Medicare Open Enrollment: Check Your Drug Coverage for 2027

What can change on January 1

Three kinds of change can reach your prescriptions.

Changes to your drug. Your plan can drop a medicine from its list, change what you pay for it, or add rules to it. The Annual Notice of Change lists them.

Changes to the plan’s price. The national base premium that Part D premiums are built from rises 6%, from $38.99 to $41.33 a month, according to CMS. Plans set their own premiums, so yours may differ. CMS is also ending, after 2026, the federal demonstration that was used to hold Part D premiums down, so check the premium as well as your drug’s price.

Changes to the standard benefit. The yearly out-of-pocket maximum rises from $2,100 to $2,400 in 2027, and the highest deductible a plan can charge rises from $615 to $700. Some plans charge less than the highest deductible. Our payment plan article explains how the out-of-pocket maximum works.

Check your medicines in four steps

1. Gather the list. For each medicine, write down the name, strength, form (tablet, pen, injection) and how much you take. Add the pharmacy you use. Plan Finder at medicare.gov/plan-compare uses these to estimate what you would pay.

2. Look for each medicine on the drug list. Medicare calls a plan’s list of covered drugs its formulary. Look up the exact version you take, since brand-name and generic versions may be treated differently.

3. Look for rules. Medicare.gov names three that plans can attach to a drug:

• Prior authorization. You or your prescriber must get the plan’s approval before it covers the drug.
• Step therapy. You must try a less expensive drug on the plan’s list first.
• Quantity limits. The plan covers only a set amount over a set time, such as 30 tablets a month.

Any of these can delay or block a fill. If one is a problem, you or your prescriber can ask the plan for an exception. For prior authorization or step therapy, your prescriber has to supply a supporting statement, so tell the doctor’s office early. How to request an exception walks through it. Medicare.gov also says that when your coverage begins you may get a one-time 30-day supply of a drug the plan would otherwise block.

4. Check the pharmacy. Confirm your pharmacy is in the plan’s network. Some plans give discounts or cover drugs only at network pharmacies. If you travel often, check that you can fill prescriptions where you go.

Then compare plans on the yearly total that Plan Finder estimates for your medicines, not on the premium alone.

If you miss December 7

The second chance depends on how you get your Medicare.

• You are in a Medicare Advantage plan. From January 1 to March 31 you get one change. You can switch to another Medicare Advantage plan, with or without drug coverage, or drop to Original Medicare. If you go back to Original Medicare, you can then join a drug plan. The change starts the first day of the month after the plan gets your request.
• You have Original Medicare and a separate drug plan. The January to March window does not let you switch drug plans, or add one. A few situations open a special enrollment period, and Medicare lists them on its Special Enrollment Periods page. Otherwise, the next chance is the following October.

If you get coverage through a current or former employer or a union, contact its benefits administrator before you change anything. Joining a Medicare plan can affect that coverage.

When the best plan still costs too much

Some medicines stay expensive on every plan. Enrollment season is a good time to look up the help that exists for those, while you are already reading the numbers.

Each drug page on mendmeds lists the assistance programs we know about, with income limits and a source for each. Which kind of help fits your insurance is covered in our copay card guide. If your income and savings are limited, read about Extra Help first, and does Medicare cover your medication walks through the rest of the options.