As we move through the fourth quarter, many of us are focused on finishing the year strong—reviewing our goals, preparing for the year ahead, and making sure we haven’t overlooked anything important. But there’s another area that deserves our attention this time of year: our health coverage.

Open enrollment begins on November 1 in most states, which means now is the time to assess your family’s health insurance needs. And that is why I asked my friend, Bonnie Dobbs, to write this week’s article for the Fourth Quarter Playbook.  

Bonnie is an author, speaker, and founder of Insurance and Other Red Tape, LLC, a brokerage agency specializing in Medicare and Medicaid coverage. In her article below, Bonnie answers some of the most common questions about Medicare enrollment, plan changes, and more. Her practical insights will help you understand what to look for, which questions to ask, and why it’s important not to make assumptions about your coverage.

I encourage you to take a few minutes to review Bonnie’s advice today, even if you are not currently enrolled in Medicare—perhaps you will learn something that helps a loved one or neighbor. Health care planning is just like everything in business: a little preparation in Q4 can make a meaningful difference in the future.

What’s New With Medicare Coverage in 2027

By Bonnie Dobbs, Insurance and Other Red Tape, LLC

Medicare open enrollment is Oct. 15-Dec. 7. Let’s take a look at some frequently asked questions about the changes happening in 2027.

How will Part D be affected when the government subsidy ends?

After 2026, President Donald Trump’s administration is ending a subsidy program ⁠that reduced premiums for Medicare prescription drug plans. According to Centers for Medicare & Medicaid Services Administrator Mehmet Oz, this temporary program benefited the insurance companies. Now, the insurance companies will pass the cost of premiums to beneficiaries, and costs could vary greatly from plan to plan.

That subsidy was part of the Part D Premium Stabilization Demonstration that was introduced in response to the 2022 Inflation Reduction Act. Annual Part D premiums may not increase more than 6% each year through 2029, but that doesn’t include additions to the premiums. This is for standalone Part D only. Medicare Advantage plans offering Part D are not affected.

For 2027, the Part D deductible has risen to $700 annually with $2,400 maximum amount of pocket. 

 

With an expected 3 million plans existing in the Medicare Advantage market, what should I do if my plan is terminated?

If you receive a non-renewable notice, this is an opportunity, and you have options. You can enroll in a Medicare Supplement plan with a one-time opportunity to bypass medical underwriting. That’s right — you qualify for guaranteed issue with no medical underwriting!

Or, you can compare all Advantage plans in your service area and enroll in a new plan. These notices must be mailed no later than Oct. 2, giving you plenty of time to make a new decision. So, there’s no need to worry.

 

Why is reading the annual notice of change important this year?

It’s important to know whether your plan has been terminated. It breaks down the costs of your benefits and what extras like dental, gym or Part B reduction will look like for 2027. The annual notice of change simplifies by line item the annual deductible, the cost for each benefit, the tier cost for each medication, and the total maximum out-of-pocket, also known as MOOP.  

When choosing a plan, check all providers and your medications to confirm they will be covered. If your meds are not in the formulary, the insurance company may not offer that medication or may charge a higher co-pay.

 

How can I have a Part D with a $0 premium?

You may not be paying a premium for your drug plan, but the federal government is; they’re subsidizing that payment. After 2029, that may change.

 

What is happening to my Advantage plan?

The U.S. Centers for Medicare and Medicaid Services (CMS) allows Medicare Advantage companies to submit an enrollment capacity.   This allows carriers to put a ceiling on the number of enrollments. And, once they reach that magic number of new enrollments, that’s it. They are not required to accept more. 

 

Why is my Part B premium so expensive and my friend pays $0?

Part B has a premium that is implemented when you become Medicare eligible; it is based on income. Low-income beneficiaries, which include those on Medicare and Medicaid, pay $0 premium.  Middle income beneficiaries pay $202.90 per month in 2026 and high-income earners pay more. This year, if your 2024 tax return is higher than $109,000 if single-filing or $218,000 if married filing jointly, you will pay more. Visit medicare.gov to confirm the latest increases for 2027 as they have not been released as of this writing.

 

Which is better: Advantage Plans or Medicare Supplement plans?

Once you become Medicare eligible, you have two options for additional coverage. An Advantage or Supplement plan.  With an Advantage plan, you may or may not have a monthly premium and if you do, it is usually low. The drug plan is embedded in the plan. Usually, they have additional benefits like dental, vision, hearing, gym membership, over-the-counter and sometimes food cards. But the limitations are service-area specific, and they may limit you to certain providers. They also require prior authorization for your care, like tests and procedures. Once you are on an Advantage plan, the insurance company, not original Medicare, makes the decisions on approving or not.

Medicare Supplement plans have a monthly premium; you can use these plans anywhere in the U.S. and some offer foreign travel, but they do not have the drug plan built in. The monthly premium may be tough for those depending on Social Security as their only income. A stand-alone prescription drug plan must be added to eliminate a lifelong Part D penalty. The good news is that you have the flexibility to see any provider if they accept Medicare. 

 

What happens if I don’t sign up at a certain time? Can I sign up too early or too late?

While you can enroll up to three months before you turn 65, it may not be necessary based on your existing health coverage. You may end up unnecessarily paying premiums and other out-of-pocket expenses. I’ve seen several people pay thousands of dollars simply because they signed up before they needed to.

On the other end of the spectrum, those enrolling too late will incur a lifelong penalty. Please use a Medicare broker to confirm the correct time to enroll. And remember your situation is unique to you. Timing is everything and guessing can be an expensive hobby!

 

Can Medicare discontinue coverage in a skilled nursing facility (SNF) if the patient is not progressing, but maintaining and still in need of skilled nursing?

Yes, if a patient is plateauing and not progressing, coverage can stop. Part A is for short-term stays in a skilled nursing facility. If a patient’s care shifts and only requires help with daily activities like eating, dressing and bathing, Medicare will discontinue paying.  Also, if a patient refuses to participate in prescribed therapy, coverage will end.

 

Will Medicare pay for my husband’s nursing home or provide someone to come to my home and watch him while I go grocery shopping?

No. Medicare is health insurance and does not pay for housing or sitting or companion services.

 

I am working past 65. When should I enroll in Medicare?

It depends on your situation. If you or your spouse has employer coverage and the company has 20 or more employees, that is considered Medicare equivalent coverage. You can remain on the employer’s coverage and transition when you retire. If the employer does not have at least 20 employees, you must enroll in Medicare when you first become eligible. There are penalties if you miss those enrollment dates, whether you need to enroll when you turn 65 or if you are retiring past 65. You can call my office, and we can advise you accordingly.

 

I enrolled in a Medicare Advantage plan, and now I have changed my mind and want to enroll in a Medicare Supplement plan. When can I change?

During the first six months when you become Medicare eligible, you can enroll in any Medicare Supplement plan available with no medical underwriting. Thereafter, you must pass medical underwriting. You can send an application during annual enrollment, and if you pass underwriting, you can add a prescription drug plan. There are other times you can qualify for guaranteed issue, too. If you are on a Medicare Advantage plan and move out of your service area, or if your Advantage plan is terminated, or the company goes out of business, those are called special election periods. During a special election period, you have a one-time opportunity to switch from an Advantage to a Supplement plan.

---

Celeste Giordano’s mission is to help business professionals develop the skills, knowledge and attitude necessary to “DoublePlus™” their income and become effective and inspirational leaders in their fields. Whether it’s taking your successful business to the next level or starting a new venture, she will teach you the exact skills and strategies you need to enroll more quality prospects, build a rock-solid team, and break through obstacles to achieve real profit and lasting success. Celeste is a professional business growth specialist, a master sales strategist, and dynamic speaker with more than 40 years experience in direct sales and managing high-performing teams. To learn more about Celeste, click here. Want to use this article? Please feel free to use this content as long as you keep it in its original format and include a link to the original post and Celeste Giordano’s brief bio.