Medicare Open Enrollment 2027: What to Know About Your Medicines

By ALDP Co-founders Michael Glassner and Jason Young

Oct. 19, 2026 – A few days ago, Medicare Open Enrollment started; it runs through Dec. 7. It’s the time of year when people with Medicare can change their drug plan for the year ahead.

We recently sat down with a man who was taking Xarelto, a blood thinner, plus several lower-cost medicines. His plan categorizes drugs into six pricing levels, or tiers. For 2027, the plan moved some of his drugs from one level to another. Working out what he’d pay each month – and for the whole year – took real effort. Even for someone who deals with these questions every day.

Through this process he discovered that Xarelto’s negotiated Medicare price will no longer apply come Jan. 1 (more on that below). So he asked his doctor about rivaroxaban, the generic version, and has since switched.

His experience is worth passing along. Set it and forget it can be a way to prepare a roast, but it’s not a way to manage your prescription drugs.

Medicare Part D can be complicated. Still, you can make smart, informed choices about your plan. Free, unbiased help is available. Here’s what we tell people to think about – whether you’re choosing for yourself or helping someone you love.

Two things many people don’t know

1. More lower drug prices start Jan. 1.

This year for the first time, Medicare began paying negotiated prices on ten widely used drugs. Xarelto is one of them. Medicare’s negotiated price for a 30-day supply is $197, compared with the drug manufacturer’s list price of $517 (Medicare). Medicare wasn’t paying full list price before, thanks to discounts, but it was paying more than $197.

Starting Jan. 1, four groups of medicines leave the negotiated-price program: Xarelto, Entresto, Stelara and NovoLog/Fiasp insulins. Such exits happen because generic or biosimilar competitors enter the market. (Thus our Xarelto patient could switch to rivaroxaban.) Competition can lower prices, but that doesn’t guarantee you’ll pay less at the pharmacy. A generic or biosimilar may have a very different price under your plan. If you take one of these brand-name medications, ask your doctor or pharmacist about alternatives, then check what each option will actually cost you.

Meanwhile, negotiated prices begin for 15 more medicines in 2027, including Ozempic, Trelegy, Ibrance and several other widely used treatments for diabetes, breathing problems, cancer, and other conditions. Just considering Ozempic, Medicare’s new negotiated price will be $274 a month versus a list price of $959. You can see the full list of medicines and negotiated prices here.

2. Medicare drug plans must cover the negotiated medicines.

If you take one of these medicines, there’s an important new protection you need to know about. In general, Part D plans must include on their covered-drug lists all of the medicines now subject to Medicare price negotiation.

But coverage doesn’t necessarily translate to easy access or a low copay. Your plan may still require prior approval, limit how much medicine you can receive at once, or require you to try another treatment first. Plans can also charge different amounts.

So when you compare plans, don’t stop at checking whether your medicine is covered. Check what you’ll pay, any restrictions or limitations you may face, and whether your preferred pharmacy can fill your prescription at the price you’re expecting.

Why a lower price doesn’t always show up at the counter

What you pay depends on how your plan sets up its drug pricing tiers. Four things will matter most to you:

1. Flat amount or a percentage. Each price level or tier charges either a set dollar amount, like $47, or a percentage of the drug’s price, like 25%. When you pay a percentage, a lower drug price generally means you pay less. When you pay a flat amount, a lower drug price may not change what you pay at the counter.
2. Price levels can change every year. That’s what happened to the man we met. When a drug changes tiers, this year’s bills no longer predict next year’s bills.
3. The deductible. In 2027, a plan can require you to pay up to $700 for covered drugs before regular coverage begins. Many plans waive the deductible for cheaper medicines, so your generics may cost very little from day one while a brand-name drug costs much more.
4. The yearly limit. In 2027, your out-of-pocket limit on covered drugs is $2,400. (In 2026, it’s $2,100.) Certain payments made on your behalf can also count toward that limit. Once you reach it, you pay nothing more for covered Part D drugs that year. But note: your monthly premiums don’t count toward the limit.

Here is where drug company pricing reaches your wallet. A higher drug price can mean a higher deductible payment or a larger bill when your plan charges a percentage. Medicare’s negotiated prices can lower those costs for patients, as well as spending by Medicare itself.

But a lower price doesn’t always translate to a lower copay at the pharmacy. That’s a key reason to compare your plan options.

And at ALDP, we never forget that a $2,400 spending limit is valuable protection against much larger drug bills. But $2,400, plus twelve months of premiums, is also still a lot of money for many Americans.

What’s changing for 2027

The biggest changes are a higher deductible, a higher yearly spending limit, and fewer stand-alone drug plans to choose from.

	2026	2027
Highest deductible a plan can charge	$615	$700
Yearly out-of-pocket drug spending limit	$2,100	$2,400
Average monthly premium, stand-alone drug plan	$35.09	$36.00
Number of stand-alone drug plans nationwide	360	316

Sources: Medicare, AARP and Medicare’s 2027 benefit rules.

Think of that average premium like you’d think about a national weather report. A national average temperature of 60 degrees could mean shorts in Phoenix and a parka in Fargo. What matters is your local forecast. Or in this case, your own plan’s premium. Many people will see their drug plan premiums rise by $30 a month or more next year. That’s at least $360 more a year before ever buying a single prescription. Temporary federal help that held some premiums down is also ending. The lesson? Your premium could rise sharply, barely change, or even fall. The national average won’t tell you which. Check your own plan and options.

(If you’re in a Medicare Advantage plan, Medicare projects that the average monthly premium for the drug portion of coverage will fall to about $7. That’s not the total premium for Medicare Advantage coverage, however. Check your overall costs, doctors, hospitals and pharmacies, too.)

And one more thing: Your current plan may renew automatically, but that doesn’t mean its prices and coverage will stay the same.

How to compare plans and plan your budget

1. Make a complete list. Write down every medicine, the dose, how often you take it, and where you fill it. Include the cheap ones, because they add up.
2. Read the letter your plan mailed in September. It’s called the Annual Notice of Change. Look for medicines that moved price tiers, were dropped, or now require special approval. Check the new premium and deductible, too.
3. Put Medicare’s Plan Finder to work. Enter your list at Medicare.gov/plan-compare and the site will estimate your drug costs under each plan. Look at the total for the year, not just the premium.
4. Check for restrictions. Does the plan require pre-approvals? Will it cover your dose and quantity needs? Do you have to try another treatment first? If a lower-cost plan comes with hurdles, isn’t necessarily the best plan for you.
5. Look hard at January through March. That’s when your deductible resets and percentage charges can sting more. If those months will be tight, consider the free Medicare Prescription Payment Plan. It lets you spread your out-of-pocket drug costs into monthly bills. It doesn’t reduce what you owe, but it can make it easier to manage.
6. Check your pharmacy. Prices can vary across pharmacies, and mail delivery prices make be different from retail prices. A plan that looks cheapest may not be cheapest at the pharmacy you actually use.
7. Compare cash prices, too. Sometimes paying cash is cheaper than using your insurance. TrumpRx.gov lists discounted cash prices for some brand-name medicines, and it has helped lower prices for people who are willing and able to pay directly. Other discount programs may also be worth checking out. But there’s an important tradeoff: when you buy a drug outside your Medicare plan, that payment generally doesn’t count toward your Part D deductible or the $2,400-a-year limit. Compare both the immediate savings and the effect on your costs over the whole year.
8. Ask for an exception if you need one. If your plan charges a high copay for a medicine you need, your doctor may be able to help you request a lower one, particularly if cheaper alternatives aren’t medically appropriate for you. If the plan refuses to cover a medicine, you can also request an exception or appeal its decision. A denial isn’t necessarily the last word.
9. Write down what you chose and why. Save or print your Plan Finder results, including the medicines and pharmacies you entered. Keep them with your enrollment confirmation. Next October, you’ll be glad that you did.

Helping a parent or loved one? Sit down together with their pill bottles and plan letters. Let them make the call; your job is to help with the math. Ask their doctor whether any changes to their medicines are likely next year, since that can affect which plan is best.

Free, unbiased help

None of these resources sells plans. All of them are free.

• Your state’s SHIP. Every state has a State Health Insurance Assistance Program with trained counselors who can help you compare plans by phone or in person. Some states use other names, like SHINE in Florida. Find yours at shiphelp.org or call 877-839-2675.
• Medicare itself. Call 1-800-MEDICARE (800-633-4227) or use Medicare.gov. You can get help comparing available plans.
• Medicare Rights Center. This nonprofit offers free counseling at 800-333-4114, weekdays from 9 a.m. to 5 p.m. (Eastern) (Medicare Rights Center).
• Extra Help. If money is tight, check whether you qualify for this federal program. It can pay your drug plan premium and deductible and substantially reduce what you pay at the pharmacy. In 2027, qualifying beneficiaries generally pay no more than $5.80 for a covered generic prescription or $14.40 for a covered brand-name prescription. Some people pay even less. Apply through Social Security at 800-772-1213 or visit Medicare’s Extra Help information. A SHIP counselor can also help.

If you switch plans and encounter trouble getting an existing prescription filled, ask about a temporary supply while you and your doctor work through the plan’s requirements. Medicare has protections designed to prevent some interruptions in treatment.

And be cautious with unexpected calls offering to “help” you choose a plan. A trustworthy counselor won’t rush you, pressure you to enroll, or ask for your bank or credit card information.

The bigger picture

Drug manufacturers agreed to substantially lower prices when Medicare finally had the authority to negotiate. They have continued supplying their medicines. That tells us something important: the prices manufacturers initially asked Americans to pay were not the only prices possible. We know that from looking at what other countries pay, too.

Medicare’s negotiations are progress, but they don’t erase the larger problem. Too many Americans still face high prices for medicines they need. Those costs pop up in a lot of places: premiums, deductibles, copays, and taxes. And even with Medicare’s new protections, choosing a drug plan can be exhausting.

You can’t change the prices drug companies set from your kitchen table. But you can ask questions, compare your options, get help, and choose the coverage that works best for you. It’s worth doing. And while you’re doing your part, we’ll keep working to make sure the companies setting those prices do theirs.If you’ve already completed the Open Enrollment process this cycle, tell us what was hardest or what you learned. Your experiences keep us grounded in what’s happening and tell us where to take our advocacy next.