Guidance on Reporting Medicare Open Enrollment

The open enrollment period for Medicare, a crucial time for existing beneficiaries to review and potentially modify their coverage plans, is fast approaching. With changes set to take effect from January 1, 2027, beneficiaries can modify their Part D prescription plan, revert from a Medicare Advantage plan to the original Medicare, and in certain states, swap their Medigap plans. This year brings several updates, providing local coverage opportunities.

Let’s remind you: The Medicare Fall Open Enrollment session commences from October 15 and ends on December 7.

Key Points to Consider

Here are some significant factors and common mistakes to take into account:

Premium estimates should be treated as approximations, instead of concrete figures. As per the 2026 Medicare Trustees Report, the standard Part B premium for 2027 is anticipated to rise from $202.90 to about $209.50 monthly – equating to a $6.60 monthly increase or roughly $79 annually. Also, the Part B deductible is expected to go up from $283 to approximately $292. However, these numbers will only be confirmed in late October or November by the Centers for Medicare and Medicaid.

Examining Prescription Drug Costs Beyond Premiums

Understanding the Part D out-of-pocket cap hike. Established under the Inflation Reduction Act, the Part D out-of-pocket cap has been adjusted from $2,000 in 2025 to $2,100 this year and will further rise to $2,400 in 2027. This can serve as a story angle on the cost of drugs, importance of annual drug plan reviews, and smart plan selection.

Don’t presume that readers are aware of the Medicare Prescription Payment Plan or how to enroll. The Medicare Prescription Payment Plan allows beneficiaries with costly medications to divide the $2,400 cap into nearly equal monthly payments. However, enrollment isn’t automatic. Beneficiaries must apply through their plan and those switching plans during open enrollment must set it up again with the new plan.

Consider formulary and tier changes beyond just the premium. Changes in formulary and tier are often overlooked by beneficiaries, says Louise Norris from medicareresources.org. A drug shifting to a lower-cost tier can save you money, while a shift to a higher tier will increase out-of-pocket expenses, even with the $2,400 cap in place. This can serve as a reminder to not just check if a drug remains covered, but also its tier placement before auto-renewing.

Medigap: A Separate Story

Medigap premium increases should be covered separately from Part B. With a possible hike in Medigap plans in 2027, beneficiaries should be aware that these increases don’t occur uniformly on January 1, but individual policy anniversaries.

Explain why most people can’t simply search for a less expensive Medigap plan. Most people only get a single six-month guaranteed-issue window, which is tied to turning 65 and enrolling in Part B. In most states, after this period, changing Medigap plans would require medical underwriting. Health changes can thus effectively block someone from switching – a frequent source of confusion that benefits from clear explanation.

Localize the Medigap underwriting rules that vary by state. States like New York and Connecticut don’t medically underwrite Medigap applicants no matter when they apply. Massachusetts, Maine, Missouri, Washington, and several others have their own limited windows or “birthday rule” provisions allowing switches without underwriting under specific conditions. This state-by-state breakdown can help you understand what applies in your coverage area since the rules vary widely and most readers may not know their state’s specific protections.

Keeping Track of Medicare Advantage Plans Exiting Market

Monitoring Medicare Advantage plans leaving your market becomes crucial as different rules apply. Beneficiaries whose Medicare Advantage plan is leaving the market in 2027 get guaranteed-issue access to most Medigap plans in their area if they opt to switch back to original Medicare. Checking which plans are withdrawing locally is an important aspect that could impact a large segment of your audience.

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