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What's Changing in Medicare for 2027
Medicare's rules were finalized by CMS on April 2, 2026. Here's what actually matters to you — in plain English. Most changes start with coverage on January 1, 2027.
Your drug cap goes up a little
The yearly out-of-pocket limit on covered prescriptions rises from $2,100 (2026) to $2,400 (2027). The deductible moves from $615 to $700.
Expect more sales calls
CMS rolled back several marketing limits, so agents and brokers can contact you more freely starting October 2026.
Star ratings get simpler
CMS removed 11 paperwork-style measures and is adding a depression screening measure. Ratings now lean more on real care and patient experience.
Benefit debit cards tightened up
If your plan gives a flex card for groceries or over-the-counter items, it now has to confirm what's covered right at checkout, and the balance resets each plan year.
Fewer reminder letters
Plans no longer have to mail a mid-year notice about extra benefits you haven't used yet.
When the changes start
Marketing changes begin October 1, 2026. The cost and coverage changes apply to plans starting January 1, 2027.
Source: CMS Contract Year 2027 Medicare Advantage & Part D Final Rule (published April 2, 2026) and the 2027 Part D benefit parameters. Always confirm your own plan's details at medicare.gov.
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Verify before you decide: figures on this site reflect 2026 rules (with clearly labeled 2027 projections) and can change. Plan examples are illustrative. Always confirm details at medicare.gov, with 1-800-MEDICARE, or a licensed professional before enrolling.
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Medicare Basics
Everything you need to know about Medicare in plain English — start with the basics and drill down into what matters most to you.
The 4 changes worth knowing for 2027
Quick version — the details are in each section below.
Up from $2,100 in 2026. You still pay $0 after you hit it.
Marketing limits eased. Shop on medicare.gov or with SHIP.
Fewer paperwork measures; more focus on real care.
Verified at checkout; spend the balance before year-end.
Not sure where to start?
Answer one question and jump to what matters most for your situation.
Medicare Has 4 Parts
Original Medicare vs. Medicare Advantage
| Feature | Original Medicare | MA Plan |
|---|---|---|
| Monthly premium | $203 (Part B) | Often $0 |
| Out-of-pocket cap | None | $9,250 max |
| Provider choice | Any provider | Network only |
| Dental/Vision | Not covered | Usually included |
| Drug coverage | Need Part D | Usually bundled |
Common Questions
Medicare Timeline Tracker
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Find and Compare Medicare Plans
Search plans in your area, compare them side-by-side, and go directly to Medicare.gov to enroll officially.
What Would You Actually Pay Each Year?
Data updated: June 2026 Illustrative estimate — verify current plans at Medicare.gov Plan Finder.
Drag the slider to set how much healthcare you expect to use. See how Medicare Advantage and Medigap compare in real dollars.
What Star Ratings Mean for You
Medicare rates every plan 1–5 stars for quality and member experience. Source: CMS Star Ratings · updated each October
Smart Shopping Checklist
Enter Your ZIP Code to Search Plans
We will show you representative Medicare Advantage and Part D plans available in your area, sourced from CMS data.
Go Directly to Medicare Plan Finder →Medigap (Medicare Supplement) Guide
Original Medicare only pays 80% of your medical bills. Medigap is private insurance that covers the gap — the remaining 20% — so you know exactly what you will owe. Here is everything explained in plain English, sourced directly from CMS and Medicare.gov.
The Problem Medigap Solves
Original Medicare pays 80% of your approved medical costs. You pay the remaining 20% — with no annual limit. For a $100,000 surgery, that is $20,000 out of your pocket. Medigap puts a predictable cap on what you owe.
What Medigap Covers
Medigap fills in what Original Medicare leaves behind — copays, coinsurance, and deductibles. It is sold by private insurers but standardized by the federal government, so Plan G from one company covers the exact same things as Plan G from another.
What Medigap Does NOT Cover
Medigap does not cover dental, vision, hearing, long-term care, or private-duty nursing. It also does not include prescription drug coverage — you still need a separate Part D plan for medications.
One Policy Per Person
You and your spouse must each buy separate Medigap policies. One policy does not cover both of you. As long as you pay your monthly premium, your Medigap policy is guaranteed renewable every year — they cannot cancel it because your health changes.
Your 6-Month Open Enrollment Window
Starting the month you are both age 65 AND enrolled in Part B, you have a 6-month guaranteed issue window. During this time, insurers cannot deny you coverage or charge more for pre-existing conditions. Miss this window and they can reject you or charge significantly higher rates.
The 10 Standardized Medigap Plans
Every plan with the same letter covers the same benefits — no matter which company sells it. The only difference is the price. Data sourced directly from Medicare.gov.
| Benefit | Plan A | Plan B | Plan D | Plan G ⭐ | Plan K | Plan L | Plan M | Plan N ⭐ |
|---|---|---|---|---|---|---|---|---|
| Part A coinsurance & hospital costs (up to 365 extra days) | ✓ 100% | ✓ 100% | ✓ 100% | ✓ 100% | ✓ 100% | ✓ 100% | ✓ 100% | ✓ 100% |
| Part B coinsurance or copayment | ✓ 100% | ✓ 100% | ✓ 100% | ✓ 100% | 50% | 75% | ✓ 100% | ✓ 100%* |
| Blood (first 3 pints) | ✓ 100% | ✓ 100% | ✓ 100% | ✓ 100% | 50% | 75% | ✓ 100% | ✓ 100% |
| Part A hospice coinsurance or copayment | ✓ 100% | ✓ 100% | ✓ 100% | ✓ 100% | 50% | 75% | ✓ 100% | ✓ 100% |
| Skilled nursing facility coinsurance | ✗ | ✗ | ✓ 100% | ✓ 100% | 50% | 75% | ✓ 100% | ✓ 100% |
| Part A deductible (2026 amount) | ✗ | ✓ 100% | ✓ 100% | ✓ 100% | 50% | 75% | 50% | ✓ 100% |
| Part B deductible (2026 amount) | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ | ✗ |
| Part B excess charges | ✗ | ✗ | ✗ | ✓ 100% | ✗ | ✗ | ✗ | ✗ |
| Foreign travel emergency (80%, after $250 deductible) | ✗ | ✗ | ✓ 80% | ✓ 80% | ✗ | ✗ | ✓ 80% | ✓ 80% |
| Annual out-of-pocket limit (2026) | None | None | None | None | $8,000 | $4,000 | None | None |
Plans C and F Are No Longer Available to New Medicare Enrollees
If you became eligible for Medicare on or after January 1, 2020, you cannot purchase Plan C or Plan F. These plans are only available to people who were already eligible for Medicare before that date. Plan G is now the most comprehensive plan available to new enrollees, and covers everything Plan F covers except the Part B deductible (2026 amount).
Plan G vs. Plan N — The Two Best Choices for Most People
These are the most popular Medigap plans for people turning 65 in 2026.
- Covers Part A and Part B coinsurance 100%
- Covers the $1,736 Part A hospital deductible
- Covers Part B excess charges (doctors who charge above Medicare rates)
- Covers skilled nursing facility coinsurance
- 80% foreign travel emergency coverage
- Does NOT cover the $283 Part B annual deductible (you pay that)
- No drug coverage — add a separate Part D plan
- Covers Part A and Part B coinsurance 100%
- Covers the $1,736 Part A hospital deductible
- Covers skilled nursing facility coinsurance
- 80% foreign travel emergency coverage
- You pay up to $20 copay per doctor office visit
- You pay up to $50 copay for ER visits (that do not result in admission)
- Does NOT cover Part B excess charges
What Does Medigap Actually Cost?
Premiums vary by plan letter, your age, your state, and which insurer you choose. These ranges are for a 65-year-old non-smoker in 2026.
The 3 Ways Insurance Companies Set Your Premium
This is one of the most important things to understand before you buy — it affects how much you pay over your lifetime.
Community-Rated
Everyone pays the same monthly premium regardless of age. Premiums only increase due to inflation or other general factors — not because you get older. Best long-term value if you plan to keep the policy for many years.
Issue-Age-Rated
Your premium is based on your age when you first buy the policy and stays lower over time compared to attained-age pricing, though it can still increase for inflation. Good middle ground — lock in a lower rate by buying at 65.
Attained-Age-Rated
Your premium increases as you age. Starts cheapest of all three methods, but becomes the most expensive over time. A 65-year-old paying $90/month may pay $238/month by age 75. Most common — know what you are buying.
Important Medigap Rules from CMS
Guaranteed Renewable for Life
As long as you pay your monthly premium, your Medigap policy must be renewed every year. The insurance company cannot cancel it because your health gets worse or because you file too many claims.
Same Benefits, Different Prices
Federal law requires that all plans with the same letter cover the exact same benefits. Plan G from UnitedHealthcare and Plan G from Mutual of Omaha cover identical services. The ONLY difference between them is the monthly price — so always shop around.
No Drug Coverage
Medigap plans sold after 2005 do not include prescription drug coverage. You must enroll in a separate Medicare Part D drug plan. If you have Medigap, you cannot join a Medicare Advantage plan — the two do not work together.
Foreign Travel Emergency Coverage
Most Medigap plans (D, G, M, N) cover 80% of emergency medical care outside the United States, after a $250 annual deductible. Your lifetime maximum for this benefit is $50,000. Original Medicare alone provides no coverage outside the U.S.
3 Special Enrollment Situations
Outside your open enrollment period, you generally have guaranteed issue rights if: (1) your Medicare Advantage plan leaves your area, (2) you move out of your plan service area, or (3) your plan commits fraud. In these cases, insurers must sell you certain plans without health questions.
Medigap vs. Medicare Advantage — You Must Choose One
You cannot have both a Medigap policy and a Medicare Advantage plan at the same time. If you switch from Original Medicare to Medicare Advantage, your Medigap coverage is useless since Advantage replaces Medicare — and you may not be able to get Medigap back later.
Compare Medigap Plans in Your Area
Medicare.gov has a free tool to compare Medigap plans and estimated premiums available in your ZIP code from every licensed insurer in your state.
Medigap Questions, Answered Simply
Medicare Advantage (Part C) Guide
Medicare Advantage is the private-plan path: one plan that replaces Original Medicare and usually bundles drug coverage plus extras like dental and vision. More than half of people on Medicare choose it. Here is how it really works — the good and the trade-offs — in plain English.
One Plan Instead of Several
With Medicare Advantage, a private insurance company takes over your Part A (hospital) and Part B (medical) coverage. Most plans also include Part D drug coverage. You still pay your Part B premium to Medicare, plus any plan premium.
Extra Benefits Original Medicare Lacks
Most plans add dental, vision, hearing, gym memberships, and over-the-counter allowances. These extras vary a lot between plans, and coverage limits can be modest — always read the details before you count on them.
The Trade-Off: Networks
You must generally use the plan’s network of doctors and hospitals. Going outside the network costs more — or is not covered at all. If keeping a specific doctor matters to you, call their office and confirm they accept the exact plan before you enroll.
Built-In Spending Cap
Unlike Original Medicare alone, every Medicare Advantage plan has a yearly limit on what you pay for covered medical care (up to $9,250 in-network in 2026). After you hit the cap, the plan pays 100% for the rest of the year.
HMO vs. PPO — The Two Main Flavors
About 95% of Medicare Advantage members are in one of these two plan types. The difference is how strict the network is.
- Usually the lowest premiums and copays
- One primary doctor coordinates your care
- Must stay in network (except true emergencies)
- Usually need a referral to see a specialist
- Can see out-of-network doctors (you pay more)
- No referrals needed for specialists
- Premiums and copays usually higher than HMO
- Out-of-network care counts toward a higher spending cap
“$0 Premium” Does Not Mean $0 Cost
About 3 in 4 Medicare Advantage members pay no plan premium. Here is what you can still pay — and why the out-of-pocket maximum matters more than the premium.
What you still pay with a $0-premium plan
Illustrative ranges from CMS plan data. Your plan’s numbers will differ — check the Evidence of Coverage.
The rule of thumb
In a healthy year, a $0-premium Medicare Advantage plan is usually the cheapest way to have Medicare.
In a serious-illness year (cancer treatment, major surgery, a long hospital stay), copays stack up fast — you could pay several thousand dollars, up to the plan’s yearly cap.
So compare plans by the worst-case yearly cost (premium × 12 + out-of-pocket maximum), not the monthly premium. A lower cap is often worth a small premium.
Drug Coverage and Prior Authorization
Drug coverage is built in — usually
Most MA plans (called MA-PD plans) include Part D drug coverage. The yearly out-of-pocket drug cap applies here too: $2,100 in 2026, rising to $2,400 in 2027. After you hit it, covered drugs cost $0 for the rest of the year.
Every plan has its own drug list (a formulary) with pricing tiers. The same pill can cost $2 on one plan and $47 on another.
Prior authorization: approval before care
Prior authorization means the plan must approve certain care — like scans, surgeries, or nursing-home stays — before it pays. Nearly all MA plans use it for some services. Original Medicare rarely does.
Current CMS rules require plans to answer urgent requests within 72 hours and standard requests within 7 days, and to give a written reason for any denial.
When Medicare Advantage Is a Good Fit — and When It Is Not
Often a good fit if you…
- Want low or $0 monthly plan premiums
- Live in one area most of the year
- Are flexible about which doctors you see
- Want dental, vision, and hearing in one plan
- Are comfortable reviewing your plan every fall
Think twice if you…
- Must keep specific specialists (cancer, heart, transplant care)
- Travel often or live in two states — networks are local
- Have complex health needs and want no approval hurdles
- Want fixed, predictable costs no matter how sick you get
- May want Medigap later — switching back can require health underwriting
How to Compare Medicare Advantage Plans — 6 Steps
Medigap or Medicare Advantage? Side by Side
This is the #1 question people turning 65 ask. There is no single right answer — it depends on your health, budget, doctors, and travel. Here is an honest comparison.
| What matters | Original Medicare + Medigap + Part D | Medicare Advantage |
|---|---|---|
| Monthly cost | Higher — roughly $340–$460/month all-in (Part B + Medigap + Part D) | Lower — often just the $202.90 Part B premium |
| Cost predictability | Very predictable — almost no surprise bills after premiums | Varies — copays add up when you use care, up to $9,250/year |
| Doctor choice | Any doctor in the U.S. who accepts Medicare (most do) | Plan network only; out-of-network costs more or is not covered |
| Referrals & prior approval | Rarely needed | Common — many services need plan approval first |
| Travel & snowbirds | Works nationwide; most plans add foreign emergency coverage | Local networks; emergencies covered, routine care away from home often is not |
| Dental, vision, hearing | Not included — buy separately | Usually included (limits vary) |
| Drug coverage | Add a separate Part D plan (~$35/month average) | Usually built in |
| Switching later | Can move to Medicare Advantage any fall, no health questions | Moving to Medigap later usually means health underwriting — you can be denied or charged more |
In plain words: Medigap costs more every month but protects you from big bills and lets you see almost any doctor. Medicare Advantage costs less every month but uses networks, requires approvals, and can cost thousands in a bad health year. The switch back to Medigap gets harder the longer you wait.
Three Common Situations
“I see specialists and want zero surprises.”
If you manage ongoing conditions, travel to see family, or simply want bills you can predict — then consider Original Medicare + Medigap Plan G + Part D. Buy Medigap in your first 6 months on Part B, when no one can turn you down.
“I’m healthy and watching my budget.”
If you rarely see doctors, stay local, and the Medigap premium feels steep — then consider a 4-star-or-better $0-premium Medicare Advantage plan with a low out-of-pocket maximum. Just re-check your plan every fall.
“My income is limited.”
If you have Medicaid, or your income is under about $1,800/month — then check D-SNP eligibility first. A Dual Special Needs Plan can bundle rich benefits at $0, and Extra Help cuts drug costs. See our .
Not sure which way to lean?
Answer 8 quick questions about your health, doctors, travel, and budget. You will get a plain-English recommendation — no email or account needed.
Medicare Advantage Questions, Answered Simply
D-SNP Guide: Extra Coverage at $0 for Dual Eligibles
If you qualify for both Medicare and Medicaid, a Dual Special Needs Plan (D-SNP) can bundle everything into one plan — usually at $0 per month, with dental, vision, transportation, and a care coordinator. About 4.8 million people are enrolled, and many more qualify without knowing it.
Who Qualifies for a D-SNP?
You qualify if you have both Medicare (Part A and/or B) and help from your state’s Medicaid program. This is called being “dual eligible.”
You likely qualify if…
- You already have a Medicaid card from your state
- Your income is roughly under $1,500–$1,800/month (single — limits vary by state)
- Your savings are limited (many states also look at assets)
- A Medicare Savings Program already pays your Part B premium
Even partial help counts. If your state pays only your Part B premium, many D-SNPs will still accept you.
How to check — three free ways
What a D-SNP Covers
Everything a regular Medicare Advantage plan covers, plus extras designed for people with limited income — usually at $0.
In plain words: if you qualify, a D-SNP almost always gives you more coverage for less money than any other Medicare choice. The trade-off is the same as any Medicare Advantage plan — you use the plan’s doctor network.
Extra Help (LIS): Big Drug Savings
Extra Help — also called the Low-Income Subsidy (LIS) — is a separate federal program that slashes Part D drug costs. Most D-SNP members qualify automatically.
What Extra Help gives you (2026)
Worth an estimated $6,200 per year on average, per the Social Security Administration.
How to get it
If you have Medicaid, an MSP, or SSI, you get Extra Help automatically — no application needed.
Otherwise, apply free in about 15 minutes at ssa.gov or by calling Social Security at 1-800-772-1213. Since 2024, one income limit (about 150% of the federal poverty level) gets you the full benefit.
You Can Enroll or Switch Almost Any Time
Unlike most people on Medicare, dual eligibles are not locked into the fall enrollment window.
Monthly Special Enrollment Period
If you have Medicare and Medicaid (or Extra Help), you can join a D-SNP or switch to a different one once per month in most cases, with coverage starting the first of the next month. If you just became dual eligible, you can enroll right away — no waiting for October.
Keep Your Medicaid Active
Your D-SNP depends on staying Medicaid-eligible. Complete your state’s Medicaid renewal paperwork every year, on time. If you lose Medicaid, the plan gives you a grace period to fix it — act fast and call your care coordinator or SHIP counselor.
How Medicare and Medicaid Work Together
Check Your Eligibility — It Is Free
Millions of people qualify for dual-eligible benefits and never claim them. Ten minutes with your state Medicaid office or a SHIP counselor can be worth thousands of dollars a year.
D-SNP Questions, Answered Simply
Plan Your Retirement and Medicare Together
Medicare and retirement go hand in hand. Here is a clear, plain-English roadmap covering everything from age 60 to your first years on Medicare — so nothing catches you off guard.
Step-by-Step: Ages 60 to 67
The actions you take at each age directly affect your Medicare coverage and retirement income. Here is what to do and when.
- Get a Social Security statement at ssa.gov to understand your projected benefit
- List all current prescriptions — this shapes your Part D choice
- 👨⚕️ Identify all doctors and specialists you want to keep
- Understand that income above $106,000 triggers higher Medicare premiums (IRMAA)
- Review your income for the next 2 years — IRMAA brackets are based on MAGI
- Consider Roth conversions carefully — they increase MAGI and can trigger IRMAA
- Speak with a financial advisor about income timing and Medicare cost implications
- 🆓 Schedule a free SHIP counseling session for Medicare-specific guidance
- Use medicare.gov/plan-compare to preview plans in your area
- 👨⚕️ Call each of your doctors — ask if they accept Medicare and which plans
- Check your drugs on each plan's formulary at medicare.gov
- If choosing Original Medicare, get Medigap quotes from 3+ insurers
- Note your enrollment window: starts 3 months before your 65th birthday month
- Enroll in Parts A and B at ssa.gov (fastest) or call 1-800-772-1213
- Enroll in Medicare Advantage OR choose Original Medicare + Medigap
- Enroll in Part D drug plan (even if healthy — avoid the penalty)
- Enroll in Medigap during your 6-month guaranteed issue window
- Schedule your free "Welcome to Medicare" preventive visit
- Your full retirement age: age 67
- Each year you delay Social Security past 67 increases your benefit by ~8%
- Review your Medicare plan every October 15–December 7 (Annual Enrollment Period)
- Check if your plan benefits changed — premiums, drugs, and networks update annually
Budget for Medicare as a real retirement expense. The average retiree spends $6,000–$12,000 per year on Medicare premiums, copays, and out-of-pocket costs depending on plan choice and health needs.
How Retirement Decisions Affect Your Medicare
These relationships trip people up. Know them before you retire.
Income Affects Your Premiums (IRMAA)
If your income exceeds $106,000 (individual) or $212,000 (couple), you pay a surcharge called IRMAA on top of your standard Part B and Part D premiums. It is based on your income from 2 years ago, so retirement income planning matters.
Still Working? Your Employer Coverage Matters
If you or your spouse has employer coverage at a company with 20+ employees, you can delay Medicare without penalty. But if the employer has fewer than 20 employees, Medicare becomes primary at 65 — sign up to avoid gaps.
Social Security Timing and Part B
If you take Social Security before 65, you are automatically enrolled in Medicare at 65. If you delay Social Security, you must actively sign up for Medicare during your enrollment window — it is not automatic.
HSA Contributions Must Stop at 65
Once you are enrolled in Medicare, you cannot contribute to a Health Savings Account (HSA). However, you can still use your existing HSA balance to pay Medicare premiums, copays, and out-of-pocket costs — a great tax-free way to fund healthcare in retirement.
Missing Enrollment = Permanent Penalty
There is no undo button. Missing your Initial Enrollment Period adds 10% to your Part B premium permanently for every 12 months you delayed. Missing your Medigap window means insurers can charge you more based on health. The calendar matters.
Long-Term Care Is NOT Covered by Medicare
Medicare does not pay for long-term custodial care (help with daily activities in a nursing home). This is one of the biggest financial surprises in retirement. Consider long-term care insurance or a hybrid life/LTC policy well before you need it.
Need Help Putting It All Together?
A free SHIP counselor can walk you through both Medicare and retirement planning — at no cost and with zero sales pressure. They are trained specifically to help people in your situation.
Find Your Best Medicare Path
Answer 8 quick questions about your health, travel, and budget. Get a personalized recommendation in under 3 minutes.