Medicare Open Enrollment Is Coming: Five Things to Review Before December 7
Medicare Open Enrollment begins October 15 and continues through December 7, 2026. During this period, people already enrolled in Medicare can review and change their Medicare Advantage or prescription-drug coverage for 2027.
Any changes made during Open Enrollment generally take effect January 1, 2027.
Even if you are satisfied with your current plan, it is important to review the information arriving in your mailbox. Plans can change their costs, provider networks, prescription-drug coverage, pharmacy networks, prior-authorization requirements and additional benefits each year.
Prescription-drug changes for 2027
Medicare Part D will have a $2,400 annual out-of-pocket threshold in 2027, increasing from $2,100 in 2026. Once an enrollee reaches that threshold through qualifying Part D expenses, the person will not pay additional cost-sharing for covered Part D medications for the remainder of the calendar year.
However, not every medication expense counts toward the $2,400 threshold. Monthly premiums, medications not covered by the plan and certain expenses outside the Part D benefit may not apply.
Beginning January 1, 2027, Medicare-negotiated prices will also take effect for 15 additional high-cost Part D medications used to treat cancer, diabetes, asthma and other chronic conditions.
These changes may help many people, but individual savings will depend on the medications prescribed, the selected plan, the pharmacy used and the plan’s coverage requirements.
Five questions to ask before renewing your plan
Before comparing plans, prepare a complete list of your medications, doctors, specialists, preferred hospitals and pharmacies. Then ask:
1. Will my doctors and hospital remain in-network?
Do not assume that a provider who accepts your current plan will remain in the network for 2027. Confirm directly with both the plan and the provider.
2. Are all my medications still covered?
Review each medication—not just the most expensive one. Check its pricing tier, copayment, preferred pharmacy requirements and whether a generic or alternative medication is required.
3. Will I need prior authorization?
Some plans require approval before covering certain medications, treatments, medical equipment or services. Others may require you to try a different treatment first.
4. What will I pay altogether?
A low or zero-dollar monthly premium does not automatically make a plan less expensive. Compare:
- Medical and prescription deductibles
- Primary-care and specialist copayments
- Hospital and rehabilitation costs
- Prescription-drug expenses
- Out-of-network costs
- The plan’s annual medical out-of-pocket maximum
5. Will I actually use the additional benefits?
Dental, vision, hearing, transportation, meal and over-the-counter benefits can be valuable. Review their limits, participating providers and authorization requirements before counting them as meaningful savings.
How community organizations can help
Senior living communities, churches and senior centers can help older adults prepare without recommending a specific insurance plan.
Consider:
- Sharing the October 15–December 7 deadline
- Hosting an educational Medicare event
- Helping older adults prepare medication and provider lists
- Providing information about unbiased Medicare counseling
- Reminding people never to give personal information to an unexpected caller
- Encouraging families to include a trusted support person in important coverage decisions
Free, unbiased Medicare assistance
Washington residents can receive free, confidential and unbiased Medicare counseling through the Statewide Health Insurance Benefits Advisors program, commonly known as SHIBA.
SHIBA advisors can help people:
- Compare Medicare health and prescription plans
- Understand Medicare letters and notices
- Review coverage options
- Apply for assistance with premiums or medication costs
- Find local Medicare counseling events
Call SHIBA at 800-562-6900, Monday through Friday from 8:30 a.m. to 4:30 p.m., or visit the Washington State Office of the Insurance Commissioner.
Plans can also be compared through the official Medicare Open Enrollment website or by calling 1-800-MEDICARE.
Planning for more than insurance
Medicare coverage is an important part of planning for aging, but it is only one piece of the larger care plan. Families should also consider medication management, caregiving capacity, transportation, home safety, finances and what will happen if care needs increase.
CayCare helps older adults and families understand these practical pieces so they can make informed decisions before a health crisis forces the issue.
To learn more, visit www.caycare.com or call 253-777-3804.
This article is provided for general educational purposes and is not insurance, legal or financial advice. Medicare benefits and plan details vary. Verify individual coverage directly with Medicare, the insurance plan or an authorized benefits counselor.