Medicare Open Enrollment Starts Today. Expect Network and Formulary Questions From Your Patients.
Open enrollment runs Oct. 15 through Dec. 7. CMS projects a 16.5 percent drop in the average Medicare Advantage premium for 2027, but premium averages say little about whether your patients keep their physicians and drugs.
Medicare open enrollment begins today and runs through Dec. 7. For the next eight weeks, front desks and clinical staff will field questions from patients about whether their physician, specialist or medication is covered next year.
The Centers for Medicare and Medicaid Services (CMS) published its 2027 projections on Sept. 28. Its headline numbers are favorable. The practical effect for a clinic depends on the plans in your own market.
What CMS projects
CMS projects that the weighted average monthly Medicare Advantage premium, including plans with drug coverage and special needs plans, will fall from $14.37 in 2026 to $12.00 in 2027, a 16.5 percent decline. Based on plan projections, it expects enrollment of 34 million, about 47.4 percent of people with Medicare, and notes that plan projections have historically understated actual enrollment. The number of Medicare Advantage plans is expected to change little, from 5,553 to about 5,532.
For stand-alone Part D plans, CMS projects the average monthly premium will rise from $35.09 to $36. The agency says the Part D market is returning to normal conditions after the narrowing of the voluntary Part D Premium Stabilization Demonstration for 2026 and its planned discontinuation in 2027. CMS also says about 8 in 10 Medicare Advantage beneficiaries will be able to stay in their current plan at the same or a lower premium.
A weighted average premium describes the market. It does not tell a patient whether you are in network next year.
What the averages leave out
The release addresses premiums, plan counts and access to plans. It does not quantify plan exits, network changes or formulary changes, and those are the changes that reach the exam room. CMS's own estimate also implies that roughly 2 in 10 Medicare Advantage enrollees will not be able to keep their current plan at the same or a lower premium.
CMS says Medicare.gov now lets beneficiaries find and save their providers, and that starting in October the site will show clear messages about changes to their current plans for 2027 and link to plan formularies. Patients who arrive with a saved list will ask your staff to confirm it.
What practices should do now
Pull your payer contract list, confirm which Medicare Advantage plans you will participate in for 2027, and give the front desk a plain answer script. Check that the plan lists on your website and phone tree match your contracts. Staff should direct coverage-choice questions to 1-800-MEDICARE or the Medicare Plan Finder rather than recommend a plan.
Decide how you will handle patients who switch plans in December and arrive in January with a different network. Our earlier piece on the 2027 star ratings covers the quality measures plans are judged on.
Why it matters
Low average premiums can coexist with narrow networks and tight formularies. The practices that fare best in January are the ones that answered the network question in October.
Reported, fact-checked and edited by The Script Pad's editorial staff.
This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.
