Medicare open enrollment 2027: 10 moves to make before Dec. 7

Medicare's enrollment window for 2027 coverage runs from Oct. 15 through Dec. 7. What you decide before the deadline determines whether your doctor still takes your plan, whether your prescriptions stay affordable and how much a hospital stay costs you next year. Celebrity-fronted television ads blanket the fall schedule. None of them can tell you which of the roughly 30 plans sold in a typical ZIP code fits your health and your budget.

Coverage shifts even when you do nothing. Traditional Medicare and the private Medicare Advantage plans sold alongside it both change from one year to the next, whether or not you revisit your enrollment. Insurers revise provider networks, rewrite drug formularies and reset what you owe out of pocket. A plan that worked in 2026 can leave you exposed in 2027. Staying put is a choice, and it is rarely free.

The checks that follow track the pressure points Consumer Reports flags for this enrollment season. They cover your doctor network, your drug formulary, your out-of-pocket ceiling and the income-based surcharge that catches higher earners off guard. Each takes minutes to verify. Each can be worth hundreds or thousands of dollars.

This guide also covers when a move between traditional Medicare and Medicare Advantage is worth the tradeoff, in either direction. It lays out how referral and prior authorization rules diverge between the two paths. It compares 2027 premiums and deductibles side by side. It explains what to do if you are turning 65 soon, and where to find free help when the comparison shopping stalls.

None of this requires guesswork. Medicare.gov publishes plan-level detail on networks, formularies, star ratings and costs. Federally funded counselors will review your own medications, doctors and income at no charge, and nonprofit groups will do the same. No single plan fits every household, and the right answer depends on which doctors you see, which drugs you take and how much income you reported two years ago. The point of Medicare open enrollment 2027 is narrower and more useful than picking a winner: ask the right questions while there is still time to act on the answers.

Illustration: Quartz

Call your doctors' offices directly and ask whether they will accept your specific Medicare Advantage plan in 2027. Network status is the one detail plan marketing will not volunteer. Traditional Medicare enrollees can skip the exercise, since the program is honored at nearly every physician practice and most hospitals nationwide.

Advantage plans run on a closed model. The plan pays for your care only inside its own regional roster of clinicians, hospital systems and outpatient facilities. Medical groups have been exiting those rosters over reimbursement levels and contract conditions they consider inadequate. A doctor you saw all last year can become unavailable in January even though nothing about your enrollment changed.

Every Advantage plan must send an Annual Notice of Change by Sept. 30, by mail or email, describing what shifts for the coming year. Some notices catalog all local providers leaving the network, not only the ones treating you, and those lists run long and dense. Emily Whicheloe, who heads education at the Medicare Rights Center, suggests calling your physicians whenever the paperwork leaves the answer unclear. If one is dropping your plan, ask which Advantage carriers that practice will contract with for 2027.

Several paths remain open if a preferred doctor will not join any plan on your shortlist. Private Fee-for-Service plans, known as PFFS, carry no fixed network; you ask each provider individually whether the plan's payment rates and conditions are acceptable to them. Preferred Provider Organization plans pick up part of the bill for out-of-network care. Health Maintenance Organization plans generally cover nothing beyond the network except in emergencies.

The most direct fix is often a return to traditional Medicare paired with a supplemental Medigap policy, which reopens access to almost any provider that bills Medicare. That move carries underwriting and premium tradeoffs that deserve a close look first. Settle the question before Dec. 7 — after that date, the consequences hold for the full year.

Illustration: Quartz

No Part D plan covers every medication, and the list it does cover — the formulary — can be rewritten each year. A drug that cost you a modest copay in 2026 may sit on a higher tier in 2027, or disappear from the plan's list entirely.

Plans sort covered medications into tiers to control spending, from inexpensive generics at the bottom to high-cost specialty drugs at the top. Your share rises with the tier, sometimes as a fixed copay and sometimes as a slice of the price. That difference matters more than it used to. Stacie Dusetzina, a professor of health policy at Vanderbilt University School of Medicine who studies Medicare drug policy, says Part D plans are increasingly charging enrollees a share of what a medication costs rather than a set dollar amount.

Two other shifts land on 2027 bills. The federal government let a subsidy that had kept Part D premiums lower expire at the end of July, after two years in place, and enrollees could see at least $120 added to their annual premium as a result. Separately, Medicare reached deals lowering the price of 15 widely used drugs that have no generic alternative. Enrollees taking one of those medications under a plan that charges a percentage of the drug's cost rather than a flat copay could see their share shrink.

To see where you stand, read your Annual Notice of Change or sign in to your account at medicare.gov and check whether any of your prescriptions were dropped or moved to a pricier tier.

If the news is bad, open the Plan Finder tool on medicare.gov. Enter each medication with its exact strength and dosage, then list as many as five pharmacies near you. Use the Star Ratings filter to limit results to plans rated three stars or better. Line up three plans side by side to weigh premiums and deductibles, then open Plan Details and Drug Coverage to see what a year of your medications would cost at each pharmacy. Pharmacies the plan flags as preferred usually charge the least, and the gap can be wide.

Illustration: Quartz

Traditional Medicare sets no annual ceiling on what you spend. It pays 80% of covered costs, leaves the rest to you, and that 20% share keeps running all year with nothing to stop it. Medicare Advantage plans and Part D drug plans, by contrast, must cap your spending.

A Medigap policy is what closes that gap, and the type you hold determines whether a cap even applies. Ten standardized versions exist, labeled A through D, F, G and K through N. Plans K and L are the only two expected to carry their own spending limits in 2027, estimated at $8,400 and $4,200. The remaining eight are designed to pick up what Medicare leaves behind in full, so there is no second ceiling to watch.

Advantage caps are permitted to sit well above that. Regulators are expected to allow a 2027 maximum of roughly $9,850 for HMO-style plans and $14,800 for PPO-style plans, the PPO figure covering in-network and out-of-network care combined. Many insurers choose a lower number than the rules permit, so the legal maximum says little about what you would actually owe. Sign in at medicare.gov, open the "Find Health or Drug Plans" tool, and pull the cap listed for your own Medicare Advantage plan, the coverage also known as Part C.

Drug spending is capped separately, at an estimated $2,400 for 2027. That figure holds whether you buy a stand-alone Part D policy to sit alongside traditional Medicare or get drug coverage packaged into an Advantage plan. Most enrollees never spend enough at the pharmacy to hit it, which is why the shared cap is a weak excuse to skip comparing drug plans on price.

These ceilings stack, and that is what catches people out. Medical coverage, drug coverage and supplemental coverage each carry their own costs, and one hospitalization paired with an expensive specialty medication can push you against more than one limit in the same calendar year. Add the figures that apply to you and ask whether the combined total is something your savings could absorb. Dec. 7 is the last day to change the answer for 2027.

Illustration: Quartz

Three situations justify leaving a Medicare Advantage plan for traditional Medicare: a doctor you want to keep has left the plan's network, a complex diagnosis has you seeking care at an out-of-state center, or you are tired of waiting on prior authorization before treatment.

Cost usually runs the other way. Advantage premiums are generally lower than what you pay for traditional Medicare combined with a supplemental Medigap policy, so this move trades money for access and predictability.

The access argument is the strongest one. Someone referred to a center like the Mayo Clinic for a complicated condition gains from traditional Medicare, which the overwhelming majority of U.S. doctors and hospitals accept. The prior authorization argument has federal backing. Two federal studies documented a pattern of Advantage plans turning down authorization requests for care that traditional Medicare pays for with no advance approval needed. Kaiser Family Foundation research separately ranked prior authorization at the top of the list of what consumers find most frustrating about U.S. healthcare.

The catch is the supplemental policy. This switch only works if you can buy Medigap coverage at a price you can live with, and the enrollment windows that force insurers to take you regardless of health history may already have passed. Underwriting typically involves a physical exam. An insurer can respond by quoting a higher rate or refusing to cover you at all, based on your medical history.

Jack Hoadley, a research professor emeritus at Georgetown University's Health Policy Institute, says the switch is worth attempting anyway, despite a widespread assumption that it is too hard or too costly. He points to one circumstance that improves the odds: a move beyond the geographic area your Advantage plan serves opens a special enrollment period, which carries a guaranteed right to buy supplemental coverage.

Sequence matters here. Shop for and secure a Medigap policy before you drop your Advantage plan, not after. Dropping first and getting declined later leaves you on traditional Medicare with no cap on the 20% of costs you owe.

Illustration: Quartz

The case for moving from traditional Medicare into a Medicare Advantage plan is narrow. One group fits it: enrollees with no Medigap policy who want protection from an open-ended hospital bill and have found every supplemental plan nearby too expensive.

Traditional Medicare picks up 80% of covered costs. The other 20% is yours, and nothing caps it. A long inpatient stay, a course of cancer treatment or a serious injury can push that share into five figures. Roughly 13% of traditional Medicare enrollees carry no supplemental policy, according to a 2025 Kaiser Family Foundation analysis, and they absorb that exposure themselves.

Every Medicare Advantage plan must set an annual limit on what you pay out of pocket, and that limit is what this switch buys. Predictability replaces open-ended risk. The trade is a local network of doctors and hospitals, plus prior authorization requirements that can apply to tests, procedures and medical equipment before the plan pays.

Treat the move as hard to reverse. A guaranteed-issue right lets you go back to the original program and buy a Medigap policy without medical underwriting, but only if you act within 12 months of joining the Advantage plan. Once that period lapses, a Medigap insurer can review your health history, charge more or turn you down.

To compare, sign in to your medicare.gov account and choose "Find Health & Drug Plans" to pull up the Advantage options sold in your ZIP code. Look past the premium to each plan's stated out-of-pocket maximum. Insurers may set limits well under the federal ceiling, and the figures differ among plans in the same metro area. Check the provider directory for your current doctors while you are there.

If the comparison is close, walk through it with a counselor from the State Health Insurance Assistance Program before Dec. 7 rather than after. The program is federally funded and free, and a counselor can price your specific prescriptions and doctors against each plan on your list.

Illustration: Quartz

IRMAA is an income-related surcharge that raises what higher earners pay each month for Part B and prescription drug coverage. Social Security sets it automatically from the tax return you filed two years earlier. Individuals reporting more than roughly $110,000 a year land on the sliding scale, and because the number comes from dated IRS records, it is not always correct.

The two-year lookback is where errors start. Your 2027 charge reflects what you earned before you retired, wound down a business or began drawing on savings. A single unusual transaction can distort the result. Selling a house, converting a retirement account or taking an outsized 401(k) withdrawal can push one year of reported income into a higher tier, even when your ordinary monthly cash flow sits well below it.

Two remedies exist, and they work differently. If the figures Medicare relied on are wrong or outdated, you can appeal the determination. If the figures are right but your circumstances have since changed, you can request an adjustment or waiver based on a life-changing event — retirement, a layoff, the death of a spouse or another documented drop in income. Neither remedy is automatic. No one at the Social Security Administration will notice the change and recalculate your premium for you.

The bottom of the income range carries an overlooked benefit of its own. Annual income below $18,000, combined with countable assets under about $9,500, can qualify you for help covering those same monthly premiums. Your house, your vehicle and certain personal belongings sit outside that asset total, so more people clear the threshold than assume they will.

Run the eligibility questionnaire the Patient Advocacy Network hosts at panfoundation.org/extrahelp to check. If you appear to qualify, a Medicare counselor can walk you through the application. Confirming the premium on your statement is correct takes only a few minutes and can shift several hundred dollars a year in either direction.

Illustration: Quartz

Referral and prior authorization rules are where traditional Medicare and Medicare Advantage diverge most in daily use. Nearly every physician and hospital in the U.S. takes traditional Medicare, which asks for no referral before a specialist visit and rarely requires prior authorization. Advantage plans attach conditions to all three points.

With an Advantage plan, nonemergency care is generally paid for only inside a defined regional network of providers and treatment sites. Whether a referral stands between you and a specialist depends on plan structure. PPO plans typically let you book a specialist directly. HMO plans require a referral from your primary care physician, and the specialist must be in-network for the visit to be covered at all.

Out-of-network rules split the same way. HMO plans pay nothing for out-of-network care outside emergencies. PPO plans cover part of it — up to half the cost in many designs — so a specialist outside the network becomes expensive rather than unreachable.

Prior authorization adds a timing variable traditional Medicare enrollees rarely face. An Advantage plan may demand approval before certain tests, procedures, imaging or durable medical equipment are covered, and that approval sits between the doctor's order and the appointment date.

The practical result: the same medical need can unfold on two timelines. Someone on traditional Medicare can usually call a Medicare-accepting specialist in any state and schedule. Someone in an HMO-style Advantage plan may need a primary care visit for the referral, confirmation that the specialist participates, and insurer sign-off before that appointment happens.

Neither structure fits every patient, but the friction is worth measuring before you enroll. Ask your primary care office how referrals and authorizations tend to move under the Advantage plans common in your area. Check the plan type — HMO, PPO or PFFS — on anything you are weighing, since that label sets the rules you will live under all year.

Illustration: Quartz

Traditional Medicare is estimated to cost $210 to $1,100 a month in total for 2027. Medicare Advantage sits in a narrower band of roughly $210 to $410. The gap comes almost entirely from supplemental coverage, which is priced by plan type and by insurer.

Part A, the hospital portion, carries no monthly premium for most people on either path. Part B is estimated at about $210 a month in 2027. You pay it whether you pick traditional Medicare or an Advantage plan, and higher earners pay more — that threshold starts around $110,000 in annual income for an individual.

What sits on top of Part B is the variable. A Medigap policy is estimated to run anywhere from $30 to $800 a month, depending on which standardized letter plan you buy. A stand-alone Part D drug plan adds an estimated $40 to more than $100 a month, with the deductible driving where it lands. Advantage plan premiums average about $200 a month. Many Advantage plans charge nothing beyond Part B, and most bundle drug coverage instead of billing it separately.

Deductibles cut the other way. Part A carries an estimated $1,788 deductible per hospital admission under traditional Medicare, and the Part B deductible is estimated at $310. Most Medigap policies have no deductible of their own. The exception is the high-deductible Type G version, estimated at $3,050 for 2027. Many Advantage plans carry no medical deductible at all. The Part D drug deductible of up to an estimated $700 applies under either path.

Dental and vision belong in the same arithmetic. Traditional Medicare covers neither. Many Advantage plans include some level of both, which can offset a higher medical deductible for someone who uses those services regularly.

Run the figures against your own expected year — hospital risk, specialist visits, drug spending — rather than comparing headline premiums. The cheapest monthly number and the cheapest annual total are often different plans.

Illustration: Quartz

Your Medicare sign-up window opens three calendar months before the month you turn 65 and runs seven months total. If an employer plan still covers you past 65, you get eight months after that coverage ends to enroll without a penalty.

Start at socialsecurity.gov, not medicare.gov. Create an account there and enroll in Part A, the hospital benefit most people pay nothing for, and Part B, the doctor and outpatient benefit estimated at about $210 a month in 2027. Take this step no matter which path you choose later. Advantage plans require enrollment in both Part A and Part B, because Advantage is a private repackaging of those same benefits.

Then set up a separate account at medicare.gov and look at what is sold in your area — an Advantage plan, or, if you are staying with traditional Medicare, a Medigap supplemental policy and a stand-alone Part D drug plan. Coverage usually begins the month you sign up, so there is little reason to delay once you have compared the options.

First-year enrollees get one protection worth knowing about. Choose an Advantage plan, decide within 12 months that it does not fit, and you can move back to traditional Medicare and buy a supplemental policy on a guaranteed basis, with no medical underwriting. After that first year, an insurer can require underwriting, which may involve a physical exam, a higher rate or a denial based on your health history.

Missing the window entirely costs money for years. Medicare can add as much as 10% to your monthly Part B charge for every year you delayed signing up, and a separate late penalty applies to drug coverage. Those surcharges can stay attached to your premiums for as long as you keep the coverage. Medicare also may not pay retroactively, leaving you responsible for nearly every medical bill you incur before enrollment takes effect.