Medicare open enrollment starts October 15. Here is what to check before December 7

YOUR HEALTH — Issue No. 27

Every fall Medicare gives you a window to review your coverage and make changes. That window opens October 15. It closes December 7. Changes take effect January 1, 2027.

Most people do nothing during open enrollment. Sometimes that is the right call. But doing nothing and not checking are two different things — and the difference can cost real money.

Here is what to review, what is changing, and where to get help if you want it.

A note before we start

If you are not yet enrolled in Medicare — open enrollment is not your initial enrollment window. If you are approaching Medicare eligibility for the first time, you have a separate Initial Enrollment Period with different rules and different deadlines. Ask your local SHIP counselor — more on that below.

What open enrollment actually lets you do

During Medicare open enrollment you can:

Switch from Original Medicare to a Medicare Advantage plan — or from Medicare Advantage back to Original Medicare.

Change from one Medicare Advantage plan to a different one.

Join, drop, or switch a Medicare Part D prescription drug plan.

If you do nothing — your current coverage continues into 2027 at whatever costs and terms your plan has set for the new year. That is sometimes fine. It depends entirely on what changed in your plan.

The document most people throw away

Every September, Medicare Advantage and Part D plan members receive an Annual Notice of Change in the mail. It describes exactly what is changing in your plan for the coming year — premiums, deductibles, copays, drug formulary, and provider network.

Most people throw it away without reading it.

This is the single most important piece of mail Medicare sends you all year.

If you did not read yours — find it now, or call your plan and ask for a copy. What you are looking for:

Premium changes — did your monthly cost go up for 2027?

Drug formulary changes — are your current medications still covered at the same tier? A medication moving from Tier 2 to Tier 3 can increase your annual out-of-pocket cost significantly.

Provider network changes — are your current doctors and specialists still in-network?

Benefit changes — Medicare Advantage plans can add or remove supplemental benefits such as dental, vision, and hearing coverage from year to year. Check what changed.

If any of these changed in a way that affects your care or your costs — open enrollment is your opportunity to respond.

Some Medicare Advantage plans are leaving markets.

Some insurers are discontinuing plans or reducing their service areas for 2027. At least 3.8 million Medicare Advantage enrollees will need to choose new coverage — as at least 11 insurers exit the program entirely and 181 counties will have no Medicare Advantage plan available, up from 67 in 2026. If your plan is ending, you should receive a notice explaining your options.

Do not assume you will be automatically moved into the plan that best fits your needs. Review your notice, confirm your doctors and medications are covered under any replacement options, and compare available plans in the Medicare Plan Finder before December 7.

What is changing for 2027

A few things are changing for 2027 worth knowing before December 7.

The Part D out-of-pocket cap is increasing.

The annual out-of-pocket threshold for covered Part D medications rises to $2,400 in 2027, up from $2,100 in 2026. Once your qualifying out-of-pocket spending on covered Part D drugs reaches that amount, you pay nothing for covered Part D drugs for the rest of the calendar year. Your monthly plan premium still applies and does not count toward this threshold.

For most people this cap remains meaningful protection against catastrophic drug costs. But because the cap is increasing — compare plans carefully if you are a high drug cost user, because your total annual out-of-pocket costs under different plan options may vary significantly.

The Part D deductible is increasing.

The maximum standard Part D deductible is increasing from $615 in 2026 to $700 in 2027. Not all plans charge the maximum — some charge less, some charge nothing. Check your plan's specific 2027 deductible in your Annual Notice of Change.

Stand-alone Part D plans — check your actual premium.

A federal premium stabilization program that reduced stand-alone Part D premiums for the past two years is ending after 2026. Despite concern about this change, CMS projects that the average stand-alone Part D premium will increase by less than $1 per month overall in 2027. Individual plans can differ substantially from that average, however — so what happens nationally tells you very little about what your own plan will cost.

If you have a stand-alone Part D drug plan, check your Annual Notice of Change for your specific 2027 premium. Then compare your actual medications and preferred pharmacy in the Medicare Plan Finder. Do not assume your plan became more expensive just because the program is changing. And do not assume it stayed the same without checking.

The Part B premium and deductible for 2027 have not yet been finalized.

CMS announces the official Part B premium and deductible for the following year in November. As of this issue the 2027 figures are not yet final. The 2026 Part B premium is $202.90 per month with a $283 annual deductible. Plain Medicine will not publish projected 2027 Part B figures until CMS confirms them.

What you can do now: confirm your current Part B premium in your Social Security statement or at Medicare.gov, particularly if you are subject to income-related adjustments.

Before switching from Medicare Advantage back to Original Medicare — read this first

This may be the most important section in this issue for anyone considering a coverage change.

If you are currently on Medicare Advantage and are thinking about switching back to Original Medicare — you need to understand how Medigap works before you make that switch.

After the Part B deductible, Original Medicare generally pays 80% of the Medicare-approved amount for covered Part B services — leaving you responsible for the remaining 20% coinsurance. There is no annual out-of-pocket cap under Original Medicare alone. Without a Medigap supplemental policy, there is no annual limit on what you could owe.

But here is what many people do not realize until it is too late:

If you are past your initial Medigap open enrollment window — which is typically the six months after you first enrolled in Part B — insurers in most states are not required to sell you a Medigap policy. They can review your medical history and decline to cover you, or charge you significantly more based on your health status.

This means that switching from Medicare Advantage back to Original Medicare does not automatically give you access to affordable Medigap coverage. You could end up on Original Medicare without a supplemental policy — with no cap on your out-of-pocket costs.

Before making this switch — investigate specifically whether you can obtain the Medigap coverage you want, what it will cost, and whether medical underwriting applies in your state. Some states offer additional protections and guaranteed-issue rights. Do not assume you can switch back to Original Medicare and buy a Medigap policy later.

A SHIP counselor can walk you through exactly what applies in your situation. This is exactly the kind of decision that deserves a conversation before you act — not after.

The tool most people don't use

Medicare.gov/plan-compare is the official Medicare Plan Finder — a free tool that lets you compare every available plan in your area side by side based on your specific medications, dosages, and preferred pharmacy.

It shows you the total estimated annual cost for each plan — premiums, deductibles, and drug costs combined. That total annual cost is almost always more meaningful than the monthly premium alone. A plan with a lower monthly premium can easily cost more over the course of a year once drug costs are factored in.

Have your medication list and dosages ready, along with your preferred pharmacy and ZIP code. The site will guide you through the information it needs. The estimated costs are only as useful as the information you enter — so use your actual medications and actual pharmacy rather than estimates.

Free help is available — and most people don't know it exists

Every state has a State Health Insurance Assistance Program — SHIP. It is a federally funded program that provides free, unbiased Medicare counseling from trained counselors who are not affiliated with any insurance company and do not earn commissions.

SHIP counselors can help you compare plans, understand your Annual Notice of Change, evaluate whether a coverage switch makes sense for your situation, and answer questions about Medigap eligibility in your state.

This service is free. The counselors work for you.

To find your state's SHIP program: shiphelp.org

For Medicare's general assistance line: 1-800-MEDICARE

These are two different resources. SHIP provides personalized state-specific counseling from trained advisors. 1-800-MEDICARE is Medicare's national helpline for general questions. Both are worth knowing.

Should you make a change?

There is no universal answer. But here are the questions worth asking before December 7:

Did my Annual Notice of Change show meaningful cost or coverage changes for 2027?

Are my current medications still covered at the same tier and cost?

Are my current doctors and specialists still in-network?

If I have a stand-alone Part D plan — what is my specific new premium for 2027?

Is my Medicare Advantage plan continuing in my area — or am I receiving a plan discontinuation notice?

Have my own health needs changed in the past year in a way my current plan does not cover well?

If the answer to any of these is yes or not sure — the Medicare Plan Finder and a SHIP counselor are the right next steps.

If nothing has changed and you are satisfied with your current coverage — doing nothing is a legitimate choice. But it should be a choice you made after reviewing — not a default.

Something worth saying plainly:

Open enrollment is not an emergency. You have until December 7. For most people, December 7 is the deadline for making changes during the annual enrollment period — though certain life events and circumstances may qualify you for a separate enrollment window.

Thirty minutes with the Medicare Plan Finder and your Annual Notice of Change is enough to know whether you need to act. That thirty minutes is worth it.

If you want help — SHIP counselors are free, unbiased, and specifically trained for exactly this conversation. Use them.

The Member deep-dive this week goes deeper — what the Medigap versus Medicare Advantage decision actually looks like financially, how to use the Medicare Plan Finder step by step, what to look for when comparing Part D plans beyond the premium, and the income-related premium adjustments that affect higher-income Medicare beneficiaries.

Next week: Prediabetes — 115 million Americans have it and 8 in 10 don't know. Plain Medicine covers what the numbers actually mean and what the evidence shows about preventing progression to type 2 diabetes.

Plain Medicine is published for educational purposes only and does not constitute medical advice or establish a patient-provider relationship. Medicare coverage decisions involve individual circumstances — consult a licensed insurance counselor or your state's SHIP program before making changes to your coverage.

— Kyle