It is going to be a tough year for seniors shopping for Medicare coverage.
If you don't choose wisely, you might get hit with surprise bills for your medications, or learn too late that your doctors are out of network.
For the third year in a row, major Medicare insurers are pruning some benefits while adding bigger out-of-pocket charges such as deductibles.
"Medicare Advantage plans are leaning toward focusing on margin repair," said Michael Ha, an analyst with Baird. "And what does that mean exactly for seniors? It means their benefits are going to get cut again."
Medicare enrollees have from today until Dec. 7 to select coverage for 2027.
Here's what you need to know about navigating this year's Medicare enrollment.
Medicare Advantage
This year, a lot of seniors will be looking for new coverage. Around 3.2 million people are enrolled in Medicare Advantage plans that are closing or withdrawing from their markets, according to Chapter, a national Medicare brokerage.
Judy Moreland, of Mesquite, Texas, isn't happy that her Medicare Advantage plan will no longer be offered next year. She likes the flexible preferred-provider organization, or PPO, design, which lets her see specialists without getting a referral from her primary-care doctor. Many of the plans that are vanishing or shrinking are PPOs.
Moreland, 80 years old, doesn't want a more restrictive setup, like a health maintenance organization, or HMO, which would likely have a limited network. "The insurance companies are getting a little tighter and a little tighter about the things that they allow and don't allow," she said.
It is more important than ever to verify that your doctors and other healthcare providers are included in your plan, because hospital systems are increasingly breaking off their Medicare Advantage ties. The online network lists for Medicare Advantage plans may not be up-to-date. It is best to call your doctor's office, and the insurer.
Some constraints may be buried in the fine print, like services that require prior authorizations. You can find details in the documents that describe each plan, including the Summary of Benefits (here is an example) and the more in-depth Evidence of Coverage (like this one).
If you want the least restrictive option, you can choose traditional Medicare, but you will need a special supplemental policy, known as a Medigap plan, to protect you from big out-of-pocket charges.
Enrollment for these plans can be restricted. They are available after you first age into Medicare at 65, or at certain other moments, like if your current Medicare Advantage plan goes away. Here are the federal rules, and here is a list of state-specific protections.
Higher Costs
Seniors will still have access to lots of Medicare Advantage plans with no premium.
The bite will come elsewhere: Insurers are increasing what you will pay when you get care. According to analysts at Leerink Partners, Medicare Advantage plans are increasing maximum out-of-pocket costs, including copays and other charges, by 10% on average for 2027.
Primary-care doctor visits are mostly still free. But some Medicare Advantage plans are increasing copays for specialists or switching to coinsurance, which means you pay a share of the total cost, rather than a flat amount.
Large Medicare Advantage insurers are also trimming many of the extra benefits that are popular with seniors -- things like dental plans, coverage for over-the-counter health products and transportation.
Drug Plans
Some of the trickiest issues this year are coming in the drug benefits.
The number of stand-alone drug plans continues to shrink -- to 316 next year, a 12% drop from this year and a 55% falloff since 2024.
The Medicare agency says overall, the average premium for Part D plans -- which cover prescription medications -- is barely rising.
Still, consulting firm Avalere Health found that many people will face a substantial increase in their monthly bill if they choose to hang onto the same Part D plan next year.
Peter Harrigan, a 75-year-old retiree in Rehoboth Beach, Del., says his stand-alone Part D plan's premium is set to jump 85% next year, to nearly $175 a month. He doesn't want to switch out of traditional Medicare, because it is important to keep access to all of his current doctors. He will keep the pricey drug plan for now, but "it's definitely a squeeze," he said.
In Medicare Advantage plans, which typically cover both prescription medications and medical care, drug deductibles are increasing by 30% on average, according to the Leerink Partners analysis, rising well above $500 in many cases.
You will need to get in the weeds to understand what you will pay for your medications, including running them through the drug-checker tool on Medicare.gov. Subtle tweaks can make a huge difference.
Mike Smith, president emeritus of The Brokerage, a company that works with insurance agents selling Medicare plans, said he is seeing some medications moved between tiers, raising the cost for people who take them. He has also seen plans make more tiers of drugs subject to deductibles, so that enrollees who were used to a small copay for a medication may have to pay out hundreds of dollars before their coverage kicks in. "That's going to cause a lot more squawking in January," Smith said.
Hidden Plans
Seniors may want to move faster this year, rather than waiting until late in the annual enrollment period to settle on a plan.
For a small number of Medicare Advantage plans, insurers are capping enrollment -- which means that once a certain number of people sign up for it, the plan is no longer available. It isn't always obvious, so if you find something you like but you're not ready to decide, you might want to check with the insurer to make sure it will be around later.
"It's actually going to be very confusing" for seniors who may not be aware of the enrollment limits, said Cobi Blumenfeld-Gantz, chief executive of Chapter.
Medicare insurers are also discouraging sign-ups for certain plans by eliminating the commissions they pay insurance brokers, or yanking the products off electronic platforms agents use.
Seniors need to do their own homework to ensure they are seeing all the options. Start with the plan finder tool at Medicare.gov, which should list everything available in your area.
You can find Medicare advice from the State Health Insurance Assistance Program in every state. This website has links for each of them. The nonprofit Medicare Rights Center maintains a national hotline.
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