Medicare Open Enrollment: How to Compare Plans—and Why Work Expenses May Matter

Medicare Open Enrollment runs each year from October 15 through December 7. It is your annual opportunity to review your coverage, compare costs and benefits, and make changes for the coming year. Any changes made during this period generally take effect January 1. Even if you are satisfied with your current coverage, a yearly review can help you avoid surprises when premiums, drug formularies, provider networks, or out-of-pocket costs change.

Major Medicare Changes for 2027

·        New access to certain GLP-1 drugs: Medicare’s GLP-1 Bridge offers certain weight-loss medicines to eligible people with Part D who are not already receiving Part D coverage for them. Those who qualify pay a $50 copayment for a one-month supply. This is a temporary demonstration project that will run through December 2027.

·        Expanded support for chronic conditions: The new ACCESS care model may provide eligible people with Original Medicare technology-supported services such as virtual visits, wearable devices, and lifestyle coaching, potentially at low or no cost.

·        Telehealth flexibility continues: Medicare has extended current telehealth flexibilities through December 31, 2027. The Medicare Diabetes Prevention Program also includes virtual-only providers and both live and self-paced sessions.

·        Electronic prior authorization: Beginning January 1, 2027, some Medicare Advantage plans may process prior authorization requests electronically, and decisions may be available through a patient portal.

·        Changes to plan quality ratings: CMS is refocusing Medicare Advantage and Part D Star Ratings on clinical quality, health outcomes, and patient experience, while removing some measures that provide little useful distinction between plans.

·        Updated Medicare eligibility requirements: Medicare’s 2027 handbook advises that applicants must meet applicable citizenship, nationality, or immigration-status requirements when enrolling.

These national changes do not mean every plan will offer the same benefits or costs. Premiums, deductibles, copayments, drug formularies, pharmacy arrangements, provider networks, and supplemental benefits can still change by plan and service area. Review the plan’s Annual Notice of Change and compare 2027 options in Medicare Plan Finder before making a decision. For more detail, see Medicare’s official 2027 changes fact sheet and the CMS 2027 Medicare Advantage and Part D final rule.

What You Can Change During Open Enrollment

·        Switch from Original Medicare to a Medicare Advantage plan.

·        Switch from Medicare Advantage back to Original Medicare.

·        Move from one Medicare Advantage plan to another, with or without drug coverage.

·        Join, change, or drop a standalone Medicare Part D prescription drug plan if you have Original Medicare.

How to Find a Plan That Fits

Start with Medicare’s official Plan Finder. You can enter your ZIP code to browse available health, drug, and Medicare Supplement options. If you sign in to your Medicare account, the tool can use your saved prescriptions and pharmacies to estimate plan costs more personally.

1.       List your must-haves. Write down your prescriptions, preferred pharmacies, doctors, specialists, hospitals, and any services or equipment you regularly use.

2.       Compare total yearly cost—not just the premium. Review deductibles, copayments, coinsurance, the plan’s out-of-pocket limit, and estimated prescription costs.

3.       Check the network and drug list. Confirm that your providers participate and that each medicine is covered at the expected tier. Note any prior authorization, step therapy, or quantity limits.

4.       Review quality and convenience. Consider star ratings, pharmacy access, travel coverage, referrals, telehealth, and extra benefits—but weigh extras against the medical and drug coverage you need.

5.       Ask for unbiased help. Your State Health Insurance Assistance Program can provide free, one-on-one Medicare counseling. You can also call 1-800-MEDICARE.

6.       Talk with us – Medical co-pays can have an impact on how work affect your Social Security Benefits.   Sabrina or I are happy to help you navigate the Medicare site and discuss how changes to out-of-pocket costs will impact your benefits. 

A Simple Open Enrollment Checklist

·        Review your current plan.

·        Update your medication, pharmacy, provider, and preferred-hospital lists.

·        Compare estimated annual costs under at least two or three options.

·        Verify networks and formularies directly with the plan before enrolling.

·        Gather receipts and supporting records for possible IRWE.

·        Complete any enrollment change by December 7 and save the confirmation.

Open Enrollment is a chance to make sure your coverage still works for your health, finances, and day-to-day life. Everyone’s situation is different, we are here to help you thrive.