Medicare tightens its belt
By Deborah Jeanne Post
Medicare changes for 2027 include a few painful adjustments for consumers.
Vicki James, CEO of Clear Benefits Advisors in Rochester, said one of the biggest changes subscribers will notice is the shift among Medicare Advantage PPO plans.
“We’re seeing more of these plans leaving the area,” James said.
Pay attention to any notices you have received about your plan.
“If someone gets a note their plan is terminated, if they don’t have a plan by Dec. 31, they won’t have drug coverage until they pick a plan,” James said.
One reason is that insurers are leaving or reducing their plans in the area is that they are struggling to keep PPOs profitable. For the PPO plans still available in the area, James said that insurers are reducing the benefits and increasing premiums.
“Some plans removed preventative dental care or scaled back to one cleaning a year and the other cleaning would be out-of-pocket,” she said as an example.
In some cases, insurance providers are reintroducing different plans to provide an alternative to canceled plans instead of pulling out of the region altogether.
For 2027, the mandatory maximum out-of-pocket for Advantage plans is $9,850 for in-network services and $14,800 for in-network and out-of-network for PPO plans, representing an increase of $600 from the 2026 maximum. The 2027 prescription deductible is $700. These figures represent the legal maximums; plans will differ.
Coverage for certain medications is always an ever-shifting part of Medicare coverage.
“This is the second year Medicare has negotiated prescription drug costs down, including diabetes drugs, inhalers, and GLP-1s,” James said.
The GLP-1 Bridge Program, begun July 1, 2026, will continue through December 2027.
“Those who qualify, pay $50 a month,” James said of the popular weight loss drug.
She added that the Medicare Part D Premium Stabilization Demonstration ends Dec. 31, 2026, affecting those with prescription-only plans, but no one else. Launched in 2025, the voluntary program for people with Medicare Part D reduces premiums by up to $15 and caps plan premium increases at $35.
James said that more than half of Medicare subscribers chose Advantage plans over standard Medicare alone. It’s easy to see why.
“For the last three years, all the Advantage plans had a lot of extras at no extra cost,” she said. “You’re not spending a lot on premiums as you go. Eyewear, prescriptions and dental are covered so it makes sense.”
Of course, there are a few exceptions.
James noted that people who receive maintenance treatment or high-end medication for chronic health conditions find that Advantage plans do not suit their needs as well. These might include those who receive injected medications at their doctor’s office regularly, dialysis or treatment such as chemotherapy or radiation.
Original Medicare allows subscribers to use any provider, but Advantage plans limit subscribers to in-network providers to receive the full extent of coverage. Advantage plan subscribers can use providers out of their network but they have to pay more for the visit.
Original Medicare is comprised of “parts” that are all under one umbrella in Advantage plans. Medicare Part A covers inpatient hospital and skilled nursing care, limited home care and end-of-life hospice care. Part B focuses on out-patient care such as doctors’ visits, diagnostic screenings, durable medical equipment, lab work and preventive services. Part D is separate for medication, as original Medicare does not cover prescriptions. Medigap policies can assist with Medicare deductibles and copays.
To find the right Medicare plan for your needs, visit medicare.gov/plan-compare or contact a broker.
It’s illegal for an insurance broker to call you to solicit your business unless you contact the broker first to request information.
Fewer Plans in Place
According to Mymedicareplans.org:
• In the United States, 5,561 Medicare Advantage plans from 255 insurers are offered for 2027, compared with 5,595 from 278 insurers for 2026.
• For 2027, 1,150 of the Medicare Advantage plans offered in the United States for 2026 are leaving and 1,116 are new, while 1,632 continuing plans change premium, drug deductible, plan type or name.
• The 2027 Medicare Advantage plans in the United States include 2,541 HMO, 1,142 HMO-POS, 1,827 PPO, 11 PFFS, 1 MSA and 39 Cost plans, and 1,969 of them are Special Needs Plans.