Review '27 Medicare coverage before plans renew

The phone calls, the flyers, the text messages: They're not just telling you to vote. If you are nearing 65 or have reached that birthday milestone, there is a full-court press right now to have you sign up for Medicare.

The federal health insurance plan mostly for seniors or anyone with a debilitating medical condition has open enrollment from Oct. 15 to Dec. 7. It's the period when you can make a change to your current plan or choose a different type of Medicare. If you are in the process of turning 65, your enrollment period begins three months before your birth month and ends three months after it.

Telemarketers are promising you free groceries, gym memberships and transportation to doctors' appointments. But what they are not offering you is automatic coverage, lower premiums or more affordable medications.

It's buyer-beware season for Medicare plans because making a change could have long-term consequences, and not making any changes also could be detrimental.

If you never make any selections at all or you don't realize your current plan is no longer available, the federal government will enroll in you the bare-minimum: Part A hospital coverage and nothing else (no prescription drug coverage or doctor's visits, for example). If your current plan is still available, you will automatically be re-enrolled.

"Decision paralysis" -- not making any changes because of feeling overwhelmed by the amount of information -- is a real concern, said Louise Norris, a health policy analyst with the consumer group medicareresources.org.

If you do make a decision and you have buyer's remorse, you can make a switch between Medicare Advantage plans from Jan. 1 through March 31. You also can switch back to Original Medicare, but you cannot switch from Original Medicare to a Medicare Advantage plan at this time or switch your Original Medicare drug plan.

The federal government has released some of the figures, but not all of them, Norris said.

Part A, the hospital portion, does not have a monthly premium for 99% of Medicare recipients, unless they or their spouse did not work long enough to fully pay into the plan. There is a deductible for a hospital stay. In June, the board of trustees for Medicare estimated it would be $1,788 in 2027, up from $1,736 this year.

In 2027, the Part B monthly premium (for doctor's visits and therapy appointments), is projected to go up from $202.90 to $209.50. Those usually come out of your Social Security checks. Some Medicare Advantage plans do help cover those premiums.

The deductible for Part B is expected to go up to $292 from $283 this year.

Part D, the prescription drug plan, will have a $2,400 maximum out-of-pocket expense, up from $2,100 this year. And the deductible can be as high as $700, up from $615.

If you have Medicare Advantage, the maximum out-of-pocket cost for non-prescription services is $9,850 for in-network care and $14,800 for combined in-network and out-of network care. That's up 6.5% from 2026 of $9,250 and $13,900.

Not all plans available

That should be the No. 1 question to research right now: whether you have Original Medicare with a Medigap plan (to cover the 20% Medicare doesn't) and a Part D prescription plan or a Medicare Advantage with everything included.

You should have received a letter in the mail if your plan does not exist in 2027, but just in case, check with your plan provider.

Texas had the most Medicare Advantage plans that are being discontinued from 2026 to 2027, nine out of 36, more than any other state. If you had one of those nine plans, you need to pick a new one.

You do have an opportunity in this circumstance. You can pick another Advantage plan, but you can also pick Original Medicare and not face any penalties when buying a Medigap plan. You also do not have to meet any physical health requirements to qualify for a Medigap plan.

The advantage of Original Medicare is it travels with you nationwide, you can pick any doctor (there's no in-network or out-of-network restriction), and prior authorizations are not required for most services.

Typically, you pay more with Original Medicare, but you are unlikely to get denied care. If you have an employer that provides retirement healthcare, often it can serve as your Medigap coverage and even your Part D prescription coverage, which might save you money.

Research your plans

Even if your plan is available, plans change from year to year, or you might find a different plan that is less expensive but covers more.

Before you just let your plan roll over to the next year, do your research, especially if you have a Medicare Advantage plan, which has fewer government regulations.

Have costs gone up? Consider deductibles, monthly premiums, co-pays and other costs.

Are your doctors still accepting your plan? "You don't want to find out in January that your doctor is not in-network," Norris said.

Are your medications still covered and at what cost? "Each plan designs its own drug coverage and that can be really different," Norris said.

Are vision, hearing and dental benefits included and do your providers still take that plan? Would it be less expensive to pay out of pocket for those services?

Ready to pick a plan?

If you are staying with Original Medicare, you can pick a Part D plan during this enrollment period. To enroll in Part A and Part B, you should do that as you are turning 65, and it's done through the Social Security Administration. Your Medigap plan should have been chosen when you turned 65, or you can pick it now if you have the ability to switch from Medicare Advantage to Original Medicare because your plan is no longer available.

Shopping on Medicare.gov, we found 12 Medigap plans for ZIP code 78704 ranging in price from $29 a month to $2,098, not including the monthly Part B costs. Some had no hospital deductibles; others had up to $1,736 in deductibles. Some of them covered foreign travel. some did not.

We found 10 Part D plans in ZIP code 78704. Drug deductibles ranged from $300 to $700; monthly premiums ranged from $5.30 to $199. It would be impossible to know what you would be buying with these plans without putting in your pharmacies and your prescriptions to compare them.

For people who choose to go the Medicare Advantage route, we found 28 Medicare Advantage plans for 78704. We found plans with $0 to $138 monthly premiums. Some plans had the maximum cost of $9,850 for in-network and $14,800 for in-network and out-of-network, while others had a lower in-network maximum cost, but no out-of-network maximum. Most had a $0 health plan deductible, but some had deductibles as high as $750. Drug deductibles ranged from $0 to to $700. You'll want to put in your providers and your medications to find the true costs of each plan.

If you are switching Medicare Advantage plans, your medical history can be considered in the pricing. With Original Medicare, that history isn't a factor.

Common mistakes

People often forget to get all the different parts of Original Medicare. They might take Part A, which is the hospital part, but then forget to get Part B for doctor visits, or Part D for prescriptions.

If they don't get Part B, they would be paying in full for everything except hospital stays. There are penalties if they don't get Part B when they sign up at age 65. It's roughly 10% for each year they didn't sign up.

There also are penalties for not signing up for Part D -- 1% extra each month that you could have signed up. That's 12% more a year.

The penalties are for the life of the plan, so signing up for Parts B and D is important when you initially sign up for Part A.

The second-biggest mistake is taking Original Medicare without taking Medigap plan when first signing up. The costs can't go up on these policies, even if you get sick, and the insurer can't reject you for previous health issues if you sign up when you get Medicare. If you sign up afterward, you will have to go through a qualifying process and can be charged based on your age and current health situation.

Remember, with Original Medicare, there isn't a maximum out-of-pocket expense. Think about a $1 million hospital stay: 20% is $200,000 that you would owe without a Medigap plan. You pay a monthly premium to your Medigap insurer, and each insurer will differ in costs and coverage.

Before you sign up for Medigap, though, check your retiree benefits to make sure you don't have a supplemental insurance already.

Even Medigap doesn't cover everything. Usually, you're still paying extra for long-term care that is not skilled nursing, as well as vision, dental, hearing and private nursing.

The third mistake is not picking a plan that actually covers your ZIP code. Medicare.gov always starts with your ZIP code.

The final mistake is not signing up for assistance programs. In Texas, assistance is available through programs for individuals who make less than $1,330 a month or couples making less than $1,804 and have resource limits of $9,660 for individuals or $14,470 for couples. In another program, the monthly limits are less than $2,660 for individuals and $3,607 for a couple. Call the Texas Medicare Help Line at 800-252-9240 to get help signing up for assistance.

Another resource: Area Agency on Aging of the Capital Area: 512-916-6178 or capcog.org/divisions/area-agency-on-aging.

Don't wait until December to look at your selections. Support services get really busy around Thanksgiving as everyone is trying to make the Dec. 7 deadline.

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