are some downsides to Medicare Advantage plans in that you must use in-network providers, or pay much more for your care; these plans are more prone to using Prior Authorization and other tools that limit access; and some healthcare systems no longer accept Medicare Advantage patients. We’re also hearing reports of Medicare Advantage plans going away or limiting the number of members, so it is important to ensure your current plan will still be available next year if that is your preference.
For 2027, CMS (the Center for Medicare & Medicaid Services) projects average Medicare Advantage premiums to decrease from $14.37 per month in 2026 to about $12 per month in 2027, but your premiums, benefits, provider network, and out-of-pocket costs may vary based on where you live. Ensure that your doctors, specialists, and hospitals will be in-network in 2027.
As you review plans, look for plans’ Medicare Star ratings for comparison purposes.
While Medicare Open Enrollment is only from October 15 to December 7, if you’re in a Medicare Advantage Plan and not happy with it, you may be able to change plans or change back to Original Medicare from January 1 to March 31. However, you may have limitations or higher costs in accessing a Medicare Supplement or Part D plan.
You may want to review the slides at the bottom of this page to learn more about Medicare plans along with Medicaid (and dual eligibility), if you qualify for it.
Formulary Changes on Medicare Drug Plans
If you have an existing Part D or Medicare Advantage drug plan, it can be worth downloading or checking your Drug Guide (formulary) from your plan’s web site (if it was not mailed to you) to check for changes to the formulary for your current medications.
Another option is to enter your medications and quantities, along with your pharmacies, in Medicare’s Plan Finder (https://www.medicare.gov/plan-compare/). There, you can get cost comparisons of your current plan to other medication plans based on what is covered and what is not by the plans available in your area.
If your plan drops your medications from the formulary, it could be costly to you. That can happen when brand drugs go off patent and generics are available, or when drugs are very expensive. When that happens, you may have to pay 100% or be forced to switch medications (called “non-medical switching”).
Non-medical switching means your insurance plan forced you to change medications against the wishes of you and your doctor. If you’re stable on your medications and they work well for you, having to switch could harm your health. Insurance companies should not play doctor, changing your doctor’s decisions.
In 2027, non-medical switching may happen with Xarelto as it goes generic. Currently, one dose is generic, and that dose is not for afib. If you’re on Xarelto for afib stroke prevention, you may want to search your formulary for both Xarelto (brand) and rivaroxaban (generic). We’ve heard reports that some formularies have dropped Xarelto entirely and that rivaroxaban is also not available.
In that case, if you are on Xarelto and it has been dropped, you may wish to call your plan and determine what they will do in 2027. We’ve heard reports that some insurance companies will cover Xarelto next year until it goes generic, and then will cover the generic rivaroxaban. We suspect that there are as many variations as there are insurance companies, so you may wish to call your insurance company to find out what they will do, and then document your conversation. It might not hurt to repeat the process again in early December in case anything changes.
On some plans, expensive drugs may require extra steps, such as:
- Prior Authorization (PA), where your doctor has to provide documentation as to why the drug is medically necessary for you.
- Step Therapy, where you are required to try a lower-cost drug first and fail it before you are allowed to have the medication that your doctor prescribed for you.
If any of your medications have been dropped, the Plan Finder can help you find plans that cover them. If you need to change plans, the Plan Finder makes learning about your options easy and even helps you change to a new plan.
You have until December 7 to make changes. You may want to make a note to recheck the formulary of your chosen plan a few days before open enrollment ends to ensure nothing has changed (and while you still have time to make last-minute adjustments).
2027 Medicare Drug Plan Changes
A lot is changing in 2027, so you can expect the following changes in Medicare drug plans:
- The standard Part D deductible will increase from $615 in 2026 to $700 in 2027. Individual plans may have different deductibles.
- Part D premiums are expected to remain fairly stable. CMS projects average monthly premiums for Medicare Part D plans to be about $36 in 2027, compared with $35 in 2026, though individual plans can vary significantly. Thus, check your specific plan and compare it with others.
- The Part D out-of-pocket cap for covered Part D medications will increase from $2,100 in 2026 to $2,400 in 2027. Once you pay $2,400 for covered medications, you pay nothing more for the remainder of the year. It is worth reiterating that this cap applies only to Covered Medications. If your medication is not on your plan’s formulary, the cap does not apply, and you could end up paying significantly more for your medications in that case. We’re seeing some costly medications being removed from formulary for this reason. If this happens to you, your doctor can submit a Prior Authorization request. If turned down and you choose to pay for the medication yourself out-of-pocket, it is not considered a covered medication and the $2,400 cap does not apply to it.
- Insulin and vaccine cost protections will continue in 2027. For covered insulin, your payment for a month’s supply is limited to the lowest of $35, 25% of Medicare’s negotiated price when applicable, or 25% of your plan’s negotiated price. Thus, some people may pay less than $35. Medicare will continue to cover 100% of recommended adult vaccines under Part D.
- Medicare Prescription Payment Plan (MPPP, often called “smoothing”) will continue and allows spreading your medication costs across the entire year. In 2027, you should be able to sign up for this at your pharmacy. If you signed up previously and stayed with the same drug plan, it should continue automatically. See Medicare Prescription Payment Plan for more information.
- In 2027, negotiated prices will go into effect for the 15 medications Medicare negotiated with the manufacturers, including Ozempic and Wegovy. The first negotiated group of 10 medications, whose negotiated prices took effect in 2026, included Eliquis and Xarelto. While Medicare refers to them as Maximum Fair Prices (MFPs), they are often referred to as “government-set” prices (if the price Medicare decided to pay was not agreed to, the manufacturer’s drugs would be removed from Medicare, which is not a negotiation.) Medicare will pay less for the negotiated drugs, but patients may not, since middlemen called Pharmacy Benefit Managers (PBMs) are charging more for many medications to make up for lost margins on the negotiated drugs and drug caps.
My concerns about the impact of these changes on patients prompted me to write these two op-eds:
You may want to review the slides at the bottom of this page to learn more about Medicare drug plans.
What If You Take or Are Considering Taking a GLP-1 Medication?
GLP-1 medications have been approved for treating obesity, diabetes, cardiovascular disease, and sleep apnea. And, there is a lot of recent data, much of it presented at our 2025 and 2026 patient conference, about how these medications can help with afib. But, insurance plans often don’t cover them, or they make them prohibitively expensive for most people.
That is why there was so much excitement from those on Medicare when CMS announced that the GLP-1 Bridge Program would run from July 1, 2026 through December 31, 2027 and provide people with Medicare Part D certain GLP-1 medications for weight management for just $50 per month.
Unfortunately, the reality was not quite as rosy as what was promoted. If you had a condition that a GLP-1 was already approved for, such as type 2 diabetes or moderate-to-severe obstructive sleep apnea, you didn’t qualify for the Bridge Program.
Applications to the Bridge Program often resulted in patients being referred back to their Part D plan, even though it didn’t cover the GLP-1. In cases where the plan did cover it, we’ve heard of patients being quoted prices of $450-$850 per month for them, which is just not accessible for most patients.
Another gotcha is that the $50 per month you pay through the GLP-1 Bridge Program doesn’t count toward your annual Medicare Part D out-of-pocket cap.
Don’t assume that a plan will cover your medication or that you will qualify for the Bridge Program. Enter the exact medication and dose into the Medicare Plan Finder and check your coverage and estimated annual cost before choosing your 2027 plan.
The good news is that it appears that with the negotiated prices for Ozempic and Wegovy, they may actually be more accessible in 2027. Some people are seeing reasonable prices for them in the Plan Finder for next year. But, that does not apply to medications that were not negotiated. So checking the Plan Finder is more important than ever if you’re interested in the GLP-1s.
If your chosen GLP-1 medication is not accessible for you in any plan, there are other options. For example, NovoCare Pharmacy offers self-pay options for certain Novo Nordisk medications, including Wegovy, and LillyDirect offers direct options for certain Lilly medications, including Zepbound and Foundayo. (You’ll find links to them in the slides below.)
Medication Affordability Options
If you cannot afford your medications, there are other options for getting help, such as Medicare Savings Programs, Extra Help with drug costs for those with lower incomes, Medicaid, and state programs. Check Medicare.gov to learn more about these options, or check with your state for any state programs.
Also, check whether manufacturers offer direct self-pay options, but keep in mind that when you pay cash outside of Medicare, those purchases don’t count toward your Part D deductible or annual cap.
While a manufacturer’s monthly cash price may appear to be less than what you would pay through Medicare, if your Medicare-covered prescription costs count toward the $2,400 annual Part D out-of-pocket cap, Medicare could ultimately cost you less over the entire year.
Before paying cash, compare the total annual cost, not just the cost of the first prescription or one month’s supply. Ask:
- Is this medication covered by my Part D plan?
- Am I likely to be on it for a full year?
- What will I pay for it over the entire year?
- Will my payments count toward my $2,400 Part D out-of-pocket cap?
- Am I eligible for the Medicare GLP-1 Bridge Program?
- Is there a manufacturer direct/self-pay option?
- Which option has the lowest total cost for me?
Talk with your healthcare provider and Medicare plan before making changes to how you obtain a prescription. You may want to review the slides below for information about some low and no-cost options for medications.
What If You Get Your Medications From Outside the US?
Some patients have relied on Canadian and other international mail-order pharmacies to obtain medications at a lower cost. New US customs requirements may disrupt some international prescription shipments, and changes affecting duties and tariffs may create additional uncertainty and costs.
If you receive medication from an international pharmacy, don’t wait until you are running low to explore your options. Check whether your medication is covered by a Medicare plan for 2027 and compare your estimated costs through Medicare with other available medication-assistance options.
Please be aware that federal rules generally restrict individuals from importing prescription medications purchased outside the US, although the FDA has historically allowed limited personal importation in certain circumstances.
Check Your Coverage Before December 7
A low monthly premium doesn’t necessarily mean a plan will cost you less. This is especially important for people with afib who may take several medications.
When comparing your 2027 medication plans:
- Enter every prescription you take.
- Provide both brand and generic names to see which is covered.
- Check your preferred pharmacy.
- Compare the estimated total annual cost, not just the premium.
- Check drug tiers and copays or coinsurance.
- Look for indications that prior authorization, step therapy, quantity limits, and formulary exclusions may be involved.
A plan with an inexpensive monthly premium could cost more if it doesn’t provide good coverage for the medications you actually use.
Additionally, for Medicare Advantage plans, confirm that your medications will be covered and your doctors, specialists, and hospitals will still be in-network. As above, an inexpensive monthly premium may not provide the best value.
We have indicated above the changes that we know about for 2027, but there may be more that surface as Medicare Open Enrollment rolls out. We’ll update you as we hear about them. Please let us know of things you discover that we might not know about yet. To do so, click on Contact Us at the top of this page.
Don’t Wait! Review Your Medicare Coverage Today!
Medicare Open Enrollment ends December 7, 2026. Take the time now to review your medications, compare your plan options, and make sure your doctors and hospitals will still be covered in 2027.
Visit Medicare.gov/plan-compare to compare plans and make any needed changes before the deadline.
Taking action now could help you avoid unexpected costs or disruptions in your afib care next year.
Slides: Medicare, Medicaid, and Affordability Options