Medicare Open Enrollment 2027: The Money Checklist

📐 Figures verified Sep 26, 2026 against CMS, Medicare.gov and Social Security sources (the 2026 Parts A & B fact sheet, the July 28, 2026 Part D release and the 2026 Medicare Trustees Report). The official 2027 Part B premium and IRMAA brackets arrive in November; this page will be updated when they do. How we check numbers →

Numbers That Matter for 2027 Open Enrollment

What Changed for 2027

Every fall, Medicare plans reset their prices and rules for the coming January. Most years the changes are small enough that renewing on autopilot costs a few dollars. 2027 is not one of those years for anyone with a drug plan, and it pays to know what moved before you open a single plan brochure.

The Calendar: Every Date That Matters This Fall

Open enrollment is short, and the information you need arrives in pieces. This is the order it lands in, with the move that goes with each date.

During the October–December window you can join, switch or drop an Advantage plan or a drug plan, move from Original Medicare to Advantage or back, or keep what you have. What you cannot use this window for is buying Medigap on guaranteed terms, which is why Step 4 matters so much. Medicare's own enrollment-period rules spell out each option.

Step 1: Read Your Annual Notice of Change Like an Accountant

If you are in a Medicare Advantage or Part D plan, the Annual Notice of Change is the most useful document you will receive all year. It lists what your current plan will charge and cover in 2027 next to what it charges in 2026, and it should arrive by September 30. Staying put is a decision too: if you do nothing and your plan continues, it simply renews on January 1 with whatever changes the notice describes.

Read it with a pen and pull out five numbers and two lists:

1. The monthly premium, 2026 against 2027.
2. The drug deductible and which drug tiers it applies to. For 2027 no plan's deductible can exceed $700.
3. What each of your drugs will cost per fill. A drug that moves from a flat copay to a percentage coinsurance can cost several times more.
4. The in-network out-of-pocket maximum (Advantage plans only): the most you would pay for covered medical care in a bad year.
5. Copays for the care you actually use: primary care, specialists, imaging, outpatient surgery and hospital stays.
6. The drug list: is every drug you take still covered, and does any of them now need prior authorization or step therapy?
7. The networks: are your doctors, your hospital and your preferred pharmacy still in network for 2027?

Write those down next to last year's numbers. Anything that got worse is a reason to shop. A plan that raised nothing still deserves a price check, because its competitors repriced too, and a rival that was more expensive in 2026 may be cheaper for your particular drug list in 2027.

Step 2: Price Your Drugs Under the 2027 Part D Rules

Part D now works in two phases. You pay the plan's full price for covered drugs until you meet your plan's deductible: at most $700 in 2027, and many plans charge less, charge none, or skip it for cheaper tiers. Then you share the cost through copays or coinsurance (25% in the standard design) until your own spending on covered drugs reaches $2,400. After that, covered Part D drugs cost you nothing until December 31.

Three details decide what that means for you:

• Premiums do not count toward the cap. A plan's monthly premium is paid on top of the $2,400. For anyone who will reach the cap anyway, the premium becomes the deciding number.
• Only covered drugs count. A drug that is not on the plan's list, or that you buy outside the plan, does not move you toward the cap. Check every drug by name, dose and quantity.
• The cap resets every January 1. Heavy users pay the whole $2,400 early in the year. The Medicare Prescription Payment Plan turns those costs into monthly bills spread across the year instead. It does not lower the total, and you can sign up with your plan during open enrollment or later in the year.

The national base beneficiary premium, the starting point in each plan's premium formula, rises to $41.33 for 2027 from $38.99, according to CMS's July 28, 2026 Part D release. The law caps that base figure's growth at 6% a year through 2029, but the cap does not limit what an individual plan charges. With the premium stabilization subsidy ending, standalone drug plans can reprice more than they could in 2025 and 2026, so treat this fall as a year to compare rather than renew. CMS said it would post the full 2027 plan data and average premiums in mid-to-late September; your own plan's 2027 premium is in your notice and in Medicare Plan Finder.

Step 3: Check Your IRMAA Tier (Your Tax Return Sets Your Premium)

Higher-income enrollees pay an income-related monthly adjustment amount, IRMAA, on top of the standard Part B and Part D premiums. Social Security decides it from your tax return two years back, using modified adjusted gross income: adjusted gross income plus tax-exempt interest. CMS says roughly 8% of people with Part B pay it. These are the 2026 tiers, set from 2024 income, per the CMS 2026 fact sheet:

Married people who lived together at any point in the year but file separately face a far steeper schedule: above $109,000 of MAGI they go straight to $649.20 for Part B, and to $689.90 at $391,000.

What you can still change. Your 2027 tier comes from your 2025 return, which is already filed, so for 2027 there is little to optimize beyond errors and life changes. The live planning window is 2026 income, which sets your 2028 premiums: a Roth conversion, a large capital gain or an extra IRA withdrawal before December 31 can push you over a line two years from now. The thresholds are adjusted for inflation each year and CMS publishes the 2027 brackets in the fall, so plan with a cushion rather than to the dollar. Our Roth conversion timing guide shows how to size conversions around these lines.

If your income fell. Retiring or cutting back work, marriage, divorce, the death of a spouse and the loss of a pension are "life-changing events." If one of them reduced your income, file Form SSA-44 and ask Social Security to use a more recent year; its page on premiums for higher-income beneficiaries lists every qualifying event. A one-time capital gain, a home sale or a Roth conversion does not qualify.

Step 4: Medicare Advantage or Original Medicare? Decide on Risk, Not Extras

This is the biggest choice open enrollment offers, and it is usually sold on dental coverage and gym memberships. Look at it as a question of who carries the risk of an expensive year instead.

Original Medicare has a $283 Part B deductible in 2026, then 20% coinsurance with no yearly cap, plus a $1,736 Part A deductible for each hospital benefit period. Most people who choose it add a Medigap policy to cover those gaps and a separate Part D plan for drugs. You pay more in premiums every month and very little when you are sick, and you can use any provider in the country that accepts Medicare.

Medicare Advantage plans bundle hospital, medical and usually drug coverage, often for a low or $0 premium on top of Part B. In exchange you accept a provider network, prior authorization for many services, and copays that stop only at the plan's yearly in-network out-of-pocket maximum. You pay little in a healthy year and more in a sick one, up to that limit. Check the maximum in the plan's summary of benefits; it is the number that matters most if something goes wrong.

The one-way door is Medigap. Your best chance to buy it is the six-month Medigap open enrollment period that starts when you are 65 or older and enrolled in Part B; during those months insurers cannot turn you down or charge more because of your health. After it, in most states, an insurer can review your health and decline you or raise the price if you try to move from Advantage back to Original Medicare. There are exceptions: federal trial rights protect people who try Medicare Advantage for the first time and leave within 12 months, and a few states give yearly switching rights. So the order of operations is strict. Get a Medigap approval in writing before you drop an Advantage plan, never after.

One more lever: if a Medicare Advantage or drug plan in your area earns five stars in the quality ratings CMS publishes each October, you can switch into it once between December 8 and November 30, outside the normal windows.

Step 5: Check the Programs That Cut Costs to Near Zero

Two programs are underused because people assume they will not qualify.

• Extra Help (the Part D Low-Income Subsidy) pays some or all of your drug plan premium and deductible and lowers your copays. Since 2024, full Extra Help reaches people with incomes up to 150% of the federal poverty level who meet the resource limit. Apply at SSA.gov/extrahelp; you can apply at any time, not only during open enrollment.
• Medicare Savings Programs are run by states and can pay your Part B premium ($202.90 a month in 2026, or $2,434.80 a year) and sometimes your deductibles and coinsurance. Qualifying for one also qualifies you for Extra Help automatically. Apply through your state Medicaid office; Medicare.gov's Medicare Savings Programs page explains the levels.

If a parent or relative is on a tight budget, these two applications are often worth more than any plan comparison. Our guide to money on a fixed income covers the other benefits worth checking.

Step 6: Budget the Net Social Security Check

If you receive Social Security, your Part B premium is usually taken out of your benefit before it reaches you, so the number you budget from is the net. Two announcements set it for 2027: Social Security's cost-of-living adjustment on October 14, then CMS's Part B premium, typically in November. On the Trustees' estimate the premium rises from $202.90 to about $209.50, so $6.60 of each month's COLA goes to Medicare before you see it.

For most people a "hold-harmless" rule keeps a Part B increase from shrinking the net check below the previous year's. It does not protect people who pay IRMAA, people new to Medicare or Social Security, or people whose state pays their premium. Our guides on Social Security optimization and turning 65 cover the claiming decisions that set the size of the check in the first place.

The Checklist in One Place

1. Find your Annual Notice of Change and note the 2027 premium, deductible, out-of-pocket maximum, drug costs and networks.
2. List every drug with its dose and how often you fill it, plus the pharmacy you use.
3. List the doctors and hospitals you want to keep.
4. From October 1, price that exact list in Medicare Plan Finder and sort by total estimated yearly cost.
5. Compare at least three plans, including the one you have now.
6. Check your 2025 income against the IRMAA tiers; file Form SSA-44 if a life-changing event cut your income.
7. If you are leaving Medicare Advantage, get a Medigap approval first.
8. See whether Extra Help or a Medicare Savings Program fits your income.
9. If you expect to reach the $2,400 cap, decide on the Medicare Prescription Payment Plan.
10. Enroll by December 7 and save the confirmation.
11. In November, update your budget with the official 2027 Part B premium and IRMAA brackets.
12. After January 1, check your first prescription fills and bills; Advantage enrollees can still switch once by March 31.

Under 65 and buying your own coverage? The Marketplace has its own open enrollment from November 1, and the enhanced subsidies are gone; our ACA 2027 open enrollment preview runs the numbers.

Decision Rules and Common Mistakes

Frequently Asked Questions