5 Things You Should Consider During Medicare Open Enrollment for 2027
Medicare open enrollment season is officially here. If you're currently enrolled in Medicare, now is the time to review your health and prescription drug coverage to determine whether your current plan is still the best fit for you.
From October 15 through December 7, Medicare beneficiaries can make changes to their coverage for the upcoming year. And with a bombardment of television commercials, online ads, direct mail, and celebrity endorsements promoting various Medicare plans, it can be difficult to know which options are actually worth considering.
The important thing to remember is that the plan that worked well for you this year may not be the best choice for 2027. Your healthcare needs may have changed, your prescriptions may cost more, or your insurance company may have changed its provider network or coverage rules.
In this article, I'll walk you through five important things to consider during Medicare open enrollment so you can make an informed decision about your coverage and avoid unnecessary healthcare expenses in retirement.
1. Make Sure Your Doctors Will Be in Your Network in 2027
One of the first things I recommend doing during Medicare open enrollment is confirming that your preferred doctors, specialists, and hospitals will continue accepting your health insurance plan next year.
This is particularly important if you're enrolled in a Medicare Advantage plan.
Why Your Medicare Advantage Network Matters
Unlike Original Medicare, which is accepted by most doctors and hospitals nationwide, Medicare Advantage plans typically use provider networks. Depending on your plan, you may need to use in-network providers to receive the lowest costs or to have certain services covered.
The problem is that provider networks can change from one year to the next. Hospitals and physicians sometimes leave a network because they cannot agree with an insurance company on reimbursement rates or contract terms.
If your doctor leaves your plan's network, you could find yourself needing to change doctors or switch insurance plans to maintain access to the providers you prefer.
How to Check Your Doctors' Coverage
Start by reviewing the Annual Notice of Change from your current Medicare Advantage plan. This document outlines changes to your coverage for the upcoming year, including updates that may affect your provider network and healthcare costs.
You should also contact your doctors directly and ask whether they expect to participate in your specific Medicare Advantage plan in 2027. Don't assume that a doctor's office will accept your plan simply because it accepted it this year.
If your doctor won't be in your current network next year, ask which Medicare Advantage plans they do accept. You can then compare those plans against your existing coverage.
If you have difficulty finding a Medicare Advantage plan that includes your preferred providers, you may want to explore other coverage options, including Original Medicare with a Medicare Supplement Insurance policy, commonly known as Medigap.
The bottom line is that you should verify your provider network before choosing a Medicare plan for 2027. A plan with a low premium isn't necessarily a good deal if it prevents you from accessing the healthcare providers you trust.
2. Confirm That Your Prescription Drugs Will Still Be Covered
The second thing to review is your prescription drug coverage.
Whether you have a standalone Medicare Part D prescription drug plan or a Medicare Advantage plan that includes drug coverage, it's important to check that your medications will remain covered and affordable in 2027.
Why Medicare Part D Formularies Matter
Medicare prescription drug plans maintain a list of covered medications called a formulary. These formularies can change each year.
For example, your plan might:
Stop covering a medication you currently take.
Move a prescription to a higher-cost tier.
Change your copayment or coinsurance.
Require prior authorization or step therapy before covering certain medications.
Change which pharmacies offer preferred pricing.
Even if your monthly insurance premium stays the same, these changes could significantly increase your prescription drug expenses.
This is particularly important if you take several medications or rely on expensive brand-name or specialty drugs.
How to Compare Medicare Prescription Drug Plans
Start by reviewing your Annual Notice of Change to identify any changes to your current plan's drug coverage.
Next, visit Medicare.gov's Plan Finder to compare the available plans for 2027.
When comparing plans, enter your current prescriptions, including the dosage and frequency, and check which pharmacies you use.
Don't focus exclusively on the monthly premium. Instead, compare your estimated annual costs, including premiums, deductibles, copayments, and coinsurance for the medications you expect to take.
A plan with a slightly higher monthly premium could save you money over the course of the year if it provides better coverage for your prescriptions.
Also, remember that the Medicare Part D out-of-pocket spending limit for covered prescription drugs is scheduled to be $2,400 in 2027. However, reaching that limit isn't a reason to ignore your plan's formulary or cost-sharing rules. You should still compare plans to determine which one offers the best overall value for your particular medications.
My recommendation is to review your prescriptions every year during Medicare open enrollment. Even if you're happy with your current plan, don't automatically assume it will remain the most cost-effective option.
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3. Check Your Medicare Out-of-Pocket Maximum
The third thing to consider is how much you could be required to pay out of pocket if you experience a serious illness, need surgery, or spend time in the hospital.
Many retirees focus on their monthly Medicare premiums without fully considering how much they could owe when they actually need medical care.
That's a mistake that could leave you facing substantial healthcare expenses during retirement.
Understanding Medicare Out-of-Pocket Costs
Medicare coverage generally involves more than just your monthly premium. Depending on your coverage, you may also be responsible for deductibles, copayments, and coinsurance.
These costs can add up quickly, particularly if you develop a serious medical condition that requires ongoing treatment.
The amount you're potentially responsible for depends on the type of Medicare coverage you have.
Original Medicare vs. Medicare Advantage
Original Medicare, which includes Part A and Part B, generally does not have an annual out-of-pocket maximum for covered services. After meeting your Part B deductible, you typically pay 20% of the Medicare-approved amount for most Part B services.
That means your potential expenses could continue adding up unless you have additional coverage, such as a Medigap policy, Medicaid, or certain employer or retiree coverage.
Medicare Advantage plans, on the other hand, have an annual maximum out-of-pocket limit for covered Part A and Part B services. Once you reach that limit, the plan generally pays 100% of covered services for the remainder of the year, subject to the plan's rules.
Keep in mind that the limit can differ between plans, and some plans have separate limits for in-network and out-of-network services. Prescription drug expenses are subject to separate Part D rules.
Should You Consider a Medigap Plan?
If you have Original Medicare, a Medicare Supplement Insurance policy may help cover some of the deductibles, coinsurance, and other expenses that Medicare doesn't pay.
For example, Medigap Plan G generally covers the Part A and Part B cost-sharing amounts that fall within the plan's benefits after you've met the annual Part B deductible. You'll still be responsible for that deductible, as well as your premiums and any services the policy doesn't cover.
However, Medigap policies don't all work the same way. Plans K and L have their own annual out-of-pocket limits, while other standardized plans have different cost-sharing structures.
If you're enrolled in Medicare Advantage, review your plan's maximum out-of-pocket limit for 2027 and consider whether you could comfortably afford that amount if you experienced a costly medical event.
You can review your plan information through Medicare.gov.
When comparing plans, consider more than the monthly premium. Look at your expected healthcare expenses, provider access, prescription drug costs, and the financial risk you would face if your health changed.
4. Decide Whether Medicare Advantage or Original Medicare With Medigap Is Right for You
The fourth thing to consider is whether you should continue with your current type of Medicare coverage or switch to a different arrangement.
There are two main ways to receive Medicare coverage: Original Medicare, potentially combined with a Medigap policy and a standalone Part D plan, or Medicare Advantage.
Neither option is automatically better for everyone. The right choice depends on your health, budget, preferred doctors, prescription needs, and lifestyle.
When Medicare Advantage May Make Sense
Medicare Advantage plans often appeal to retirees because they may offer relatively low monthly premiums and can include additional benefits, such as certain dental, vision, hearing, or wellness benefits.
Many plans also bundle prescription drug coverage with medical coverage.
However, you need to consider the plan's provider network, cost-sharing requirements, prior authorization rules, and out-of-pocket maximum.
Medicare Advantage may be a reasonable fit if your preferred providers participate in the plan, the benefits meet your needs, and the potential out-of-pocket costs fit your retirement budget.
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When Original Medicare With Medigap May Be Worth Considering
You may want to explore Original Medicare with a Medigap policy if:
You want greater flexibility to see Medicare-participating providers nationwide without relying on a Medicare Advantage network.
You anticipate needing specialized medical care or want to consult providers in different states.
You split your time between multiple homes in different states.
Your current Medicare Advantage plan no longer includes your preferred doctors.
You want to reduce certain medical cost-sharing expenses through a Medigap policy.
Original Medicare generally allows you to see any provider nationwide who accepts Medicare, without the typical network restrictions associated with Medicare Advantage. You will still need to confirm that the provider accepts Medicare and that the services are covered.
Medigap can help pay certain out-of-pocket costs, but it generally doesn't include prescription drug coverage. If you choose Original Medicare, you'll usually need to evaluate a separate Part D plan if you want Medicare prescription drug coverage.
The trade-off is that Medigap policies generally have their own monthly premiums, which can be considerably higher than the premiums of some Medicare Advantage plans.
Be Careful Before Switching From Medicare Advantage to Medigap
This is an important point that many retirees overlook.
Although Medicare open enrollment allows you to change between Original Medicare and Medicare Advantage, it does not automatically guarantee that you can buy a Medigap policy without medical underwriting.
In many states, if you're outside your initial Medigap open enrollment period and don't qualify for a guaranteed-issue right, an insurer may be able to review your medical history, charge more, or deny your application.
Some states provide broader Medigap enrollment protections than federal law requires. Your options depend on the state where you live and the circumstances surrounding your application.
Before leaving Medicare Advantage, check your Medigap eligibility and obtain confirmation of your ability to purchase the desired policy. Don't cancel existing coverage before understanding when replacement coverage can begin and what restrictions apply.
It's also possible to move in the opposite direction. If you're paying substantial premiums for Medigap and aren't using many medical services, you might consider whether Medicare Advantage could reduce your monthly costs.
However, lower premiums can mean greater exposure to copayments, coinsurance, network restrictions, and other plan rules. You should also consider whether you could return to Medigap later if your health changed.
The key is to evaluate your total healthcare costs and coverage flexibility, not simply choose the plan with the lowest monthly premium.
5. Check Whether You're Paying the Correct Medicare Part B and Part D Premiums
The fifth thing to review is whether you're paying an income-related surcharge on your Medicare premiums and whether that surcharge accurately reflects your circumstances.
Some retirees are surprised to discover that their Medicare premiums are higher than the standard amounts because of their income.
This additional charge is known as the Income-Related Monthly Adjustment Amount, or IRMAA.
What Is Medicare IRMAA?
Medicare may charge higher-income beneficiaries an additional amount for Part B medical insurance and Part D prescription drug coverage.
The surcharge is based on your modified adjusted gross income, including certain tax-exempt interest, and generally uses your federal tax return from two years earlier.
For example, your 2027 Medicare IRMAA determination generally uses your 2025 tax return.
This means certain financial decisions you make before or during retirement can affect your future Medicare costs.
Large withdrawals from traditional retirement accounts, Roth conversions, substantial capital gains, and other income events can potentially push your income above an IRMAA threshold.
This is one reason I encourage retirees to consider Medicare premiums as part of their broader retirement and tax-planning strategy.
What If Your Income Has Gone Down Since Your Tax Return?
The good news is that you may be able to ask Social Security to reconsider your IRMAA if you experienced a qualifying life-changing event that reduced your income.
Qualifying events can include:
Retiring or stopping work.
Getting married.
Getting divorced or having a marriage annulled.
Losing a spouse.
Losing income-producing property because of an event such as a natural disaster.
Losing certain pension income.
Receiving an employer settlement payment under qualifying circumstances.
Not every reduction in income qualifies for an adjustment. Social Security evaluates the specific event, your current circumstances, and the supporting documentation you provide.
If you believe your Medicare premiums are too high because your income has declined, review Social Security's official IRMAA appeal guidance.
How to Appeal a Medicare IRMAA Surcharge
You can generally request a new determination by completing Form SSA-44, Medicare Income-Related Monthly Adjustment Amount—Life-Changing Event, and submitting the required supporting documentation.
Depending on your circumstances, this could include documentation showing your retirement, change in marital status, loss of income, or another qualifying event.
If Social Security approves your request, your Medicare premium adjustment may be revised based on the applicable rules.
Don't assume that you must continue paying an income-related surcharge simply because it appeared on your notice. If you've experienced a qualifying life-changing event, it may be worth reviewing your appeal options.
At the same time, remember that a large retirement account withdrawal or capital gain does not automatically qualify you for an appeal. The important distinction is whether you experienced a qualifying event and can demonstrate that your income has changed in a way Social Security recognizes.
Your Medicare Open Enrollment Checklist for 2027
Before the December 7 deadline, I recommend taking time to complete these five steps:
Confirm that your doctors, specialists, and preferred hospitals will accept your plan in 2027.
Review your prescription drug formulary, pharmacy options, and estimated annual medication costs.
Compare your plan's out-of-pocket limits, deductibles, copayments, and coinsurance.
Evaluate whether Medicare Advantage or Original Medicare with Medigap better fits your healthcare needs and budget.
Review your Medicare premium notice and determine whether an IRMAA surcharge applies or whether you may qualify to appeal it.
You can compare available 2027 Medicare plans using the official Medicare Plan Finder.
Remember, the Medicare open enrollment period runs from October 15 through December 7, 2026. Changes you make during this period generally take effect January 1, 2027.
Frequently Asked Questions About Medicare Open Enrollment
When Is Medicare Open Enrollment for 2027?
Medicare open enrollment runs from October 15 through December 7, 2026. During this period, eligible beneficiaries can switch Medicare Advantage plans, change prescription drug plans, or change between Original Medicare and Medicare Advantage. Most changes take effect January 1, 2027.
Do I Need to Change My Medicare Plan Every Year?
No. You can keep your current plan if it continues to meet your needs. However, you should review your coverage annually because premiums, provider networks, prescription drug formularies, and cost-sharing requirements can change.
Can I Switch From Medicare Advantage to Original Medicare During Open Enrollment?
Yes. You can switch from Medicare Advantage to Original Medicare during the annual open enrollment period. However, if you want a Medigap policy to help cover Original Medicare's out-of-pocket costs, you should first verify whether you can obtain that policy and whether medical underwriting applies.
Can My Medicare Prescription Drug Plan Stop Covering My Medication?
A plan's formulary can change from year to year, subject to Medicare's coverage and notice requirements. Review your Annual Notice of Change and compare your medications using the Medicare Plan Finder before selecting your 2027 coverage.
What Is Medicare IRMAA?
IRMAA stands for Income-Related Monthly Adjustment Amount. It is an additional charge that higher-income beneficiaries may pay for Medicare Part B and Part D. The determination generally uses tax-return information from two years earlier, so your 2027 surcharge will generally be based on your 2025 tax return.
Can I Appeal My Medicare IRMAA If I Retire?
Potentially, yes. Retirement or work stoppage can qualify as a life-changing event if it meets Social Security's requirements and results in a qualifying income reduction. You can submit Form SSA-44 with supporting documentation to request a new determination.
Final Thoughts
Medicare open enrollment is an important opportunity to make sure your healthcare coverage continues to fit your needs and budget in retirement.
Even if you're satisfied with your current plan, taking the time to review your doctors, prescriptions, out-of-pocket expenses, coverage options, and Medicare premiums could help you avoid unnecessary costs in the coming year.
And remember, healthcare is one of the biggest expenses many retirees face. Making informed decisions about Medicare can help you protect both your health and your retirement savings.
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Have a great week—and I’ll talk to you next Tuesday.
Written by Ryan Morrissey CFP®, CLU®, CHFC®, CMFC
Founder & Principal Advisor of Morrissey Wealth Management
Host of the Retire with Ryan Podcast