5 Things You Should Evaluate During Medicare Open Enrollment #328
Medicare open enrollment is here, running from October 15th to December 7th, and it's especially important for those who rely on Medicare. Plans change each year—and so may your needs. Not reviewing your Medicare coverage could leave you exposed to unexpected costs or disrupt your access to preferred doctors and medications. On this week's show, I explore five key steps to help ensure you get the right coverage for 2027.
You will want to hear this episode if you are interested in...
[01:40] Reviewing Medicare coverage for 2027
[02:49] How to check provider status: annual notice of change, contacting providers
[03:27] Medicare Advantage and drug coverage options
[08:03] Medicare Advantage vs Medigap Plans
[11:01] Eight life events that may permit an IRMAA appeal
[11:20] Appealing your Medicare premiums
Reconfirm Your Doctors Are In-Network
One of the most important aspects of Medicare coverage is access to your preferred doctors and hospitals. If you are on traditional Medicare, this is less of a concern since nearly all healthcare providers accept it. Those enrolled in Medicare Advantage plans need to be careful; these plans have specific networks, and providers can leave them at any time. Recently, there’s been a trend of hospitals and doctors dropping out of certain Medicare Advantage networks due to disagreements over pay rates and terms.
If your doctor is leaving your network, call their office to find out which plans they’ll participate in for 2027. If your preferred doctors aren't part of any Medicare Advantage plan, consider a private fee-for-service (PFFS) plan or a Medicare Advantage plan with a preferred provider organization (PPO), which may allow limited out-of-network coverage. Alternatively, switching to a Medigap plan with traditional Medicare could provide broader access to providers.
Verify Prescription Drug Coverage
No Medicare plan covers every prescription, and the list of covered medications, known as a formulary, is updated each year. These changes could mean vital prescriptions become uncovered or move to a higher-cost tier, increasing your out-of-pocket costs. Many Part D plans are shifting from flat copayments to a model where your cost is a percentage of the drug’s price—a significant change for those relying on costly specialty medications.
Check your annual notice of change or log into your Medicare.gov account to confirm which prescriptions will be covered in 2027 and whether their costs have changed.
Understand Your Out-of-Pocket Maximum
Don’t overlook out-of-pocket maximums. Traditional Medicare has no maximum, leaving you potentially responsible for 20% of costs indefinitely, but a supplemental Medigap policy can limit your exposure. For Medigap Plan G, once you meet the annual Part B deductible, it covers the full cost of approved services.
To find your plan’s specific limit, log in to your Medicare.gov profile and go to your health or drug plan information. Understanding these limits helps prevent devastating financial surprises if you face serious medical needs in 2027.
Consider Switching Plans
Life changes or network shifts may prompt you to consider switching between Medicare Advantage and Medigap. For example, if your doctor drops your Medicare Advantage plan, you split time between multiple states, want to avoid prior authorizations, or need out-of-network coverage, Medigap could be a better fit—even if it carries higher monthly premiums. Most states require medical underwriting for this switch outside your initial six-month window.
Check Your Premiums
If your income has changed considerably, you may be eligible to appeal a higher Medicare Part B or D premium due to IRMAA (Income-Related Monthly Adjustment Amount). The calculation uses data from your tax return two years prior, so 2027 premiums are based on your 2025 income. Valid reasons for appeal include retirement, marriage, divorce, widowhood, and loss of income-producing property, among others.