Medicare Advantage plans for 2027 will provide an alternative way for eligible Medicare beneficiaries to receive Medicare Part A and Part B coverage through private Medicare-approved health plans. Plans can also include prescription drug coverage and additional benefits such as dental, vision, hearing, transportation, fitness programs, and over-the-counter allowances.
Medicare Advantage, also called Medicare Part C, is an alternative to receiving Medicare benefits through Original Medicare.
Medicare Advantage plans are offered by private insurers approved by Medicare.
Most plans include:
Many plans also provide supplemental benefits that Original Medicare generally does not cover.
In 2026, more than half of eligible Medicare beneficiaries were enrolled in Medicare Advantage, with approximately 35.2 million people participating.
The structure of a Medicare Advantage plan can affect provider access, referrals, costs, and out-of-network coverage.
HMO plans generally require members to use a network of participating healthcare providers.
Some HMO plans require a primary-care provider and referrals for certain specialist services.
PPO plans generally provide greater flexibility when receiving care from providers outside the plan network, although out-of-network services can involve higher cost-sharing.
Special Needs Plans, or SNPs, are designed for specific groups of Medicare beneficiaries.
Major categories include:
In 2026, nearly one-quarter of Medicare Advantage enrollment was in SNPs.
PFFS plans determine how much the plan pays providers and how much members pay for covered services.
Availability varies by location.
MSA plans combine a high-deductible Medicare Advantage plan with a medical savings account that can be used toward qualifying healthcare expenses.
These plans are less common than HMO and PPO plans.
The 2027 plan year follows several significant regulatory changes finalized by CMS.
The 2027 final rule includes changes affecting areas such as consumer protections, marketing and communications, supplemental benefits, utilization management, and plan administration.
Some of the policy changes are intended to strengthen certain protections, while other provisions roll back or modify previous requirements.
Because individual plan benefits are determined by insurers and can vary by location, a national policy change does not necessarily mean every Medicare Advantage member will experience the same change.
There is not one nationwide Medicare Advantage premium for 2027.
Premiums can vary based on:
Some Medicare Advantage plans may have a $0 additional premium, while others charge a monthly plan premium in addition to the Medicare Part B premium.
The absence of an additional plan premium does not mean that healthcare services are free.
Copayments, coinsurance, deductibles, and other cost-sharing can still apply.
CMS finalized a 2027 Medicare Advantage payment update in April 2026.
The American Hospital Association reported that CMS finalized a net average year-over-year increase of 2.48% in Medicare Advantage plan payments, representing more than $13 billion in additional payments compared with 2026.
KFF's analysis of the final payment announcement estimated that average per-enrollee payments would increase by nearly 5% when additional factors, including changes in risk scores, are considered.
These are payments to Medicare Advantage insurers and should not be interpreted as a guaranteed increase or decrease in an individual's premium or benefits.
Medicare uses a five-star quality rating system to evaluate Medicare Advantage and Part D plans.
The ratings consider areas such as:
CMS released draft 2027 star-rating thresholds to insurers in September 2026. Reporting on the draft thresholds indicates that several cutpoints became more difficult to reach, although the official ratings were still pending at the time of publication.
The finalized ratings are important because they can influence plan payments and may also affect certain enrollment opportunities.
Provider networks are one of the most important differences between Medicare Advantage plans.
An HMO may require most routine care to be obtained within its network.
A PPO generally allows some out-of-network care but can charge higher cost-sharing.
Before selecting a 2027 plan, it can be useful to check whether the following providers participate:
A doctor participating in a 2026 plan is not automatically guaranteed to participate in the same plan in 2027.
Many Medicare Advantage plans include Part D prescription drug coverage.
The prescription benefits can differ significantly between plans.
Important factors include:
Anyone taking several prescription medications should compare the specific formulary for the 2027 plan rather than relying solely on the plan's monthly premium.
Medicare Advantage plans that include prescription drug coverage are affected by changes in the Part D program.
CMS announced that a temporary demonstration designed to stabilize premiums for standalone Medicare Part D plans would end after 2026.
KFF reported that the demonstration had reduced average monthly premiums for standalone Part D plans in 2025 and 2026.
The effect on individual Medicare Advantage prescription premiums will depend on the plan and insurer.
Dental coverage is one of the supplemental benefits frequently associated with Medicare Advantage.
Benefits can include some combination of:
The exact benefit can vary considerably.
An advertised dental benefit may have:
Therefore, the Summary of Benefits should be reviewed before assuming a particular dental procedure is covered.
Many Medicare Advantage plans include routine vision benefits.
Depending on the plan, coverage may include:
The dollar allowance and frequency of coverage can vary by plan.
Hearing benefits can also be included in Medicare Advantage plans.
Potential coverage can include:
The participating provider network and benefit allowance should be checked in the specific 2027 plan documents.
Some Medicare Advantage plans provide an OTC allowance for eligible health and wellness products.
Possible categories can include:
However, OTC benefits are not included in every Medicare Advantage plan.
KFF reported that access to OTC benefits among individual Medicare Advantage plans declined between 2025 and 2026, illustrating why a benefit offered in one year should not automatically be assumed to continue in the next plan year.
Certain Medicare Advantage plans provide grocery or healthy-food benefits, particularly through Special Needs Plans and other plans with supplemental benefit structures.
Eligibility and covered products can vary.
Examples can include:
These benefits are generally subject to plan-specific eligibility requirements and spending limits.
A grocery allowance should not be assumed to be a standard Medicare Advantage benefit.
Some Medicare Advantage plans offer transportation benefits for qualifying healthcare-related trips.
The benefit can specify:
Because transportation benefits can change annually, the 2027 Summary of Benefits should be checked for exact terms.
Certain Medicare Advantage plans provide fitness-related benefits.
Depending on the plan, these may involve:
Availability and participating facilities vary.
Telehealth services remain an important component of many Medicare Advantage plans.
Depending on the plan and provider, members may be able to receive certain services remotely.
Coverage can include some primary-care, behavioral-health, specialist, and follow-up services.
The exact services and cost-sharing depend on the plan.
Prior authorization means a health plan requires approval before certain services, treatments, or medications are covered.
Medicare Advantage plans can use prior authorization for certain services.
The 2027 regulatory framework includes changes related to utilization management and prior authorization.
Members should review the plan's requirements for services that are likely to be needed, particularly specialist procedures, advanced imaging, inpatient services, and certain medications.
One major feature of Medicare Advantage is the annual maximum on member out-of-pocket spending for covered Part A and Part B services.
This is different from Original Medicare, which generally does not have an annual out-of-pocket maximum unless additional coverage is in place.
The plan-specific maximum can vary.
A lower monthly premium can therefore come with different cost-sharing than a plan with a higher premium.
The two approaches work differently.
| Feature | Medicare Advantage | Original Medicare |
|---|---|---|
| Part A | Included through the plan | Direct Medicare coverage |
| Part B | Included through the plan | Direct Medicare coverage |
| Part D | Often included | Usually separate |
| Provider network | Usually applies | Generally broader provider access |
| Annual Part A/B out-of-pocket limit | Yes | No standard annual limit |
| Dental/vision/hearing extras | Often available | Generally limited |
| Referral requirements | May apply | Generally fewer plan-level restrictions |
| Private insurer | Yes | No Medicare Advantage insurer |
Neither structure is identical to the other, and individual costs depend on the coverage selected.
The Medicare Annual Enrollment Period generally runs from October 15 through December 7 each year.
Coverage selected during this period generally takes effect January 1 of the following year.
For 2027 coverage, this means the key Annual Enrollment Period will be October 15 through December 7, 2026.
During this period, eligible beneficiaries can generally:
Specific enrollment rights can depend on individual circumstances.
The Medicare Advantage Open Enrollment Period generally runs from January 1 through March 31.
People already enrolled in Medicare Advantage can generally:
A separate Part D plan can generally be added when returning to Original Medicare.
Medicare Advantage plan availability varies significantly by location.
An insurer may offer several plans in one county and fewer plans in another.
Similarly, a plan that exists in 2026 may not necessarily be offered in 2027.
This makes location-specific plan comparison particularly important.
A comprehensive comparison should include more than the monthly premium.
Check:
Medicare Advantage plans are annual products.
Insurers can change:
Therefore, information from a 2026 plan brochure should not automatically be applied to 2027 coverage.
The Annual Notice of Change and 2027 Evidence of Coverage are more relevant when evaluating the upcoming plan year.
A useful comparison can start with the healthcare services used most frequently.
For example, someone who regularly sees specialists may place greater importance on specialist copayments and network access.
Someone taking multiple medications may need to focus more closely on formularies and pharmacy networks.
Someone expecting dental work may want to examine dental annual limits and provider networks.
A person with frequent hospital visits may need to examine inpatient cost-sharing and the annual out-of-pocket maximum.
The same plan can therefore have very different financial implications depending on healthcare usage.
Special Needs Plans can provide specialized coverage structures for certain beneficiaries.
C-SNPs are designed for people with qualifying chronic conditions.
D-SNPs are designed for people who qualify for both Medicare and Medicaid.
I-SNPs generally serve people who meet specific institutional or institutional-equivalent care requirements.
KFF reported that SNP enrollment accounted for nearly one-quarter of Medicare Advantage enrollment in 2026, with D-SNPs representing most SNP enrollment.
Eligibility requirements should be confirmed for each individual plan.
Prescription spending can vary significantly between plans.
Two plans with similar monthly premiums can have different prescription costs because of differences in:
For anyone taking regular medications, entering the exact prescriptions into Medicare's plan comparison tools can provide a more useful estimate than comparing premiums alone.
Once a plan is selected, coverage generally begins January 1, 2027, provided the enrollment is completed during an applicable enrollment period.
Before the coverage year begins, it can be useful to obtain:
Existing members should also review any Annual Notice of Change received from their insurer.
The main Annual Enrollment Period for 2027 coverage runs from October 15 through December 7, 2026.
Individual premiums vary by plan and location. CMS's 2027 payment update to insurers does not directly determine the premium charged to an individual beneficiary.
Many Medicare Advantage plans provide dental benefits, but benefits can change annually. The specific 2027 plan documents should be checked.
OTC benefits are plan-specific and can change from year to year. A 2026 OTC allowance should not automatically be assumed to continue in 2027.
Some plans have no additional monthly premium beyond the Medicare Part B premium, while others charge a plan premium. Even a $0-premium plan can have copayments, deductibles, coinsurance, and other costs.
In many circumstances, people enrolled in Medicare Advantage can make changes during the Medicare Advantage Open Enrollment Period from January 1 through March 31.
Availability varies by county and insurer. The plans offered in one location may differ substantially from those offered elsewhere.
Medicare Advantage plans for 2027 will continue to provide an alternative to Original Medicare, with plans potentially combining Part A, Part B, and prescription drug coverage with supplemental benefits.
The 2027 plan year also follows several CMS policy changes affecting Medicare Advantage and Part D. CMS finalized the 2027 rule in April 2026, while additional plan-specific details will become important during the fall enrollment period.