No one expects to be in a car accident, have a tree fall on their home, or experience damage from a storm. Unfortunately, life happens and it’s As summer comes to an end and our thoughts turn to fall and pumpkin spice, it’s hard to believe that the 2027 Medicare Annual Election Period (AEP) is almost here.
From October 15 through December 7, Medicare beneficiaries can make changes to their coverage, including changing a Part D prescription drug plan, changing Medicare Advantage plans, or returning to Original Medicare and enrolling in a Part D plan. Changes made during AEP take effect January 1, 2027.
2026 was a year of change in Ottawa County as certain Part D Prescription Drug and Part C Medicare Advantage plans left the service area forcing many beneficiaries to select a new plan. Increased premiums for many Part D Prescription Drug Plans and the unprecedented increases in Medicare Supplemental Plan premiums also fueled change as the carriers work to adjust to inflation and the rising costs of healthcare.
What Could Change in 2027?
Medicare beneficiaries should expect changes to premiums, deductibles, copays, maximum out of pockets, drug costs and other plan benefits in 2027.
- The temporary Medicare Part D Premium Stabilization Demonstration pilot program officially ends on January 1, 2027, which may shift more cost to carriers and beneficiary premiums. This program started in 2025 and provided temporary subsidies that helped slow premium increases resulting from the legislation contained within the Inflation Reduction Act of 2022 that intended to lower Medicare prescription drug costs and reduce federal spending.
- 15 more negotiated “fair maximum prices” take effect on January 1, 2027, including popular diabetes and obesity treatments like Ozempic, Wegovy as well as others for diabetes, cancer, asthma, and COPD.
- 15 more drugs selected for price negotiation to take effect in 2028 including Botox, Botox Cosmetic, Trulicity, Xolair, Anoro Ellipta, Xeljanz, Entyvio, as well as other medications for cancer, psoriatic arthritis, asthma, COPD, and rheumatoid arthritis.
- The Part D Prescription Drug deductible increases from $615 to $700 and the maximum out of pocket limit increases from $2,100 to $2,400.
Beneficiaries with both Full Medicare and Full Medicaid benefits will see more changes from the Next Generation MyCare Ohio program. MyCare Ohio is a managed care program that aligns Medicare and Medicaid services under one carrier to provide an integrated approach to care. If you have Full Medicare & Full Medicaid benefits, you must select a fully integrated plan offered by a carrier participating in this program. Failing to do so may result in a disruption of your benefits. For more information, watch for paper communications from Medicaid, visit: https://medicaid.ohio.gov/families-and-individuals/citizen-programs-and-initiatives/mycareohio/mycare-ohio, or call our office at 419-732-3111 for an appointment to discuss your options.
Many beneficiaries will again be faced with important Medicare decisions and being prepared is the key to choosing the coverage that best fits your needs. Don’t assume your current plan will be your best option for 2027.
Your AEP Readiness Checklist:
- Watch for Your Annual Notice of Change (ANOC). Every Part D Prescription Drug Plan or Part C Medicare Advantage plan is required to provide an annual notice that details the upcoming changes in coverage and costs that will be effective January 1 of the coming year. The ANOC should arrive by the end of September and is a helpful tool when determining whether to stay with your current plan. Pay close attention to upcoming changes, especially if there are updates to provider network participation, your formulary (covered drugs), or if your plan is being discontinued. If your plan is being terminated, you will need to take action to ensure you understand your out-of-pocket cost potential and maintain prescription drug coverage for the coming year.
- Review Your Part D Drug Plan. Make a current list of your medications, including the dosage and how often you take each one. Drug formularies (lists of covered drugs), premiums and out-of-pocket costs can change from year to year, so it’s important to make sure you compare current costs and benefits to other plans available in your area.
- Compare Pricing of Your Medicare Supplement. Medicare Supplement plans provide the same standardized benefits regardless of which insurance company offers the plan, but premiums can vary significantly from one company to another. This can make comparing rates an important part of your annual review. Unlike Medicare Advantage and Part D plans, you are not limited to the Annual Enrollment Period to change or enroll in a Medicare Supplement. However, with the significant premium increases we’ve seen over the past year, now is a good time to review your options and see whether comparable coverage may be available at a more competitive price.
- Review Your Current Medicare Advantage Plan or Learn More About This Option.
Medicare Advantage plans, also known as Part C of Medicare, are offered by private health insurance companies and can provide both medical and prescription drug coverage. These plans cover the same services as Original Medicare but are typically PPO or HMO plans, which means that you will need to utilize carrier networks for your healthcare. It is important to check that your medications are covered and the medical providers and facilities that are important to you are contracted and in-network with the plan before you enroll. It is also important to know and understand the deductibles, co-pays, co-insurance, and annual out of pocket maximums that apply to the plan.
Don’t Go It Alone
Medicare decisions can be confusing, particularly when plans, premiums, provider networks and prescription coverage change from year to year.
As a Licensed Independent Insurance Agent at Bolte Insurance, I represent the major health insurance companies in our area and can help you understand your options. My fellow agents and I can help narrow down the choices and guide you through the enrollment process to find a Medicare solution that fits your needs and budget.
We’re happy to review your options and help you make an informed decision. Call Bolte Insurance at 419-732-3111, ask for Amanda!
Disclaimer: Not connected with or endorsed by any government or Federal Medicare Program.
