If you have Medicare, the decisions you make during the 2026 Annual Election Period (AEP) can determine how your coverage works throughout 2027.
The AEP runs from October 15 through December 7, 2026. Any change you make during this window generally takes effect on January 1, 2027 (your plan must receive your enrollment request by December 7).
This year, reviewing your coverage is especially important because Medicare beneficiaries may see changes to prescription drug plans, negotiated drug prices, premiums, formularies, and access to certain GLP-1 medications.
At Total Benefit Solutions, we help you review your options, compare plans, understand the fine print, and advocate for the benefits you are entitled to receive.
What You Can Do During Medicare AEP
During Medicare Open Enrollment, you can make several important changes.
You can:
- Join a Medicare Advantage plan.
- Switch from one Medicare Advantage plan to another.
- Drop Medicare Advantage and return to Original Medicare.
- Move from Original Medicare to Medicare Advantage.
- Join, drop, or switch a Medicare Part D prescription drug plan.
- Add or remove prescription drug coverage from a Medicare Advantage plan.
According to Medicare.gov’s Open Enrollment guidance, changes made during AEP are effective January 1, 2027.
If you move from Medicare Advantage to Original Medicare, you may also need a separate Part D plan. You may want Medicare Supplement Insurance (Medigap), but Medigap enrollment is governed by separate rules and may involve medical underwriting.
That means returning to Original Medicare does not always guarantee that you can purchase the Medigap policy you prefer. Review your eligibility before making a change.
Your Annual Notice of Change Arrives in September
Your current Medicare Advantage or Part D plan should send you an Annual Notice of Change (ANOC) in September.
The ANOC explains what will change in your plan for 2027, including:
- Monthly premiums.
- Annual deductibles.
- Copayments and coinsurance.
- Prescription drug tiers.
- Formulary changes (the list of medications the plan covers).
- Pharmacy networks.
- Doctor and hospital networks.
- Prior authorization requirements.
- Benefits such as dental, vision, hearing, transportation, or over-the-counter allowances.
- Maximum out-of-pocket limits.
Do not file your ANOC away and wait until December. Review it as soon as it arrives.
For example, a plan may keep the same name but move one of your prescriptions from a preferred tier to a higher tier. Your doctor may also leave the plan’s network, or your preferred pharmacy may no longer receive the plan’s lowest negotiated price.
These details can affect your total annual cost far more than the monthly premium alone.
What’s New for Medicare in 2027?
1. The Medicare GLP-1 Bridge Demonstration
One of the most significant developments for eligible beneficiaries is the Medicare GLP-1 Bridge demonstration.
The demonstration runs from July 1, 2026, through December 31, 2027. It may provide eligible Medicare Part D beneficiaries access to certain GLP-1 medications for weight management at a flat cost of $50 per month.
Covered medications identified in CMS materials include:
- Wegovy
- Zepbound
- Foundayo
Eligibility generally includes Medicare Part D enrollment, a BMI of 27 or higher, and qualifying health conditions under the program’s rules. Your healthcare provider must determine whether the medication is clinically appropriate and submit the required prior authorization request.
The $50 monthly amount is not an automatic benefit for every Medicare beneficiary. It depends on program eligibility, clinical criteria, the prescription, and approval through the required process.
The demonstration operates separately from the ordinary Part D benefit structure. Therefore, the $50 payment may not count toward your standard Part D deductible or annual out-of-pocket limit.
Read the current program information directly from CMS’s Medicare GLP-1 Bridge page, and speak with your prescribing physician about eligibility.
You should also ask for written confirmation of:
- The specific medication and formulation covered.
- Whether prior authorization is required.
- The BMI and qualifying-condition requirements.
- How the prescription should be submitted.
- Whether the medication is available through your pharmacy.
- Whether the $50 cost applies for the full period you expect to use the program.
Do not assume that a plan advertisement promising low-cost GLP-1 access applies to your situation. Confirm the rules before changing coverage.
2. New Part D Drug Price Negotiations
Beginning January 1, 2027, Medicare’s negotiated prices for an additional group of high-spend Part D drugs are scheduled to take effect.
The 2027 negotiated list includes drugs used to treat conditions such as diabetes, cancer, asthma, pulmonary disease, and other chronic illnesses. The list includes:
- Ozempic, Rybelsus, and Wegovy
- Trelegy Ellipta
- Xtandi
- Pomalyst
- Ibrance
- Ofev
- Linzess
- Calquence
- Austedo and Austedo XR
- Breo Ellipta
- Tradjenta
- Xifaxan
- Vraylar
- Janumet and Janumet XR
- Otezla
You can review the official list and negotiated prices on CMS’s Selected Drugs and Negotiated Prices page.
A negotiated Medicare price does not necessarily mean that your copay will be exactly the same in every plan. Your plan may still apply its own deductible, tier structure, pharmacy rules, or utilization management requirements.
This is particularly important if you take one of the affected medications. Compare the 2027 formulary, pharmacy network, deductible, and estimated annual drug costs before selecting a plan.
Also, do not confuse the negotiated price for Wegovy with the separate $50 GLP-1 Bridge demonstration. These are different programs with different eligibility and payment rules.
3. Part D Plan Designs May Change
Medicare Part D plans can change their premiums, deductibles, formularies, pharmacy networks, and cost-sharing structure each year.
Even when federal rules provide greater protection from high prescription drug costs, your personal expenses can still vary significantly by plan. A plan with a low monthly premium may have higher costs for your specific medications, while a plan with a higher premium may produce lower total annual spending.
Your comparison should include:
- Your complete medication list.
- Dosage and quantity for each prescription.
- Preferred pharmacies.
- Mail-order options.
- Prior authorization and step therapy rules.
- Drug tiers.
- Estimated annual drug costs.
- The plan’s 2027 Evidence of Coverage.
Never compare Part D plans using premiums alone.
Medicare Advantage or Original Medicare With Medigap?
AEP is also the time to reconsider how you receive Medicare coverage.
Medicare Advantage
Medicare Advantage plans combine Medicare Part A and Part B coverage through a private insurance company. Many plans also include Part D prescription drug coverage and additional benefits.
Potential advantages include:
- One combined plan.
- Predictable copayments for many services.
- An annual maximum out-of-pocket limit for covered Medicare services.
- Additional dental, vision, hearing, or wellness benefits.
Potential challenges include:
- Provider networks.
- Referrals.
- Prior authorization.
- Plan-specific rules.
- Changes to doctors, hospitals, and benefits each year.
Original Medicare With Medigap
Original Medicare allows you to use any provider that accepts Medicare, subject to Medicare rules. You can add a separate Part D plan and, if eligible, a Medigap policy to help pay certain Medicare cost-sharing expenses.
Potential advantages include:
- Broad provider access.
- Greater flexibility when traveling.
- Fewer Medicare Advantage network restrictions.
- More predictable costs when paired with an appropriate Medigap policy.
Potential challenges include:
- Separate premiums for Part B, Medigap, and Part D.
- Medical underwriting outside certain protected enrollment periods.
- No automatic coverage for routine dental, vision, hearing, or long-term custodial care.
- The need to manage multiple policies.
Your best option depends on your health needs, doctors, prescriptions, travel habits, budget, and tolerance for prior authorization or network restrictions.
Medicare Advantage Open Enrollment Is a Separate Period
If you are already enrolled in Medicare Advantage, you have another opportunity to make one change during the Medicare Advantage Open Enrollment Period (MA OEP).
The MA OEP runs from January 1 through March 31, 2027.
During this period, you can:
- Switch to another Medicare Advantage plan.
- Return to Original Medicare.
- Join a separate Part D plan if you return to Original Medicare.
You generally can make only one change during the MA OEP. Changes typically become effective the first day of the month after the plan receives your request.
The MA OEP is not a substitute for reviewing your ANOC during AEP. Waiting until January may limit your options and leave you enrolled in a plan that does not fit your needs.
A Practical Medicare AEP Checklist
Before December 7, 2026:
- Locate your September ANOC.
- Confirm your 2027 premium and deductible.
- List every prescription, dosage, and quantity.
- Check each medication’s formulary tier.
- Confirm your preferred pharmacy remains in-network.
- Verify your doctors, hospitals, and specialists.
- Compare the annual out-of-pocket maximum.
- Review prior authorization and referral requirements.
- Check whether dental, vision, hearing, and other supplemental benefits changed.
- If GLP-1 access matters to you, verify whether you may qualify for the Medicare GLP-1 Bridge demonstration.
- Compare Medicare Advantage with Original Medicare, Medigap, and Part D.
- Submit any enrollment change by December 7, 2026.
A Visual Guide for Medicare Education
Dr. Ben E. Fitz is used here only as a visual guide for Medicare education. The important work is reviewing your actual plan documents, prescriptions, provider relationships, and eligibility requirements.
We Can Help You Review Your 2027 Options
Medicare plan changes can be difficult to interpret, especially when your ANOC, drug list, provider network, and personal healthcare needs do not line up neatly.
At Total Benefit Solutions, we act as your independent health insurance advocate. We can review your ANOC, compare Medicare Advantage with Original Medicare and Medigap, evaluate Part D options, and help you understand GLP-1 coverage requirements.
If a claim is denied or a benefit is incorrectly restricted, we help you pursue the issue and fight for the coverage you deserve. We never accept no as the final answer when there is a legitimate path to advocacy.
Visit www.totalbenefits.net or call (215) 355-2121 to schedule your Medicare review before the December 7, 2026 deadline.
This article is for educational purposes only. Medicare benefits, premiums, formularies, provider networks, eligibility rules, and coverage requirements vary by plan, location, and individual circumstances. Verify details with Medicare, CMS, your plan, and your healthcare providers before enrolling or changing coverage.
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