Medicare Open Enrollment is your annual opportunity to take a fresh look at your healthcare coverage. But choosing a plan isn't just about finding the lowest premium.
Every fall, Medicare beneficiaries receive advertisements, mailers, emails, and phone calls encouraging them to review their Medicare coverage. With so many plans and benefits being promoted, it can be tempting to focus on the plan with the lowest premium, the most impressive extra benefits, or the best television commercial.
But there is a much more important question to ask:
Will this plan work for me and the way I actually use healthcare?
Medicare Open Enrollment for 2027 runs from October 15 through December 7, 2026. During this period, eligible beneficiaries can make certain changes to their Medicare Advantage or prescription drug coverage, or switch between Original Medicare and Medicare Advantage. Changes made during Open Enrollment generally take effect January 1, 2027.
That makes the fall a perfect time to stop and look beyond the advertising.
Here are 10 things I recommend checking before choosing a Medicare plan for 2027.
1. Are Your Doctors Still in the Plan's Network?
This should be one of the first questions you ask.
If you have doctors you know and trust, don't assume they will remain in-network simply because they accepted your insurance company last year.
This is especially important with Medicare Advantage plans.
A doctor's office may participate with several plans offered by the same insurance company but not every plan. In other words, saying "My doctor takes UnitedHealthcare" or "My doctor takes Aetna" isn't always enough.
You need to verify that your doctor participates with your specific plan.
And don't forget your specialists.
If you regularly see a cardiologist, oncologist, orthopedic specialist, neurologist, or another specialist, check each one.
Tip: Call the doctor's office and give them the exact name of the plan you are considering. Ask whether the provider is in-network for that specific plan for 2027.
2. Is Your Preferred Hospital in Network?
Your doctor's network and your hospital's network aren't necessarily the same thing.
Before changing plans, check the hospitals and health systems you are most likely to use.
Think about where your doctor has hospital privileges and where you would want to receive care if you needed:
- Surgery
- Hospitalization
- Emergency care
- Cardiac procedures
- Cancer treatment
- Imaging
- Outpatient procedures
A plan that looks attractive on paper may become much less attractive if your preferred hospital is out-of-network or significantly more expensive under that plan.
4. Don't Look at Prescription Costs One Month at a Time
This is an easy mistake to make.
A plan might advertise a low monthly premium or a low copay for certain medications, but your total prescription costs over the entire year are what really matter.
When comparing plans, look at the estimated yearly cost, including premiums, deductibles, and medication costs.
If you take several medications or expensive brand-name drugs, this can make a significant difference.
6. Find Out the Plan's Maximum Out-of-Pocket Amount
This is one of the numbers I don't want patients to overlook.
Medicare Advantage plans have an annual maximum out-of-pocket amount for covered Medicare services. Once you reach the plan's limit, the plan generally pays 100% of covered services for the remainder of the year.
The maximum can vary from plan to plan.
If you have a chronic medical condition or anticipate needing significant medical care, this number deserves your attention.
Don't just ask, "How much is my premium?"
Ask:
"What is the most I could potentially have to pay for covered medical care in a year?"
8. If You Travel, Check the Coverage Area
Do you spend part of the year in another state?
Do you travel frequently?
Do you live in one state but spend several months each year somewhere else?
If so, network restrictions may become particularly important.
Original Medicare generally allows you to see any doctor or hospital that accepts Medicare anywhere in the United States. Medicare Advantage plans may have networks and service areas, although the rules vary by plan.
Before changing coverage, make sure you understand what happens if you need routine care while you're away from home.
Emergency and urgent care are different from routine care, so make sure you understand those distinctions as well.
9. Read Your Annual Notice of Change
If you're already enrolled in a Medicare Advantage or Part D plan, don't throw away the Annual Notice of Change, often called the ANOC.
This document is mailed to beneficiaries before Open Enrollment and explains important changes to the plan for the upcoming year.
Your plan may change:
- Premiums
- Deductibles
- Copayments
- Prescription coverage
- Drug tiers
- Provider networks
- Benefits
- Coverage rules
A plan that worked well for you in 2026 may not be the same plan in 2027.
Don't assume "no news is good news."
Read the notice.
3. Are Your Prescription Drugs Covered?
If you take prescription medications, don't simply look at the plan's monthly premium.
Make a list of every medication you take, including the dosage and how frequently you take it.
Then check:
Is the medication covered?
What tier is it on?
Is there a deductible?
Is prior authorization required?
Is step therapy required?
Are there quantity limits?
Is your preferred pharmacy in-network?
Would using mail order save money?
A medication that is inexpensive under one plan can cost substantially more under another.
Medicare recommends entering your prescriptions when comparing plans so you can estimate your annual drug costs.
5. Compare Your Out-of-Pocket Costs
The monthly premium is only one piece of the puzzle.
Think about the healthcare services you actually use.
For example, if you regularly see specialists, receive diagnostic testing, have physical therapy, or anticipate a procedure in the coming year, find out what you will pay for those services.
Look at:
- Primary care copays
- Specialist copays
- Diagnostic testing
- Imaging
- Outpatient procedures
- Hospital stays
- Emergency room visits
- Ambulance services
- Physical therapy
- Durable medical equipment
A plan with a slightly higher monthly premium may ultimately cost you less if you use healthcare frequently.
7. Understand Referrals and Prior Authorization
This is particularly important if you regularly see specialists or receive diagnostic testing.
Some Medicare Advantage plans may require referrals before you see certain specialists.
Plans may also require prior authorization before they will cover certain services, tests, procedures, medications, or treatments.
Prior authorization doesn't necessarily mean a service won't be covered. It means the plan may require approval before the service is performed.
And this is where things can become frustrating for patients.
If a service requires prior authorization and the authorization isn't obtained correctly, the claim may be denied.
So when comparing plans, don't just ask what is covered.
Ask:
"What hoops will I have to go through to actually receive that care?"
10. Compare the Total Cost—Not Just the Premium
This may be the most important advice I can give you.
A plan with a $0 monthly premium isn't necessarily the least expensive plan.
If you rarely use healthcare, a low-premium plan may work very well for you.
But if you see several specialists, take multiple medications, have frequent diagnostic testing, or anticipate surgery or other significant medical care, you need to look at the total cost of using the plan.
Consider:
Premium + deductible + copays + coinsurance + prescription costs + potential out-of-pocket exposure
That's a much more useful comparison than simply asking which plan has the lowest monthly premium.
One More Step: Talk to Your Doctor's Office
As someone who works in medical billing, this is one step I especially encourage patients to take.
Don't rely exclusively on an insurance company's website to determine whether your doctor participates with a plan.
Call your doctor's office.
Give them the exact plan name you're considering and ask:
"Does this doctor participate with this specific Medicare plan for 2027?"
You can also ask whether the office is aware of any network changes for the upcoming year.
And remember that your doctor's participation doesn't necessarily mean every hospital, laboratory, imaging center, or other provider you use participates with the same plan.
What If You're Thinking About Leaving Medicare Advantage?
This deserves extra attention.
During Open Enrollment, you can switch from a Medicare Advantage plan to Original Medicare.
But don't think of the decision as simply:
Medicare Advantage → Original Medicare
There may be other pieces you need to consider, including prescription drug coverage and Medicare Supplement Insurance, commonly called Medigap.
If you switch to Original Medicare, you may want a Medigap policy to help cover certain out-of-pocket costs. However, there are rules and limitations regarding when you can obtain Medigap coverage and what protections apply to you.
Before leaving a Medicare Advantage plan, make sure you understand what coverage you will have on January 1—not just what coverage you are leaving behind.
If you're considering making this type of change, Medicare.gov and your state's State Health Insurance Assistance Program (SHIP) can provide helpful, unbiased information.
Don't Wait Until December 6
Medicare Open Enrollment runs from October 15 through December 7.
But I don't recommend waiting until the deadline.
Start gathering your information early.
Make your list of doctors.
Make your medication list.
Review your Annual Notice of Change.
Check your preferred hospitals and pharmacies.
Then compare the plans available in your area.
And remember: You don't have to choose a plan simply because it has the lowest premium or the most attractive extra benefits.
The best plan is the one that fits your healthcare needs, your providers, your medications, and your budget.
Final Thought
Medicare can be complicated.
Insurance companies may make choosing a plan sound as simple as selecting the plan with the lowest premium or the most benefits.
It isn't always that simple.
Your healthcare is personal. Your doctors are personal. Your medications are personal. And the way you use healthcare is different from the person sitting next to you.
Don't choose your Medicare coverage based on an advertisement. Choose it based on how you actually use healthcare.
That's what being an empowered patient is all about.
Helpful Medicare Resources
For official information, plan comparisons, and enrollment assistance, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227).
You can also contact your state's State Health Insurance Assistance Program (SHIP) for free, personalized, unbiased Medicare counseling.
Sources: Medicare.gov, Centers for Medicare & Medicaid Services (CMS).