What Should Retirees Review During Medicare Open Enrollment?
Your Medicare coverage is one of the few retirement costs you can still change after you’ve retired.
Most of what drives a retirement budget gets locked in early: a pension election is permanent once you sign it, a Social Security claiming decision is largely settled once you file, and your mortgage is what it is. But Medicare works differently. Every fall, from October 15 to December 7, you get a window to change the plan you’re on, and every fall that window closes whether or not you opened it.
For 2027, give that review more attention than usual. Several of the costs are changing, one temporary program that held drug plan premiums down is ending, and the single largest number in the equation, the standard Part B premium, won’t be published by the federal government until partway through the enrollment window itself.
This piece walks through what to look at before December 7, and how those choices connect to the rest of your retirement income plan.
In This Article:
- When is Medicare open enrollment, and what can you change?
- Why does open enrollment matter more than most retirees expect?
- What is changing with Medicare in 2027?
- What should you review on your Part D prescription drug plan?
- What should you review if you’re on a Medicare Advantage plan?
- How does your income affect what you pay for Medicare?
- Can you switch back to Original Medicare and a Medigap policy?
- What does an open enrollment review look like in practice?
- What questions should you ask before December 7?
- How can a financial advisor help with Medicare decisions?
- Frequently Asked Questions
When Is Medicare Open Enrollment, and What Can You Change?
Medicare open enrollment runs from October 15 to December 7 each year. Any change you make takes effect on January 1, and the plan has to receive your request by December 7 for it to count.
During this window, Medicare allows you to join, drop, or switch a Medicare Advantage plan with or without drug coverage, move from Original Medicare to a Medicare Advantage plan or back the other way, and join, drop, or switch a standalone prescription drug plan if you’re on Original Medicare.
There’s a second window that people often confuse with this one. The Medicare Advantage Open Enrollment Period runs from January 1 to March 31, and it’s available only if you’re already enrolled in a Medicare Advantage plan. It lets you switch to a different Advantage plan or return to Original Medicare. It does not let someone on Original Medicare shop for an Advantage plan, and it does not reopen your drug plan choice if you’re on Original Medicare. If you want that flexibility, the fall window is the one that matters.
Why Does Open Enrollment Matter More Than Most Retirees Expect?
Doing nothing is still a decision; if you skip the review, you’re re-enrolled in your current plan at next year’s terms, and those terms change every year.
Your plan’s formulary can drop a drug you take. Your cost tier for that drug can move. Your physician or your preferred pharmacy can leave the network. Your premium and deductible can rise. None of that requires your consent, and none of it is reversible once the window closes (barring a limited set of special circumstances).
Each plan is required to send you an Annual Notice of Change each fall describing what’s different for the coming year. That document is the starting point for the review, and it’s the one piece of mail you don’t want to throw away.
We think about this as a control window. There’s a great deal in retirement you can’t influence from one year to the next: what the market does, what Congress does with the tax code, what your health brings. Your Medicare plan selection is in the small category of costs you can still act on, on a schedule you know in advance. That makes it worth your time.
What Is Changing With Medicare in 2027?
A few 2027 figures are settled, and one important one is not.
The Part D prescription drug benefit is confirmed. The standard annual deductible rises to $700, up from $615 in 2026. The annual out-of-pocket maximum for covered prescription drugs rises to $2,400, up from $2,100. Under the standard benefit design, you pay the deductible, then 25 percent of the cost of covered prescriptions, until your out-of-pocket spending reaches the cap. After that, covered drugs cost you nothing for the rest of the calendar year.
The temporary drug plan premium subsidy is ending. The Centers for Medicare & Medicaid Services announced in July 2026 that it will discontinue the Part D Premium Stabilization Demonstration at the end of 2026. That program had been sending direct subsidies to insurers since 2025 to smooth out pricing after the drug benefit was restructured. CMS reports that standalone drug plan bids came in close to where they were, and projects the average total standalone premium will rise by less than a dollar a month. Averages hide a lot, though. Individual plans can and do move considerably more than the national average, which is why the figure in your own plan’s notice is more important than the national headline.
The Part B premium is not final yet. CMS typically publishes the standard Part B premium, the Part B deductible, and the income-related surcharge brackets in November, which falls in the middle of the enrollment window. The 2026 standard premium is $202.90 a month with a $283 annual deductible. The 2026 Medicare Trustees Report projects roughly $209.50 and $292 for 2027, but a projection is not the announcement, and the final figures have landed away from the projection in past years.
That timing is awkward, so let’s call it what it is: you’re being asked to choose coverage before one of the prices is posted. The practical response is to make your plan decisions on the factors you can see (which are formulary, network, deductible, and total expected drug cost) and treat the Part B number as a budget line to update in November, not a reason to delay the rest of the review.
What Should You Review on Your Part D Prescription Drug Plan?
Premium is the number people compare first, but it’s rarely the number that determines the year.
What matters more is what the plan costs you in total, given the specific prescriptions you take. Two plans with a $20 difference in monthly premium can differ by far more than that once the formulary, tier placement, and pharmacy network are applied to your actual prescriptions.
Work through these in order:
- Formulary. Confirm every prescription you take is still on the plan’s covered drug list for next year. A drug coming off the list is the most expensive change a plan can make.
- Tier placement. A covered drug can move to a higher tier, which changes your share of the cost without changing whether it’s covered.
- Pharmacy network. Preferred pharmacies can change year to year, and the difference between a preferred and standard pharmacy on the same plan can be significant.
- Prior authorization and step therapy. A plan can add a requirement that you try a different drug first, or that your physician obtain approval before the plan pays.
- Total annual cost, not monthly premium. The Medicare Plan Finder lets you enter your prescriptions and see an estimated yearly cost for each plan available where you live. That estimate is the right basis for comparison.
One more point on the 2027 cap: the $2,400 out-of-pocket maximum applies to covered prescription drugs under Part D. It does not cap your Part B costs, your hospital costs, your dental or vision spending, or anything a plan doesn’t cover. It’s an important protection for households with high drug costs, and it’s narrower than the phrase “out-of-pocket maximum” suggests on first reading.
What Should You Review if You’re on a Medicare Advantage Plan?
Medicare Advantage plans bundle Part A, Part B, usually Part D, and often extra benefits into a single private plan with its own network and its own cost structure. The review looks different from a drug-plan review.
Start with the provider network. Confirm that your physicians, your specialists, and the hospital system you’d want to use are in network for next year. In the Houston area, that question has real consequences, because a plan that excludes the facility you’d choose for a significant procedure is a different plan than the one you bought, even if the premium hasn’t moved.
Then look at the plan’s maximum out-of-pocket limit for medical costs, which is separate from the Part D drug cap. Check whether the copays for the services you use have changed, particularly specialist visits, imaging, and outpatient procedures. Confirm that any supplemental benefits you rely on are still included at the same level, since dental, vision, hearing, and fitness benefits are adjusted frequently.
If you spend part of the year outside Texas, confirm how the plan covers you when you’re away. Coverage rules for care received outside the service area vary considerably between plans.
How Does Your Income Affect What You Pay for Medicare?
This is where Medicare stops being a health insurance question and becomes a planning question.
Higher-income beneficiaries pay an income-related monthly adjustment amount (known as IRMAA), on top of both the standard Part B premium and their Part D premium. For 2026, the surcharge begins above $109,000 of modified adjusted gross income for single filers and $218,000 for married couples filing jointly. At that first tier, the Part B premium rises from $202.90 to $284.10 a month, with an additional $14.50 on Part D, according to CMS. The surcharge climbs through five tiers from there.
Two features of this system tend to surprise people.
The first is the two-year lookback. Social Security sets your surcharge using the tax return you filed two years earlier. Your 2027 premium will generally be determined using income information from your 2025 tax return, although adjustments may be available in certain circumstances. Decisions you make in 2026 can also influence your Medicare premiums in 2028: the Roth conversion you run in 2026, the capital gain you realize on a concentrated position, the proceeds from a property sale, it all lands on your 2028 Medicare premium. That’s one reason we fold Medicare surcharges into year-end tax planning instead of treating them as a separate healthcare topic.
The second is the cliff: IRMAA is not phased in. Even a small amount of income above an IRMAA threshold can move you into the next surcharge tier, increasing your Medicare premiums for the applicable year. For married couples filing jointly who are both subject to Medicare premiums, this can affect both spouses.
For households managing required minimum distributions or converting pre-tax balances, knowing where the next threshold sits is part of deciding how much to convert.
There’s also a remedy many recent retirees don’t know about. If your income has dropped because of a qualifying life-changing event, you can ask Social Security to use a more recent year instead. Work stoppage and work reduction are both on the list, along with marriage, divorce, death of a spouse, loss of pension income, and a few others. The request is made on Form SSA-44. This comes up often among people who retired from one of the Houston energy companies partway through a year: their final year of salary sets a surcharge that bears no relationship to their actual retirement income, and the form is how that gets corrected.
Can You Switch Back to Original Medicare and a Medigap Policy?
You can return to Original Medicare during open enrollment. Whether you can buy a Medicare Supplement policy, also called Medigap, to go with it is a separate question with a different answer.
Medigap follows different enrollment rules than Medicare Advantage and Part D plans. Federal law provides certain protections known as Medigap guaranteed issue rights, which allow eligible individuals to purchase a Medicare Supplement policy without being denied coverage or charged higher premiums based on their health history.
These protections generally apply during your six-month Medigap open enrollment period, which begins when you’re 65 or older and enrolled in Part B, as well as in certain other qualifying circumstances.
Those circumstances include a trial right if you joined a Medicare Advantage plan for the first time and want to leave within 12 months, a plan leaving your area, or a move outside the service area. You can review the full list of Medigap protections on Medicare’s site.
Outside those circumstances, an insurer can review your health history and decline your application or charge you more. Texas has not adopted the broader state-level protections that some states offer, so the federal rules are generally what apply here.
The practical consequence: leaving Medicare Advantage for Original Medicare is straightforward, and pairing it with a Medigap policy may not be, depending on your health and your timing. If you’re weighing that move, confirm you can obtain the supplement policy before you drop the Advantage plan, not after.
What Does an Open Enrollment Review Look Like in Practice?
Consider a hypothetical Houston couple, both 68, both on Original Medicare with a standalone Part D plan. One takes two brand-name maintenance medications. The other takes a single generic.
| Item | Illustrative amount |
| 2027 Part D deductible | $700 |
| Coinsurance after the deductible, under the standard benefit | 25% of covered drug costs |
| Out-of-pocket maximum for covered drugs, per person | $2,400 |
| Spouse with brand-name prescriptions, projected drug spending | Reaches the $2,400 cap during the year |
| Spouse with one generic prescription, projected drug spending | Well below the deductible |
The planning point is in the difference between the two columns of their household. The spouse with high drug costs reaches the cap and gains real protection from it, so the formulary and tier placement on those two specific drugs drive the whole decision. For the other spouse, the formulary matters far less and the lowest reasonable premium is the sensible choice. A household that compares plans as a single unit instead of person by person can end up overpaying on one side and under-covered on the other.
This example is hypothetical, uses rounded figures, and is provided only to illustrate the planning process. It does not represent any specific client, and your own results depend on your prescriptions, your plan, and where you live.
What Questions Should You Ask Before December 7?
- Have I read this year’s Annual Notice of Change for every Medicare plan I’m enrolled in?
- Is every prescription I take still on my plan’s formulary for next year, and at what tier?
- What is my estimated total annual drug cost under my current plan, compared with the alternatives available where I live?
- Are my physicians, specialists, and preferred hospital still in network for next year?
- If I’m on Medicare Advantage, has my maximum out-of-pocket limit or my copay structure changed?
- Will my income put me above an IRMAA threshold, and do I know where the next threshold sits?
- Has my income dropped because of retirement or another life-changing event, and should I file Form SSA-44?
- If I’m considering a return to Original Medicare, can I obtain a Medigap policy, and have I confirmed that before dropping my current plan?
- How does my projected healthcare spending fit into my overall retirement income plan for next year?
How Can a Financial Advisor Help With Medicare Decisions?
Choosing between specific Medicare plans is an insurance decision, and the right people for that comparison are a licensed Medicare broker, your State Health Insurance Assistance Program, or Medicare directly at 1-800-MEDICARE. We’d point you to those resources and say so plainly.
Where we work is the layer underneath. Your Medicare premium is set by your income, and your income is something a plan can be built around. That means looking at how much your healthcare costs are likely to consume of your retirement paycheck next year, how a Roth conversion or a large realized gain this year will show up as a surcharge two years from now, whether your withdrawal sequence can be arranged to keep you under a threshold, and how this year’s Social Security cost-of-living adjustment interacts with a rising Part B premium that’s deducted from the same check.
At Concenture Wealth Management, we work with families across the Houston area who are moving from a paycheck into a portfolio, and healthcare cost is one of the moving parts we build into that transition rather than treat as a separate conversation each November.
If you’d like to see how a personalized retirement paycheck comes together, watch our complimentary masterclass on turning savings into reliable retirement income.
Schedule a conversation with Concenture to review how next year’s Medicare costs fit into your financial plan.
Frequently Asked Questions
What happens if I do nothing during open enrollment?
You stay in your current plan, and it renews under next year’s terms. Those terms can include a different premium, a different deductible, a changed drug list, and a changed provider network. Doing nothing keeps the plan, not the plan’s current pricing or coverage, which is why we treat the fall review as a standing annual item in retirement planning rather than a one-time task.
Can I change my Medicare plan after December 7?
In most cases, no. If you’re already enrolled in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period from January 1 to March 31 gives you one more opportunity to switch Advantage plans or return to Original Medicare. Outside of that, changes generally require a Special Enrollment Period, which applies to specific situations such as moving out of your plan’s service area or losing other coverage. If you think you’ve missed a window that matters to your budget, reach out to our team and we can look at the cost impact for next year.
Does open enrollment affect my Medigap policy?
No. Medicare Supplement policies follow their own rules. Your protected window to buy one without a health review is generally the six months beginning when you’re 65 and enrolled in Part B, plus a defined list of qualifying circumstances. Returning to Original Medicare during open enrollment does not by itself create that protection. A Medicare Supplement premium is a recurring monthly expense that may increase over time, so it belongs in your retirement income plan alongside your other ongoing expenses.
When will the 2027 Part B premium be announced?
CMS has historically published the following year’s Part A and Part B premiums and deductibles in November, which means the 2027 figures are expected partway through the current enrollment window. The 2026 standard Part B premium is $202.90 a month. For most beneficiaries it comes directly out of the Social Security payment, so it interacts with that year’s cost-of-living adjustment before the deposit ever reaches your bank account.
Will my Part D premium go up now that the federal subsidy is ending?
It depends on your plan. CMS discontinued the Part D Premium Stabilization Demonstration at the end of 2026 and projects that the average total standalone drug plan premium will rise by less than a dollar a month. That’s a national average, and individual plans vary widely, so the figure in your own Annual Notice of Change is the one to go by. Once you have that number, it becomes an input to your household’s financial plan for the year.
How do I know if I’ll pay an IRMAA surcharge?
Social Security notifies you by mail, generally in November or December, if your premium includes an income-related adjustment for the coming year. The determination uses the modified adjusted gross income from your tax return filed two years earlier. Because of that lag, the decisions that set your surcharge are made during year-end tax planning two years ahead, which is also where required minimum distributions and Roth conversions come into the same calculation.
I retired this year. Why is my Medicare premium based on my old salary?
Because of the two-year lookback. If your income has dropped due to work stoppage or another qualifying life-changing event, you can ask Social Security to use a more recent year using Form SSA-44, with documentation of the event and your lower income. We see this most often with people retiring from ExxonMobil, Chevron, Shell, and the other Houston energy employers, where a final partial year of salary sets a surcharge that has little to do with actual retirement income.
This article is provided for educational purposes only and does not constitute tax, legal, or insurance advice. Medicare rules, premiums, and plan terms change annually, and the figures referenced here reflect information available at the time of writing. Please consult your tax professional, a licensed Medicare resource, and your financial advisor regarding your specific situation.
