Washington wants you to feel good about Medicare open enrollment, which runs Oct. 15 through Dec. 7. The government says more than 99% of people on Medicare will have a Medicare Advantage plan to pick from next year, and 97% will have 10 or more.
Here’s what that sunny number doesn’t tell you: Your menu got smaller. Again.
KFF, the nonprofit health research group, counted the plans actually available to the typical person on Medicare. For 2027, that’s 28 Medicare Advantage plans with drug coverage, down from 32 this year. Add in plans without drug coverage and it’s 35, down from 39.
This isn’t a one-year blip. The typical beneficiary’s count of Medicare Advantage drug plans peaked at 36 in 2024, and it’s been sliding ever since.
Why? Insurers say what the government pays them hasn’t kept pace with what care now costs, Reuters reported, so they’re trimming plans and pulling out of less profitable places.
My take, after more than 35 years of watching insurance companies: When an insurer kills a plan, it’s usually because that plan was costing the insurer money. That’s no reason to cheer the replacement.
So here are five moves to make before the Dec. 7 deadline, starting with one that can’t wait.
1. Find out whether your plan even made it to 2027
Insurers that are dropping a plan or pulling out of your area send a non-renewal letter in the fall. If you got one, or you’re not sure, call the number on your member card and ask point-blank whether your plan exists in 2027.
If your plan is ending and you do nothing, you won’t lose coverage. You’ll land in Original Medicare on Jan. 1. But unless you get Extra Help, Medicare’s low-income subsidy, you’ll need to pick a separate drug plan if you want prescription coverage.
You’ll have until the last day of February to choose a new plan.
You may also get a rare right to buy a Medigap supplement policy without a health screening. That window lasts only about two months after your old plan ends, so read up on the Medigap window that protects you now.
But don’t let that February deadline lull you. Here’s why.
2. Shop in October, not December
Here’s a wrinkle most shoppers don’t know about: Some Medicare Advantage plans have a cap on how many people they’ll take. When a plan hits the ceiling the government approved, it stops taking new members.
Trade publication Becker’s Payer Issues counted 65 Medicare Advantage plans with caps for 2027, offered by 15 insurers across 11 states. The smallest cap it found was 410 members.
HealthPartners, which sells plans in Minnesota and Wisconsin, spells out what that means on its website. Apply after a plan fills up and you’ll get a denial letter instead of a confirmation. Its advice is to enroll as soon as you find a plan that fits.
Translation: The plan you’ve been eyeing could close its doors before Thanksgiving. If you find a good one in October, grab it.
And if your current plan is ending, waiting is doubly risky. The best replacement in your county could fill up while you’re still sorting through the mail.
3. See how hard your state got hit
National averages hide a lot. KFF found the typical beneficiary lost options in most states. The biggest drops in Medicare Advantage drug plans came in Texas, down nine choices; Illinois and Ohio, down eight; and Minnesota, New Mexico and Washington, down seven.
In nine states plus Washington, D.C., the typical person on Medicare now has fewer than 10 Medicare Advantage drug plans open to them. Alaska has none.
Wait — didn’t the government say 97% get 10 or more? It did.
Part of the difference is what’s being counted. KFF looks only at drug plans anyone can join, leaving out special needs plans and plans without drug coverage, and it reports a state-by-state average rather than a national share.
Want your own number? Plug your ZIP code into the Plan Finder at Medicare.gov. It lists every plan sold in your county, and the Centers for Medicare & Medicaid Services (CMS) says it’ll now flag changes that affect your current plan.
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4. Re-price your drug plan if you have Original Medicare
If you pair Original Medicare with a stand-alone Part D drug plan, this is the year autopilot gets expensive.
According to KFF’s Juliette Cubanski, as reported by AARP, no stand-alone drug plan will charge a $0 premium in 2027 for people who don’t get Extra Help. This year, 28% of Original Medicare enrollees without Extra Help were in a $0-premium plan.
The government says the average stand-alone premium is barely budging, from $35.09 a month to $36. But averages hide the people getting hit, and the $9.8 billion prop under your Medicare drug plan disappears Dec. 31.
Cubanski’s advice boils down to this: “it will pay to shop around.” And there’s good news if you do. CMS says 93% of people without Extra Help can get an enhanced drug plan for less than $6 a month.
Shopping means more than premiums, though. Enter every drug you take into Plan Finder and compare the estimated total yearly cost. A plan with a lower premium can still cost you more if your drugs land on a pricier tier.
If even the best plan leaves you staring at big pharmacy bills, it’s worth checking whether a discount beats your copay. You can compare prescription savings options here.
5. Don’t let a cheaper premium fool you
Yes, the average Medicare Advantage premium is projected to fall, from $14.37 a month to $12, according to CMS. That’s about $28 a year. As I said when Dr. Oz’s agency touted that $12 figure, it’s not your real cost.
Your real cost depends on whether your doctors take the plan.
Reuters reported that UnitedHealthcare and Aetna are shifting toward plans that limit which providers members can use. A UnitedHealth spokesperson told Reuters that 66% of its members will have access to both an HMO and a PPO next year, down from 70%.
That matters because a PPO lets you see doctors outside the network, for a higher price. An HMO generally doesn’t. When the menu tilts toward HMOs, your freedom to pick doctors shrinks.
Before you enroll, call your doctors’ offices — not the insurer — and ask whether they’ll take that specific plan in 2027. And remember that networks can change midyear. One Medicare Advantage plan just dropped a cancer hospital with four weeks’ notice.
Bottom line
CMS says about 8 in 10 Medicare Advantage members can keep their current plan in 2027 without paying a higher premium. Maybe you’re one of them.
But the same premium doesn’t mean the same doctors or the same drug costs, and coasting without looking is what insurers are counting on.
You’ve got until Dec. 7. Spend one afternoon this month comparing plans, while every plan’s door is still open.
If you’d rather not go it alone, your State Health Insurance Assistance Program, or SHIP, offers free one-on-one help. Or call 1-800-MEDICARE, which is staffed around the clock during open enrollment.
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