2027 Medicare Advantage & Prescription Drug Plan Changes

Revised September 2026 | What is confirmed — and what to watch for — as you prepare for 2027

Important: Individual plan premiums, provider networks, drug formularies and extra benefits will not be final until fall. This guide includes confirmed nationwide changes and carrier implementation updates available as of September 2, 2026.

Important Dates

• September 2026 – Watch for your plan’s Annual Notice of Change (ANOC).
• October 1, 2026 – 2027 plan information becomes available for review.
• October 15-December 7, 2026 – Medicare Annual Enrollment Period.
• January 1, 2027 – New plan coverage begins.

Confirmed 2027 Prescription Drug Changes

2027 Part D feature Amount What it means Maximum deductible $700 A plan may charge less or apply the deductible only to certain drug tiers. Annual out-of-pocket threshold $2,400 After reaching this amount for covered Part D drugs, you pay $0 for covered drugs for the rest of the year.

• Covered insulin remains capped at the lesser of $35 for a month’s supply or the applicable percentage of the drug’s

negotiated price.

• Recommended adult vaccines covered under Part D continue at $0 cost sharing.

Medicare Prescription Payment Plan Continues in 2027

This voluntary program allows members to spread covered Part D out-of-pocket costs across monthly bills from their Medicare drug plan instead of paying the full amount at the pharmacy. It does not lower the total cost of prescriptions, and members do not pay a fee or interest to participate. Important: The program may help with budgeting, but it does not always lower the amount due at the beginning of the year. Review how the program works before deciding whether it fits your needs.

Medicare Part D Coverage Is Not Going Away

Medicare Part D prescription drug coverage will continue in 2027. However, a temporary federal Premium Stabilization Demonstration that supported participating standalone Part D plans ends after 2026. The support was $15 per month in 2025 and $10 per month in 2026. It did not apply to Medicare Advantage plans with drug coverage. Medicare Supplement + Part D: Standalone Part D plans, usually paired with Medicare Supplement plans, can be reviewed and enrolled in at Medicare.gov.

• Some standalone Part D plans may have higher premiums, consolidate or discontinue.
• Premiums, deductibles, copays, formularies, drug tiers, pharmacy networks and coverage requirements may change.
• The effect will vary by plan and prescription; costs will not increase for everyone in the same way.

Important: Do not cancel prescription drug coverage because of rumors that Part D is ending. Review your ANOC and compare the total cost and coverage of your prescriptions for 2027.

What May Change in Medicare Advantage and Prescription Drug Plans

• Monthly premium and medical or prescription deductibles
• Doctor, hospital and pharmacy networks
• Prescription drug formulary, tier placement and prior authorization rules
• Copays, coinsurance and maximum out-of-pocket amounts
• Dental, vision, hearing, fitness, over-the-counter and other supplemental benefits

Do not assume a benefit is continuing. Read your ANOC carefully. A benefit that was available in 2026 may be reduced, replaced or removed for 2027. Plan details are specific to your county and plan.

New 2027 Rules for Certain Chronic-Condition Benefits

Certain C-SNP and D-SNP extra benefits classified as Special Supplemental Benefits for the Chronically Ill (SSBCI) are not automatic; plan and member eligibility must be verified.

• Carrier verification is required: Enrolling in the plan or requesting the benefit does not automatically activate it. The

carrier must verify that the member meets the eligibility requirements.

• If the carrier does not have sufficient claims or clinical information – such as for a new member or someone with a recent

diagnosis – the member’s healthcare provider may need to complete a verification form.

• A diagnosis alone is not enough: qualifying condition + risk of hospitalization or another adverse outcome + need for

intensive care coordination.

• C-SNP and D-SNP healthy-food benefits will require verification, and current recipients may need re-verification for 2027.
• Healthy-food limits are stricter: salty snacks are excluded for 2027, following prior exclusions for candy, sweets and soda.

Eligible items vary by plan. Important: The benefit will not be available until the carrier confirms eligibility. Grievance and appeal rights may apply.

What Has Not Yet Been Announced

• The standard 2027 Part B premium and Part B deductible
• Final average 2027 Medicare Advantage and Part D premiums
• The complete 2027 plan landscape, including all county-level plan benefits

Your Smart Next Steps

• Keep your plan’s ANOC when it arrives in September.
• Update your list of doctors, specialists, preferred hospitals, pharmacies and prescriptions.
• Review changes that affect your care and costs – not only extra benefits.
• Compare options during Annual Enrollment. A change is recommended only when another plan better fits your needs.

Questions About Your 2027 Coverage?

Robin Sisk Mindful Medicare Solutions | 937-766-1965 | [email protected] www.robinsisk.net Book Now