Learn More about Medicare Coverage Changes 2027 And Key Updates

Learn about Medicare coverage changes for 2027, including updates to Medicare Advantage, Part D, prescription drug coverage, enrollment guidance, Star Ratings, and care coordination. This informational guide explains important changes announced by CMS and highlights what beneficiaries should review when preparing for their Medicare coverage during 2027.

Medicare coverage changes for 2027 include several updates to Medicare Advantage, Part D prescription drug coverage, enrollment processes, quality measurements, and care coordination. The Centers for Medicare and Medicaid Services has finalized rules that will apply to Medicare programs during the 2027 plan year. Some changes affect how plans are evaluated, while others address prescription drug benefits and administrative requirements. Beneficiaries should also review their specific plan information because available coverage, provider networks, formularies, and benefits can vary. This guide explains the major Medicare coverage changes for 2027 and provides practical information for understanding what to review before the new coverage year.

Medicare coverage in 2027 will include several changes resulting from rules and policies finalized by the Centers for Medicare and Medicaid Services. These updates affect Medicare Advantage, Part D prescription drug plans, enrollment procedures, quality measurements, and certain aspects of care coordination.

Medicare Advantage Changes For 2027

CMS has finalized updates to the Medicare Advantage program for the 2027 contract year. Several changes focus on Star Ratings and how plans are evaluated for quality. CMS is also changing certain administrative and enrollment requirements.

Important areas include:

  • Updates to Medicare Advantage Star Ratings
  • Removal of several administrative quality measures
  • A new depression screening and follow-up measure
  • Changes involving plan contract consolidations
  • Updated enrollment and disenrollment guidance
  • Changes to certain supplemental benefit requirements

These changes apply to the Medicare Advantage program and may affect how beneficiaries review plan information.

Medicare Part D Coverage Changes

Medicare Part D will continue operating under the prescription drug benefit changes established by the Inflation Reduction Act. CMS is codifying several of these provisions for 2027 and future years.

The 2027 framework includes:

  • Elimination of the Part D coverage gap phase
  • A reduced annual out-of-pocket threshold
  • No cost sharing during the catastrophic phase
  • Continued operation of the Manufacturer Discount Program
  • Updated calculations for certain prescription drug costs
  • Changes to Part D risk adjustment methodology

CMS also released preliminary 2027 Part D bid information in July 2026 as plans prepared their offerings for the upcoming enrollment period.

Prescription Drug Plan Rules To Review

Individual prescription drug plans can have different formularies and coverage requirements. Medicare explains that Part D plans may use rules such as prior authorization, step therapy, and quantity limits for certain medications. Starting January 1, 2027, some plans may process prior authorization requests electronically and provide decisions through patient portals.

Beneficiaries can review:

  • Whether current medications remain covered
  • The plan's formulary
  • Pharmacy networks
  • Prior authorization requirements
  • Step therapy requirements
  • Quantity limits
  • Available alternatives when a medication is not covered

Medicare Enrollment Changes And Planning

Medicare's annual Open Enrollment period runs from October 15 through December 7. Changes made during this period generally take effect January 1 of the following year. Beneficiaries can change Medicare Advantage or Part D coverage and can also switch between Original Medicare and Medicare Advantage during the applicable enrollment period.

For 2027, seniors should consider:

  • Reviewing their current coverage
  • Checking provider networks
  • Reviewing prescription drug coverage
  • Looking at plan benefits and rules
  • Checking enrollment deadlines
  • Reviewing official Medicare plan information

Changes In Medicare Care Coordination

Beginning January 1, 2027, Medicare will introduce the Long-term Enhanced ACO Design as part of its accountable care organization initiatives. ACOs are separate from Medicare Advantage plans and are designed to coordinate care among participating healthcare providers. Medicare states that being treated by providers participating in an ACO does not by itself increase a beneficiary's Medicare costs.

Medicare coverage changes for 2027 include updates to Medicare Advantage quality measurements, Part D prescription drug policies, enrollment guidance, and care coordination programs. Because individual coverage can vary by plan and location, beneficiaries should review their current plan information, medications, providers, and applicable enrollment periods. Official Medicare and CMS resources provide the most current information when preparing for 2027 coverage.