Medicare’s 2027 plan comparison needs to go beyond the monthly premium. Prescription spending limits are rising, and a change of coverage can affect which doctors you can see and whether you can buy supplemental insurance later.
The annual enrollment window is open through December 7. A useful comparison starts with the care and prescriptions you need, then prices the coverage that actually provides them. A zero-premium plan can still carry substantial costs when you use it.
What you can change by December 7
During Medicare open enrollment, people already in Medicare can switch between Original Medicare and Medicare Advantage, change Advantage plans, or join, drop or switch a stand-alone Part D drug plan. The plan must receive the enrollment request by December 7 for coverage to begin January 1, 2027.
Your current plan’s Annual Notice of Change identifies changes taking effect in January. Plans send it in September. Request it if it never arrived; satisfaction with this year’s coverage does not establish what next year’s version will cover.
Compare the annual bill and the cost ceiling
Monthly premiums are the fixed part of the bill. Deductibles, copayments and coinsurance depend on the services and prescriptions you use. Compare the year’s premiums alongside those charges, including any separate drug or Medigap coverage.
Under Medicare’s coverage rules, Original Medicare has no annual out-of-pocket limit without supplemental coverage or other insurance. Advantage plans have annual limits for covered Medicare services, potentially with separate in-network and out-of-network limits.
A $0 Advantage premium also does not eliminate the Part B premium. Some plans help pay it, but the plan’s actual terms determine that benefit. Keep medical spending limits separate from the Part D prescription limit when comparing financial exposure.
The 2027 prescription limits are higher
Medicare’s published Part D figures show two increases:
| Part D measure | 2026 | 2027 |
|---|---|---|
| Maximum plan deductible | $615 | $700 |
| Annual out-of-pocket threshold for covered Part D drugs | $2,100 | $2,400 |
The deductible ceiling rises $85 and the drug-spending threshold rises $300. Plans may charge a lower deductible or none. After reaching the out-of-pocket threshold, you pay nothing further for covered Part D drugs that calendar year. The limit concerns covered prescriptions, so it cannot establish the total cost of all your health care.
Check each medicine against the plan’s formulary, or covered-drug list. Plans can put drugs on different cost-sharing tiers. Finding a drug on the list is only part of the comparison: its tier determines what you pay under the plan’s rules.
Some drugs also require prior authorization, step therapy or quantity limits. Step therapy can require trying a less expensive drug first. Your prescriber can support an exception request, but coverage should not be assumed before the plan approves it.
Pharmacy choice matters too. Medicare distinguishes preferred and standard in-network pharmacies; preferred pharmacies usually have lower drug costs. Out-of-network purchases may leave you paying the full amount. Compare the pharmacies you can actually use.
Confirm access to doctors and hospitals
Original Medicare generally lets you use any doctor or hospital accepting Medicare nationwide. Advantage plans may require network providers for non-emergency care; some allow out-of-network treatment at higher cost. Check the specific 2027 plan with both the insurer and the providers you want to keep.
Referrals and prior authorization also differ. Original Medicare generally does not require specialist referrals or advance approval for services. An Advantage plan may require either. Review these rules alongside the price, particularly for ongoing specialist care.
Check Medigap rights before leaving Advantage
Switching to Original Medicare during fall enrollment does not automatically guarantee access to Medigap, the private supplemental coverage that helps pay Original Medicare’s cost sharing.
The federal Medigap open-enrollment protection is generally a one-time six-month period starting when you are at least 65 and enrolled in Part B. Outside that period or another protected circumstance, an insurer may deny coverage or charge more based on health history.
State rules can expand those rights. KFF’s October 13 analysis identifies additional protections with different eligibility conditions. Rhode Island, for example, provides an annual opportunity for Advantage enrollees age 65 and older to buy Medigap during fall enrollment. That does not extend to everyone in Original Medicare who lacks a Medigap policy. Confirm your state’s rules and any applicable trial or guaranteed-issue right before making the switch.
Retiree coverage needs a separate check. KFF warns that dropping employer or union retiree benefits can mean losing coverage you cannot get back. Ask the benefits administrator how a change affects those benefits.
For plan searches, Medicare Plan Compare currently offers 2027 options by ZIP code and can use saved drugs and pharmacies for cost comparisons. For help resolving a switching or cost question, State Health Insurance Assistance Programs provide free, personalized counseling and are independent of insurance companies and health plans.
