2027 Medicare Open Enrollment Guide: Compare Plans, Drugs, and Doct…

A Medicare plan that worked well this year may not work the same way next year. Premiums are only one moving part. A plan can change its drug formulary, pharmacy contracts, provider network, prior-authorization rules, cost sharing, and extra benefits. During Medicare Open Enrollment, which runs each year from October 15 through December 7, beneficiaries can change Medicare Advantage or Part D coverage and can switch between Original Medicare and Medicare Advantage. Changes submitted during this period generally take effect January 1 of the following year.

A useful comparison does not begin with an advertisement’s monthly-premium headline. It begins with the doctors, prescriptions, pharmacies, treatments, travel needs, and total annual costs that apply to you. This guide lays out a practical sequence for reviewing 2027 coverage in fall 2026: gather the right records, use Medicare Plan Compare consistently, verify information by phone, avoid enrollment scams, and preserve proof after enrolling. It provides general information, not individualized medical, insurance, financial, or legal advice. Your health needs, state protections, employer or union coverage, Medicaid status, and Medigap rights can change the answer. Confirm a final decision with Medicare, the plan, your health care providers, your pharmacy, your benefits administrator, or an authorized free counseling program.

Know the dates and the changes you can make

Medicare.gov identifies October 15 through December 7 as the annual Open Enrollment period. Depending on your current coverage, common options during this window include:

moving from one Medicare Advantage plan to another;
switching from Original Medicare to Medicare Advantage or from Medicare Advantage to Original Medicare;
joining, dropping, or changing a stand-alone Part D drug plan while using Original Medicare; and
choosing a Medicare Advantage option with or without drug coverage when the rules allow it.

The most important caution is that leaving Medicare Advantage for Original Medicare does not automatically guarantee access to Medigap. Outside a federal or state guaranteed-issue right, an insurer may be able to use medical underwriting, charge more, offer fewer options, or deny an application. If you are considering this change, verify Medigap eligibility, timing, and the need for separate Part D coverage before dropping the current plan. State law may provide additional rights, so contact your State Insurance Department or SHIP for rules that apply where you live.

People with employer, union, or retiree coverage need an additional check. Enrolling in an individual Medicare plan can sometimes cause you or a spouse to lose group coverage, and reinstatement may not be available. Ask the benefits administrator in writing whether the new enrollment would end retiree or dependent coverage and whether that decision can be reversed.

Step 1: Start with your plan’s Annual Notice of Change

If you have Medicare Advantage or Part D, the Annual Notice of Change, commonly called the ANOC, is the starting document for next year. Do not mistake it for generic marketing. Confirm that the plan and member information are yours, then mark every change in these areas:

monthly premium and annual deductible;
cost sharing for primary care, specialists, emergency care, inpatient stays, outpatient surgery, imaging, labs, and rehabilitation;
the annual out-of-pocket maximum and expenses that do not count toward it;
drugs removed from the formulary or moved to a different tier;
new prior authorization, step therapy, or quantity-limit requirements;
limits and conditions for dental, vision, hearing, transportation, or over-the-counter benefits; and
service-area, provider-network, hospital, or preferred-pharmacy changes.

Turn each change into a personal question. “The specialist copay increased” is less useful than “How many specialist visits am I likely to have?” A lower premium may not be a savings if a monthly medication moves to a nonpreferred tier or a hospital you depend on leaves the network.

Step 2: Build a 30-minute comparison file

Collect the information below before opening Plan Compare. That lets you test every plan against the same facts. Protect documents containing your Medicare number or other identifiers; do not leave them on a public computer or in an unsecured notes app.

Prescription list

exact drug name, strength, and form, such as tablet, capsule, inhaler, or injection;
quantity taken and frequency;
30-day or 90-day fills;
which items are prescriptions rather than over-the-counter products; and
your current pharmacy and whether mail order is practical for you.

Similar drug names, extended-release versus immediate-release tablets, or different inhaler strengths can produce different estimates. Use the latest prescription labels or patient-portal list. Never stop, split, or substitute a medication solely because of an insurance estimate without consulting the prescriber.

Provider and facility list

primary care physician, frequently used specialists, and behavioral-health clinicians;
preferred hospital, surgery center, laboratory, imaging center, and rehabilitation facility;
durable medical equipment supplier and home-health provider; and
ongoing treatment, planned surgery, or recurring testing.

Checking one physician’s name may not be enough. Verify the practice location, medical group, hospitals used, and facilities that perform tests. HMOs generally have more restrictive network and referral rules, while PPO out-of-network care can still carry substantially different costs and conditions.

Lifestyle and risk preferences

Do you spend part of the year in another state or travel regularly?
Do you need routine out-of-network care?
Do you prioritize a predictable premium or protection from a high-cost year?
Are providers for advertised dental, hearing, or vision benefits actually available nearby?
Do you rely on specific diabetes supplies, oxygen, a wheelchair, or other equipment?

Step 3: Use Medicare Plan Compare with identical inputs

Enter your ZIP code, prescriptions, and pharmacies accurately in Medicare Plan Compare. Do not sort by premium and stop. Narrow the results to two or three candidates, then record these items side by side:

Estimated annual drug cost: Review the monthly estimate based on the exact drugs and pharmacies entered. A deductible can make costs higher early in the year and different later.
Total medical cost structure: Consider premiums, deductibles, office and hospital copays or coinsurance, and the medical out-of-pocket limit together.
Formulary rules: Check the tier, prior authorization, step therapy, and quantity limit for every regular prescription.
Pharmacy status: An in-network pharmacy can still be standard rather than preferred, with different cost sharing.
Network model: Review HMO or PPO rules, specialist referrals, out-of-network terms, and nonemergency coverage while traveling.
Quality and service: Use star ratings as one input, not as a substitute for checking your drugs, clinicians, facilities, and costs.

A Medicare Advantage plan advertised with a $0 plan premium does not mean the Part B premium disappears, and it does not mean care is free. Model what one hospital stay, repeated specialist care, imaging, or rehabilitation would cost. Conversely, a higher-premium plan is not automatically better. The relevant question is how the entire benefit design fits your expected use and tolerance for financial risk.

Step 4: Cross-check online results with the plan and providers

Online directories are useful but should not be your only verification. After choosing finalists, contact both the plan and the medical office. Record the date, representative’s name, and call reference number.

Ask the plan precise questions:

“Is Dr. ___ in network for this exact plan, medical group, and location in 2027?”
“What is the network status of ___ Hospital and its anesthesia, imaging, and pathology services?”
“What tier applies to this exact drug, strength, and form, and does it require prior authorization, step therapy, or a quantity limit?”
“Is my pharmacy preferred or standard? How do 90-day fills and mail order compare?”
“Does my planned procedure require authorization, and must an existing authorization be renewed for the new year?”

Do not ask a provider only, “Do you take Medicare?” Accepting Original Medicare is different from participating in a particular Medicare Advantage product. Give the office the insurer, exact plan name, year, and practice location. The billing or insurance-verification team may know more than the central appointment desk. Contracts can still change, so reconfirm before care begins under the new coverage.

A Medicare plan comparison worksheet checking prescriptions, doctors, pharmacies, annual costs, and prior authorization rules — Compare your prescriptions, clinicians, pharmacies, treatment rules, and total annual exposure on one worksheet instead of focusing on the premium alone.

Step 5: Model three total-cost scenarios

No one can predict a year of health care perfectly, but three scenarios reveal more than a premium comparison.

Scenario A: A typical year

Include your routine appointments, current prescriptions, planned tests, and extra services you realistically expect to use. Add 12 months of plan premiums, estimated drug expenses, and expected copays.

Scenario B: A higher-use year

Add more specialist visits, imaging, outpatient surgery, physical therapy, or a short hospital stay. If a costly therapy could be relevant, ask your clinician about possible treatment categories and ask the plan about coverage, facilities, and authorization—not for a guarantee about a treatment that has not been ordered.

Scenario C: A major medical year

For Medicare Advantage, review the annual medical out-of-pocket maximum and identify premiums, prescription costs, noncovered services, or other expenses that do not count toward it. Original Medicare has a different structure, so model the role of Medigap, employer coverage, Medicaid, or other supplemental protection separately.

If finalists are only a few dollars apart, do not let price decide everything. Give greater weight to continuity with essential specialists, hospital access, prescription restrictions, and the ability to obtain care while away from home.

Step 6: Use free counseling and protect yourself from scams

The State Health Insurance Assistance Program (SHIP) connects Medicare beneficiaries and families with local counseling. SHIP’s role differs from an insurance agency that earns sales commissions. Appointments can fill near the deadline, so contact the program early and bring the ANOC, medication list, and finalist plans.

Enrollment season also creates opportunities for criminals seeking Medicare numbers. Medicare.gov says Medicare will not call unexpectedly to sell something or come to your home to sell products. Follow these rules:

Do not give a surprise caller your Medicare number, Social Security number, or banking information.
If someone says you must decide today to keep benefits, end the call and dial the official number on your card.
Do not enroll during an unsolicited call. Contact Medicare or SHIP yourself if you want help.
Do not exchange your number for cash, gifts, or “free” medical supplies.
Review dates and services on Medicare statements or your secure account for unfamiliar claims.

Smartor’s Medical Bill Review Checklist explains how to compare a bill, EOB, and services received. If a caller uses a convincing cloned voice or video to pose as a relative or counselor, use the separate verification steps in the AI Voice and Video Impersonation Scam Checklist.

Step 7: Preserve proof and prepare the January transition

An enrollment is not complete just because you clicked a button. Keep:

the date and time, plus the official website or phone number used;
the confirmation number, confirmation screen, or mailed acknowledgment;
the exact plan name, identifying plan information, and effective date;
the counselor or representative’s name and call reference number; and
the drug, pharmacy, provider, and facility list used for the comparison.

When the new plan card and materials arrive, confirm your name and start date. Note when providers and pharmacies need the new information. If you will need medication early in January, ask the prescriber before year-end about refill timing, authorization, or transition procedures. Do not prematurely cancel automatic payments or terminate coverage based on an assumption; use official effective dates and instructions.

Three realistic examples

Example 1: A lower premium but no established primary doctor

Alex finds a plan with a lower monthly premium, but the exact office where a long-time primary doctor practices is not in network. There is no confirmation that another location or medical group would solve the issue. Instead of counting only the annual premium difference, Alex weighs the effort of finding a new doctor, referral rules, and continuity of existing records, then compares another finalist. The decisive detail is the practice location and medical group—not merely a name in a directory.

Example 2: The drug is covered, but pharmacy status changes the estimate

Maria’s medication is on both finalist formularies, but her neighborhood pharmacy is preferred in one plan and standard in the other. She compares 30-day fills, 90-day fills, mail order, transportation, and the monthly cost pattern. She does not change the drug on her own; she confirms the estimate with the plan and pharmacy.

Example 3: Returning to Original Medicare

Jordan wants broader provider choice and is considering leaving Medicare Advantage. Rather than assuming a Medigap policy will be available, Jordan checks state rules, guaranteed-issue rights, possible underwriting, separate Part D needs, and effective dates. Jordan confirms the sequence with SHIP and the insurer before changing the current plan, reducing the risk of an unexpected coverage gap.

Ten common mistakes

Relying on automatic renewal: the plan may continue while its costs, formulary, and network change.
Comparing only monthly premiums: deductibles, medical cost sharing, drug expenses, and risk limits matter.
Entering an approximate drug name: strength, form, and quantity can change an estimate.
Asking only whether a doctor “takes Medicare”: that does not confirm participation in a specific Medicare Advantage product.
Choosing based on the face value of extra benefits: verify limits, frequency, conditions, and usable local providers.
Assuming Medigap is always available later: underwriting and state-specific rights may apply.
Ignoring employer or retiree coverage: an individual enrollment can affect valuable group benefits.
Trusting a phone explanation without records: retain names, dates, reference numbers, and documents.
Waiting until deadline night: provider checks and counseling appointments take time.
Changing medication because of insurance without medical advice: involve the prescriber.

Final checklist

□ I marked premium, deductible, copay, formulary, network, and authorization changes in the ANOC.
□ My medication list includes exact names, strengths, forms, quantities, and pharmacies.
□ I listed my primary doctor, specialists, hospitals, labs, and equipment suppliers.
□ I compared two or three finalists in Plan Compare using identical prescriptions and pharmacies.
□ I modeled a typical, higher-use, and major-medical year instead of looking only at premium.
□ I verified the 2027 network with both the plan and the provider.
□ I checked prior authorization, step therapy, quantity limits, and pharmacy status.
□ I separately verified any effect on Medigap, retiree coverage, or Medicaid.
□ I saved the enrollment confirmation and call records.
□ I scheduled the new card, refill, authorization, and January-appointment tasks.

Frequently asked questions

Can I do nothing if I like my current plan?

The plan may renew if it remains available and you are eligible for automatic continuation, but that does not make review unnecessary. Read the ANOC and compare the plan against your current drugs and providers because premiums, formularies, pharmacies, networks, authorizations, and extra benefits can change.

Is Medicare Open Enrollment the same as Medicare Advantage Open Enrollment?

No. The fall Medicare Open Enrollment period is October 15 through December 7 and allows a broader set of changes. The Medicare Advantage Open Enrollment period from January 1 through March 31 applies to people already enrolled in Medicare Advantage and has more limited options. Ask Medicare which options apply to your situation.

Is the plan with the highest star rating always best?

Star ratings can provide useful quality and service information, but they do not replace checking your prescriptions, doctors, hospitals, pharmacies, travel pattern, and costs. Treat the rating as one factor.

If a doctor appears in the online directory, am I finished checking?

No. Contracts and location data can change. Give both the plan and provider the exact plan name, year, practice location, and medical group. Keep a record of the answers and reconfirm before care under the new coverage.

Can I automatically buy Medigap after leaving Medicare Advantage?

Not in every situation. Without a protected right, medical underwriting or limited choices may apply. State law can add protections. Verify your rights with the State Insurance Department, SHIP, and the insurer before changing the existing plan.

What if my Part D plan does not list my medication?

Compare other plans, ask the prescriber whether a covered alternative is medically appropriate, and check whether the plan offers an exception or appeal process. Do not abruptly stop the medication or reduce the dose on your own.

Where can I get free help?

Use 1-800-MEDICARE, Medicare.gov, or your local SHIP for official information and free counseling resources. If employer, union, or retiree coverage is involved, consult that benefits administrator as well.

Should I trust a caller who says they are calling from Medicare?

Do not disclose personal information. End the call and use the official number on your Medicare card or Medicare.gov to verify the claim. Medicare says it will not call unexpectedly or visit your home to sell you something.

Bottom line: Decide from your care map, not an advertisement

The purpose of Open Enrollment is not to select the flashiest benefits chart. It is to keep the care and prescriptions you need accessible on terms you can manage. Identify changes in the ANOC, build exact medication and provider lists, compare total exposure in Plan Compare, and verify the finalists with both the plan and the provider. If a decision affects Medigap or employer or retiree benefits, establish your rights and the correct sequence first.

Finally, save the confirmation number and comparison records, then prepare for the new card, refills, authorizations, and January appointments. Those records are practical protection if an enrollment error or conflicting explanation appears later.

2027 Medicare Open Enrollment Guide: Compare Plans, Drugs, and Doctors