The limit comes off

WHAT CHANGED?

If you take prescriptions on a Medicare drug plan, start with the reassuring part: on average, next year's premium is almost the same as this year's. Medicare officials projected on September 28 that the average monthly premium for a stand-alone prescription drug plan will rise by less than a dollar, from $35.09 in 2026 to about $36 in 2027.

What has changed is the thing standing behind that average. Through this year, Medicare ran a temporary program that paid each drug plan $10 a month per member and held any single plan to a $50 increase in its total premium. Medicare has now decided to end that program on December 31 and let 2027 prices be set under ordinary market conditions.

The average holds. The ceiling over your own plan does not.

Two more numbers move in January. The most a drug plan may charge as a yearly deductible rises from $615 to $700, and the amount you spend out of pocket before your plan picks up the rest of the year's drug costs rises from $2,100 to $2,400.

WHO IS AFFECTED?

• Anyone with a stand-alone Medicare prescription drug plan, the kind bought alongside Original Medicare. The premium, the deductible and the list of covered drugs are set plan by plan, and all three can change on January 1.

• Anyone in a Medicare Advantage plan that includes drug coverage. Medicare expects about 34 million people in Medicare Advantage next year, roughly 47 percent of everyone on Medicare.

• Anyone who qualifies for Extra Help, the program that covers drug-plan costs for people with limited income and savings, is largely shielded from this. Those premiums and copay amounts are set by the program, not by a plan's own pricing.

WHAT DOES IT MEAN?

An average is not a promise about your plan. With that $50 ceiling gone, two plans in the same county can move in opposite directions next year and still average out to less than a dollar. Yours may well be the steady one. It may also be the one that climbs, and there is no longer a figure in the rules that says how far.

Here is the part I would want my own mother to know. Your plan has already told you what it is doing. Drug and Medicare Advantage plans mail an Annual Notice of Change every September spelling out exactly what happens to costs and coverage in January. It is the plain envelope that looks like something you can throw away. It is the most valuable piece of paper you will get this fall.

And if you do nothing with it, nothing stops either. Medicare puts it plainly: if you are happy with your current coverage you do not need to do anything, because your coverage continues automatically. That is a comfort when the letter says your costs hold. It is expensive when the letter says otherwise. Doing nothing is still a decision.

WHAT TO DO

Find that September letter and read one line, your 2027 monthly premium, then set it against what else your county offers. Medicare's own plan finder lists every nearby plan's 2027 premium, deductible and covered drugs side by side, and the window to make a change runs from October 15 to December 7, with the new coverage starting January 1. If the letter went out with the recycling, your plan will send another copy, and 1-800-MEDICARE will go through your options with you at no charge.

If you would rather work through the comparison on paper, with your own prescriptions and doctors in front of you, The 2027 Medicare Open Enrollment Decision Kit is our own $47 guide to doing exactly that.

SOURCE: Medicare's 2027 drug-plan premium announcement

Written by Ellen Marsh

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