Medicare Open Enrollment for 2027 Coverage: 5 Prescription Drug Checks Before You Choose a Plan.

Your Medicare plan may cover your medications this year: But coverage and costs can change in 2027.

Your plan may change its list of covered drugs, require approval before covering a prescription, or use a different pharmacy network. These changes can affect your costs and access to vital medications.

Discovering a coverage problem in January may leave you scrambling to contact your plan, speak with your prescriber, or find out what options are available.

Medicare Open Enrollment runs from October 15 through December 7, 2026.

During this period, people who already have Medicare can review their coverage and make certain changes for 2027.

Changes generally take effect January 1, 2027.

Your current plan may still be the right choice. But before deciding to keep your current plan or switch to another option, take time to check how the coverage fits your medication needs.

You generally do not need to re-enroll to keep your current coverage if your plan will continue to be offered.

Before selecting your coverage for 2027, review these five areas.

1. Check That Your Medications Are Covered

Every Medicare prescription drug plan has a list of covered medications, called a formulary. Plans must cover a broad range of drugs, but they don’t all cover the same medications in the same way.

A medication covered by your current plan may not be covered by another plan, or it may fall into a different cost category.

Start with a current list of all your prescription medications.

Include each medication’s name, strength, dosage form (such as a tablet or inhaler), how much you take, and how often you take it. Also note the usual quantity you fill, such as a 30-day or 90-day supply, to help compare prescription costs across plans.

Then check each medication against the formulary for every plan you’re considering.

Pay attention to:

• Whether the exact medication is covered.
• Whether the plan covers the prescribed strength and formulation.
• Whether a generic alternative is available and covered.
• What cost category, or tier, the medication falls into.
• Whether the plan has any special coverage requirements.

Don’t assume that two medications used to treat the same condition will have identical coverage.

So, what if one of your medications isn’t covered?

Contact the plan to ask about its coverage rules and available options.

Your prescriber may be able to discuss an appropriate alternative or request a coverage exception when medically justified.

Don’t stop taking a prescribed medication or switch to another one on your own because of an insurance change.

You can start comparing coverage using Medicare’s official Plan Finder.

2. Look for Restrictions on Your Medications

Finding your medication on a plan’s covered-drug list is only part of the review. Some covered medications come with additional requirements.

Three common restrictions are prior authorization, step therapy, and quantity limits.

Prior authorization: This simply means your plan requires approval before it will cover a particular medication.

Your prescriber may need to provide information showing that the medication meets the plan’s coverage requirements.

Step therapy: Your plan may require you to try a different, usually less expensive medication first, before it covers the prescribed option.

Exceptions may be possible when medically appropriate.

Quantity limits: Your plan limits how much of a medication it will cover within a specified period.

For example, it may ordinarily cover only a certain number of tablets each month.

These rules can affect how easily you obtain a prescription, even when the medication appears on the formulary.

In some cases, getting a prescription covered may involve an extra step, such as obtaining approval or trying another medication first.

Reviewing these requirements ahead of time now gives you and your care team more time to understand what the plan requires and address potential coverage problems.

Before choosing a plan ask these questions:

• Will I need approval before filling this prescription?
• Does the plan require me to try another medication first?
• Are there limits on how much of my medication I can receive?
• If a restriction applies, what steps should I take before January?

If you switch plans and discover that a medication isn’t covered or has new restrictions, you may qualify for a temporary transition supply under Medicare’s rules.

However, eligibility and conditions apply, so contact the new plan to understand your options. A transition supply is not a guarantee of ongoing coverage.

Review the official Medicare guidance on prescription drug plan rules for more information.

3. Compare Your Total Annual Prescription Costs, Not Just the Premium

A plan with a low monthly premium isn’t necessarily the least expensive option for your medications. Think of the premium as the price tag, not the full cost of the purchase.

A lower price at the outset doesn’t always mean you’ll spend less overall. To compare plans fairly, look at what you may pay across the year, including the premium and the cost of your actual prescriptions.

To estimate what you might spend, consider the premium, deductible, copayments, coinsurance, and the costs of your actual prescriptions.

Here are four terms you need to understand:

• Premium: The amount you pay for your insurance coverage, usually each month.
• Deductible: The amount you may need to pay for covered drugs before your plan begins paying under its benefit rules.
• Copayment: A fixed amount you pay for a covered medication.
• Coinsurance: A percentage of the cost you pay for a covered medication.

For 2027, the maximum permitted deductible for Medicare Part D plans is $700. Some plans have a lower deductible or no deductible at all.

The annual out-of-pocket threshold for covered Part D drugs is $2,400 in 2027. Once your qualifying out-of-pocket spending, including certain payments made on your behalf, reaches this threshold, you pay $0 for covered Part D drugs for the rest of the calendar year.

Premiums, drugs not covered by your plan, and Part B drug costs do not count toward this Part D limit.

These figures provide useful context, but they don’t tell you what a particular plan will cost you.

Consider two hypothetical stand-alone Part D plans:

In this example, Plan A has the lower premium, but Plan B has the lower estimated annual total.

These figures are illustrative, not actual 2027 plan quotes.

Actual estimates should reflect the plan’s deductible and other applicable drug cost sharing, as well as the medicines and quantities you expect to fill.

The prescription estimates in this example include any applicable deductible and other drug cost sharing. These totals cover only the drug plan premium and prescription costs, not all Medicare or healthcare expenses.

Your out-of-pocket costs can also vary during the year depending on your plan’s cost-sharing rules, the medicines you fill, and your coverage circumstances, so compare estimated annual costs rather than simply multiplying one month’s prescription costs by 12.

When comparing plans, check:

• Your monthly premium.
• The deductible and when it applies.
• The cost of each covered prescription.
• Any differences in drug tiers or coverage restrictions.
• Your estimated annual prescription expenses.

Use Medicare Plan Finder to compare estimated annual costs using your medication list and preferred pharmacies.

4. Check Whether Your Preferred Pharmacy Is in the Plan’s Network

Your prescription coverage isn’t only about which medications are covered. Where you fill them can affect what you pay.

Medicare drug plans have networks of pharmacies that have agreed to provide covered prescriptions under the plan’s terms.

Some also designate preferred in-network pharmacies where certain prescriptions may cost less.

Before choosing a plan, check whether your usual pharmacy participates in the network. If the plan has preferred pharmacies, compare their costs with those at your usual location.

Consider these questions:

• Is the pharmacy convenient to reach?
• Can it reliably supply the medications you need?
• Is mail-order delivery available?
• Can you obtain a 90-day supply for any medications where that option is appropriate?
• Does the plan offer lower costs at another participating pharmacy?

A lower-cost pharmacy may be worth considering, but convenience and reliable access matter, too.

If you prefer to use a particular pharmacy, confirm its network status for the specific plan you’re considering. Don’t assume that participation in one Medicare plan means the pharmacy participates in every plan offered by the same insurer.

Read more in Medicare’s guidance on prescription drug pharmacies.

5. Review Next Year’s Changes Before December 7

If you already have Medicare coverage, don’t compare only the plans being advertised to you. Start by reviewing your current plan’s information for 2027.

Your plan should provide documents explaining changes to its coverage, costs, and rules.

Two important documents are the Annual Notice of Change and the Evidence of Coverage. Your Annual Notice of Change (ANOC) summarizes changes that take effect in January. You should receive it in September; if you have not received it, contact your plan.

Your Evidence of Coverage (EOC) explains your plan’s coverage, benefits, costs, and rules in greater detail.

Review both documents to understand what is changing and how those changes may affect you.

Look for changes involving:

• Covered medications and formulary tiers.
• Premiums and deductibles.
• Copayments and coinsurance.
• Prior authorization and other restrictions.
• Participating pharmacies and pharmacy costs.

Then compare your current plan with the other options available to you. Your drug coverage may come through a stand-alone Medicare Part D plan or through a Medicare Advantage plan that includes prescription drug coverage.

Make sure you’re comparing options that fit your current type of coverage and the changes you are considering.

If you’re considering changing Medicare Advantage plans, review the medical coverage as well as the prescription drug coverage. Compare provider networks, covered services, costs, and other benefits that matter to you.

If you’re considering switching to Original Medicare, remember that you may need to enroll in a separate Part D plan for prescription drug coverage.

Also understand that access to Medigap coverage may be limited by eligibility rules, enrollment periods, and state protections, so check your options before making the switch.

You may decide that keeping your existing plan is still the best choice. The important thing is to make that decision after reviewing the details.

If you discover a potential coverage problem, contact your plan before the enrollment deadline. If you have questions about whether a medication remains appropriate for you, speak with your prescriber or pharmacist.

Remember the key dates:

• October 15, 2026: Medicare Open Enrollment begins.
• December 7, 2026: Open Enrollment ends.
• January 1, 2027: Changes made during Open Enrollment generally take effect.

If you miss the deadline, you may have fewer options for changing your coverage. Certain circumstances can create other enrollment opportunities, so check Medicare’s official guidance if you think an exception applies.

Your Pre-Enrollment Prescription Checklist

Before you finalize your Medicare coverage for 2027, use this checklist:

• I have an up-to-date list of my prescription medications.
• I checked that each medication is covered by the plan I’m considering.
• I reviewed any prior authorization, step therapy, or quantity limits.
• I compared premiums, deductibles, and estimated prescription costs.
• I confirmed that my preferred pharmacy is in the plan’s network.
• I reviewed my current plan’s changes for 2027.
• I know whom to contact if a medication is not covered or requires additional approval.
• I have compared my available options before December 7.

You don’t have to work through every question alone. Your pharmacist or prescriber can help you understand medication-related concerns, while your plan can explain its coverage rules and costs.

Where to Get Help Comparing Medicare Plans

If you need help reviewing your options, start with these official resources.

Medicare Plan Finder: Compare Medicare plans. Enter your ZIP code, medications, and pharmacies to explore available coverage and estimated costs.

Medicare: Visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) for help understanding coverage and comparing options.

State Health Insurance Assistance Programs (SHIPs): These programs offer free, unbiased Medicare counseling. Visit SHIP’s official website to find assistance. Get free, unbiased Medicare counseling through your local SHIP.

Your pharmacist or prescriber: Contact them if a coverage change raises questions about your medications, possible alternatives, or steps needed to maintain your treatment.

Make Your 2027 Decision With Your Medications in Mind

Choosing Medicare coverage is about more than finding a plan with an attractive monthly premium. The plan also needs to work for the medications you take, the pharmacy you use, and the costs you can manage.

A careful review now can help you identify questions early, compare your options, and understand what to do if a coverage problem arises.

Before December 7, take the time to review your prescriptions, compare your available plans, and ask for help with anything you don’t understand.

The goal isn’t simply to choose a plan. It’s to choose coverage that supports your healthcare needs in the year ahead.

References

Centers for Medicare & Medicaid Services. (2026). Announcement of calendar year (CY) 2027 Medicare Advantage (MA) capitation rates and Part C and Part D payment policies. https://www.cms.gov/files/document/2027-announcement.pdf

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Medicare. (n.d.). Evidence of Coverage (EOC). https://www.medicare.gov/basics/forms-publications-mailings/mailings/costs-and-coverage/evidence-of-coverage

Medicare. (n.d.). How do drug plans work? https://www.medicare.gov/health-drug-plans/part-d/what-drug-plans-cover/how-drug-plans-work

Medicare. (n.d.). How much does Medicare drug coverage cost? https://www.medicare.gov/health-drug-plans/part-d/basics/costs

Medicare. (n.d.). Open Enrollment. https://www.medicare.gov/health-drug-plans/open-enrollment

Medicare. (n.d.). Plan Annual Notice of Change (ANOC). https://www.medicare.gov/basics/forms-publications-mailings/mailings/costs-and-coverage/upcoming-plan-changes

Medicare. (n.d.). Find the plan that works for you. https://www.medicare.gov/plan-compare/?lang=en&year=2027

Medicare. (n.d.). Drug plan rules. https://www.medicare.gov/health-drug-plans/part-d/what-drug-plans-cover/plan-rules

Medicare. (n.d.). What pharmacies can I use? https://www.medicare.gov/health-drug-plans/part-d/what-drug-plans-cover/pharmacies

Medicare. (n.d.). When can I buy a Medigap policy? https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy/when

Oscar Williams. (n.d.). Man holding pill bottles [Photograph]. Pexels. https://www.pexels.com/photo/man-holding-pill-bottles-15307047/

SHIP Technical Assistance Center. (n.d.). What we do. https://www.shiphelp.org/what-we-do/