5 Medicare Changes to Review Before Open Enrollment
Open Enrollment is right around the corner, and 2027 brings some significant shifts to Medicare Part D and plan options. Whether you’re already enrolled or approaching your first enrollment window, these five changes could affect your coverage and your wallet.
Here’s what you need to know — and what to do about it.
1. The Part D Out-of-Pocket Cap Rises to $2,400
Starting in 2027, Medicare Part D has a new annual out-of-pocket spending limit of $2,400 — up from $2,100 in 2026. Once you hit that threshold, you pay nothing more for covered Part D drugs for the rest of the year.
Why this matters: This cap continues to protect you from catastrophic drug costs. If you take specialty medications or multiple prescriptions, reaching this ceiling could save you thousands compared to earlier years. But the increase from $2,100 to $2,400 means your maximum exposure is slightly higher than last year.
What to do: Review your current Part D plan’s formulary to see where you stand relative to this cap. If you’ve been paying high out-of-pocket costs, the cap still provides strong protection — but comparing plans during Open Enrollment could help you find one with lower overall spending.
2. The Part D Deductible Rises to $700
The standard Part D deductible for 2027 is $700 — up from $615 in 2026. This is the amount you pay out-of-pocket before your plan starts sharing drug costs.
Why this matters: A higher deductible means more upfront spending before coverage kicks in. If you take few or no medications, this may not affect you much. But if you fill prescriptions early in the year, the higher deductible could increase your early-year costs.
What to do: Compare plans during Open Enrollment. Some plans waive or reduce the deductible for certain drug tiers, which could offset this increase.
3. Major Medicare Advantage Plan Exits Are Reshaping the Market
The Medicare Advantage market is undergoing significant consolidation heading into 2027. Several major carriers have announced exits from specific markets and plans:
- Humana is exiting markets covering approximately 600,000 members.
- UnitedHealthcare has announced plan exits affecting over 1.1 million members.
- Clear Spring Health is exiting the Medicare Advantage market entirely.
- Molina Healthcare is stopping Medicare Advantage plans with prescription drug coverage in 2027.
Why this matters: These exits mean fewer plans and less competition in many areas — particularly rural markets. If your current plan is being discontinued, you’ll need to find a new one during Open Enrollment or risk a gap in coverage. In some rural counties, beneficiaries may have very limited options.
What to do: Check whether your current MA plan is still available for 2027. If it’s being discontinued, start comparing alternatives now so you’re not scrambling at the deadline.
4. Negotiated Drug Prices Continue Expanding
The Inflation Reduction Act’s drug-price negotiation program continues to take effect. The list of medications with negotiated prices has expanded for 2027, and those lower prices are reflected in Part D plan formularies.
Why this matters: If you take one of the medications on the expanded negotiated list, your costs could drop — but only if your plan’s formulary includes it at the negotiated price. Not all plans pass the savings along equally.
What to do: Check whether your prescriptions are on the negotiated list, and compare how different plans price them. A plan that didn’t look competitive last year might be the better choice this year.
5. Prior-Authorization Pilots Are Expanding
CMS is expanding prior-authorization demonstration programs in certain Medicare Advantage plans. This means some plans may require your doctor to get approval before covering certain services or medications.
Why this matters: Prior authorization can delay care and add paperwork. If your MA plan participates in one of these pilots, you may face new approval requirements for treatments you currently receive without restriction.
What to do: Ask your plan whether it participates in any prior-authorization pilots. If so, understand which services require approval and how the process works — so there are no surprises when you need care.
What Every Beneficiary Should Do Before Open Enrollment
Open Enrollment runs from October 15 through December 7. Here’s a quick action plan:
- Review your current plan’s annual notice of change. This document explains what’s changing in your plan for 2027 — premiums, copays, formulary changes, and network adjustments.
- Compare your options. Even if you’re happy with your current plan, the landscape is shifting. Carrier exits and benefit changes mean last year’s best option may not be the best choice for 2027.
- Talk to a licensed agent. A licensed agent can walk you through the changes, compare plans side by side, and help you find the best fit for your specific needs and medications.
At Trek Insurance Solutions, we help beneficiaries navigate these decisions every day. We work with multiple carriers to find coverage that fits your life — not the other way around.
Ready to review your options? Contact a Trek representative at 888-960-0442 or visit trekis.net to schedule your personalized plan review before Open Enrollment begins.
Trek Insurance Solutions is a Third-Party Marketing Organization (TPMO). We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.