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Dr. Mehmet Oz has good news for the 34 million people expected in Medicare Advantage next year.
The average monthly Medicare Advantage premium will fall from $14.37 this year to $12 in 2027, a 16.5% drop, according to the Centers for Medicare & Medicaid Services, which Oz runs. (1)
“By slashing handouts to big insurance companies, CMS is keeping premiums stable while ensuring that 97% of Medicare beneficiaries have access to 10 or more MA plans,” Oz said on Sept. 28. (1)
That’s real. Lower premiums and plenty of choice are good things, and Oz deserves credit for both.
But here’s the catch: The premium is the smallest number on the page. Three-quarters of people in individual Medicare Advantage plans with drug coverage already pay no premium beyond their Part B premium, according to KFF. (2)
And that Part B premium is $202.90 a month in 2026, no matter which plan you pick. (3)
I’m a CPA, and when I look at a Medicare plan, I look at what it costs when you’re sick, not when you’re healthy. Open enrollment runs Oct. 15 to Dec. 7. (4) Here are six numbers to check before a $12 premium sells you.
1. The premium drop is worth about $28 a year
Do the math on that 16.5%. Going from $14.37 to $12 saves the average enrollee $2.37 a month, or about $28 a year. (1)
That’s nice. But $28 won’t go far in a year when you actually get sick.
So don’t let a low or zero premium be the reason you pick a plan. The same goes for the extras plans advertise, like gym memberships and vision perks. Some of those savings are available elsewhere, too.
AARP can help you pick a plan. Not only that, but members save on hundreds of everyday purchases, including eyeglasses, prescriptions and meal delivery, plus discounts on travel and dining. At as low as $15 for your first year with auto-renewal, a single use of one benefit can cover the cost.
2. The out-of-pocket maximum is the number that can hurt
Every Medicare Advantage plan has an annual cap on what you pay for covered in-network care. For 2027, federal rules let that cap go as high as $9,850, or $14,800 for in- and out-of-network care combined in PPO plans, according to a CMS bid memo. (5)
The average in-network limit in 2026 was $5,421, according to KFF. (2) Some plans are far lower, some are near the top.
A bad year, like a hip replacement, a hospital stay or cancer treatment, is exactly when that number comes due. Find it in your plan’s Evidence of Coverage and ask yourself whether you could write that check.
3. Your doctors and hospital have to be in the network
A plan that doesn’t include your doctors isn’t a bargain at any price. Check every doctor, specialist and hospital you use, and don’t take a salesperson’s word for it. Call the office.
Networks and plans also change. Humana said it will exit Medicare Advantage plans covering about 600,000 members in 2027, according to Healthcare Dive. (6)
If your plan is leaving your area, you should get a notice. Read it, because you’ll need to choose new coverage.
Quick gut-check — if your money advice is coming from random online influencers, you’re playing a dangerous game. I’ve been a CPA since 1981 and writing about money since before the internet existed. Sign up for the free Money Talks Newsletter and get expert advice that’s been tested by time.
4. Almost every plan requires prior authorization
Nearly all Medicare Advantage enrollees, 99%, are in plans that require prior approval for some services, according to KFF. (2)
In 2024, Medicare Advantage insurers made nearly 53 million prior authorization decisions and fully or partially denied 4.1 million, or 7.7%. (7)
Here’s the part that should make you angry: Only 11.5% of those denials were appealed, but 80.7% of appeals overturned the denial. (7)
Lesson: If your plan says no, appeal. The odds are on your side.
5. Switching back can be a one-way door
This is the Medicare mistake I worry about most, because it doesn’t show up until years later.
You get a six-month window to buy a Medigap supplement policy starting the month you’re 65 and enrolled in Part B. After that, there’s generally no federal guarantee an insurer will sell you one, and it may cost more because of your health, according to Medicare.gov. (8)
There’s a limited trial right: If you joined Medicare Advantage when you first became eligible and switch back to Original Medicare within 12 months, you can buy certain Medigap policies without medical review. (8) Some states offer more protection, so check with yours.
Translation: If you leave traditional Medicare and a supplement today, you may not be able to get back in later, just when you’d want to.
6. Neither option pays for long-term care
Whichever way you go, there’s a big bill neither plan covers.
About 7 in 10 people turning 65 will need some form of long-term care. And Medicare doesn’t cover custodial care — the day-to-day help with things like bathing and dressing — which can leave families facing six-figure bills that eat into retirement savings.
Long-term care insurance helps fill that gap, covering services like home care, assisted living and help with daily tasks. Rates are typically lowest if you buy in your 50s or early 60s. See a list of the best LTC insurance companies — takes 2 minutes.
Medicare decisions also tie into your taxes, your Social Security timing and your savings.
If you want a pro to look at the whole picture, SmartAsset matches you with up to three fiduciary advisors who are legally required to put your interests first. If you have $100,000 or more in investments, you can get matched free in minutes.
The bottom line
Oz is right that Medicare Advantage premiums are low and choices are plentiful. That’s a genuine win, and I’m not going to pretend otherwise.
But the premium is what you pay to be in the plan. The out-of-pocket maximum, the network and the approval rules are what you pay when you need it.
Before Dec. 7, read your plan’s Annual Notice of Change and compare your options on Medicare.gov.
For free, unbiased help, call your State Health Insurance Assistance Program at 877-839-2675. (9)
And if you pick a plan and hate it, people in Medicare Advantage can switch plans or return to Original Medicare from Jan. 1 to March 31. (10)
Buy health insurance for the year you get sick, not the year you feel fine.
Sources: 1. Centers for Medicare & Medicaid Services; 2. KFF; 3. Centers for Medicare & Medicaid Services; 4. Medicare.gov; 5. Centers for Medicare & Medicaid Services; 6. Healthcare Dive; 7. KFF; 8. Medicare.gov; 9. SHIP National Technical Assistance Center; 10. Medicare.gov
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