What are the specific changes we can expect to Medicare Advantage Plans, Supplements, and Part D prescription drug plans in 2027?

What are the specific changes we can expect to Medicare Advantage Plans, Supplements, and Part D prescription drug plans in 2027? 

This is Part 7 of my “Medicare Reset” series designed to prepare those on Medicare for the Annual Enrollment Period (AEP) that starts on October 15^th and runs through December 7^th. AEP is the only time of the year when those on Medicare can make any and all changes to their plan lineup. 

If you’re just seeing the Medicare Reset Series for the first time, I highly recommend reading it from the beginning. You can find all prior editions on our Facebook Group, Ask the Medicare Specialist, or our website, www.GetYourBestPlan.com.  

Advantage Plans

There are some significant changes to Advantage Plans here in Western Pennsylvania and throughout the country that people really need to be aware of. Because of these changes, it’s my opinion this might be the most important AEP since The Health Insurance opened in 2008.

One big change is that tens of thousands of Western Pennsylvanians, possibly over 100,000, are going to have their plan terminated. Three of the plans scheduled to end on December 31^st are the most popular among seniors. Unfortunately, due to some very antiquated regulations, I’m not allowed to mention the names of these companies or plans by name, but it’s important you look for a letter that may have already arrived in your mailbox, or will be soon, informing you of the plan termination. You can also call our office, and we can tell you if your plan is scheduled to be terminated. Those whose plan is no longer going to be available in 2027 must choose another by January 1^st or they will be returned to Original Medicare and become responsible for large Part A inpatient hospital bills, 20% of all Part B outpatient costs, and will have no prescription drug coverage. 

In other parts of the country, it’s now estimated that over 1 million people on Medicare Advantage Plans will face plan termination. As I’ve been writing about, for most people, this isn’t necessarily a bad thing because an Advantage Plan termination creates what is likely a once in a lifetime opportunity to purchase a Medicare Supplement (Medigap) policy using what are known as Guarantee Issue rights. These rights ensure access to certain Supplement letter at the “Preferred Rates” regardless of one’s current or past health issues. People who have chronic health problems, especially those who are paying large out of pocket costs on their Advantage Plan, really need to take a hard look and consider using this rare opportunity to move to a Supplement. Be aware that most agents are not going to mention this option or discourage it because when enrolling someone in a Supplement using Guarantee Issue, agents get paid little or no commission. 

There are some major changes in store for those who aren’t losing their plans. It’s extremely important to know what they are. They include the following:

• One of the most popular plans in Western PA is going to have a 7-day or longer hospital co-pay increased to over $2,000! This is more than $1,700 higher than what the co-pay was in 2026. We never advise clients to choose plans with hospital co-pays that high. We have over 1,000 clients on this plan and will be meeting with them to compare plans and choose another for 2027. 
• Many other very popular plans in Western PA as well as other parts of the country are moving from a $0 Part D drug deductible and just a $45 co-pay for Tier 3-5 drugs to a $700 deductible and monthly expenses of 25% of the drug’s retail cost after the deductible has been met. Let me put this change into perspective. Someone on Monjauro, or another expensive brand name medication, who currently has one of these plans will only spend about $400 out of pocket in 2026 for that drug. In 2027, they will be forced to pay $2,000 or more for the same medication! The problem our clients and others are facing is that in 2027 there are very few plans that haven’t increased the deductible to $700 and none with premiums under $100/month that still provide Tier 3 medications on a co-pay basis. All are now all moving to a coinsurance of 20% to 25%. There are no longer plans where we can shield people from the large increases in prescription costs without paying premiums of $130/month, a sizeable jump that would eat away much of the savings on the cost of brand name medications. The Health Insurance Store specializes in helping clients who are facing these additional costs by thoroughly comparing plans, screening them for state, federal, and private programs that can reduce or eliminate the financial burdens of medication expenses, as well as look at other alternatives and options. 
• Dental coverage on most popular plans is still strong in Pennsylvania, but in other parts of the country, coverage for fillings, crowns, root canals, dentures, etc., is being drastically reduced or eliminated.
• Advantage Plan companies are shrinking their network of doctors and hospitals, while some health systems and hospitals are choosing not to accept certain Advantage Plans. This continues to be an issue, and I believe it’s going to become more common every year. This is happening in Western PA and all over the country and it can cause great anxiety for seniors. 

Supplements (Medigap)

As far as those on Supplements are concerned, there are never any changes in benefits that increase out of pocket medical costs due to regulations that forbid it. This is one of the reasons people love Supplements and don’t leave them even when they get expensive. It’s also one of the reasons we recommend them.  Those on Supplements have had to deal with historically high premium increases the last two years, but at least they don’t have to worry about co-pays going up thousands of dollars, plans getting cancelled, or losing access to their medical providers. 

As I’ve been writing about at least once a week for months, those who are on Supplement letter plans C, F, and G should move to either Plan N or Innovative G if they’re eligible. The premium savings for those who have had C, F, or G five years or longer are from $1,000 to $4,000 a year, while the difference in out-of-pocket costs is negligible. We can get quotes for anyone interested and explain the small differences between letter plans. We’re licensed in over 20 states as well.

Stand Alone Part D

One change that actually occurred in 2025 and 2026 is Stand Along Part D plans are no longer paying agents commissions. Although we still help our clients determine which Part D plan is best for them each year, most agents will not, meaning people are on their own to choose one and that can be very difficult. I actually recorded a tutorial on choosing Stand Alone Part D. Click this link to watch the tutorial now. And if you’re going to be shopping for a less expensive Supplement for next year, let us help you do that. Not only we will help you make the right company and plan selection, but we will also advise you on Part D plans each year as well. 

As far as Stand-Alone Part D those on Supplements need to buy, there’s very good news regarding the least expensive plans that we will be advising 99% of our clients choose in 2027. There will be very little changes in benefit structure or out of pocket costs and premiums are actually going down on the most popular plan while only increasing around $10/month on the next most popular. 

The bottom line is that almost no one should be paying more than $35/month for a Stand-Alone Part D prescription plan in 2027! There’s almost no circumstance where Part D prescription plans with premiums higher than that, especially those over $100/month, make sense. Don’t get caught in the trap of thinking the lower price plans will expose you to risks of not being able to have expensive drugs covered. That’s simply not true! All Part D plans are regulated to protect consumers who get prescribed new or expensive medications. And if you become a client of ours, we get involved anytime there’s an issue with a prescription not being covered, ensuring there’s never a delay in getting necessary medications.  

For questions, or to make an appointment for a no-cost consultation with one of the agents of The Health Insurance Store, give us a call at 724-603-3403 or email me personally, Aaron@GetYourBestPlan.com.