Best Medicare Choices Right Now

Why it matters: If you’re on traditional Medicare, this isn’t a concern. Nearly all doctors and hospitals in the U.S. accept your coverage. But if you’re on a Medicare Advantage plan, your care is covered only when you use its local network of doctors, hospitals, and outpatient facilities.

The problem is that more healthcare providers are rejecting the pay rates and terms offered by various Medicare Advantage plans and dropping out of those networks. So if you want to be certain you can see a particular provider in 2027, you’ll need to check.

What to do: First, look for your Annual Notice of Change, a letter or email that your Advantage plan should send you by Sept. 30. (If it doesn’t, call.) These documents may list all of the providers in your area who are no longer in-network, not just the ones you go to. The lists can be complicated, so if you aren’t sure whether you’re affected, contact your doctors directly to ask whether they’ll be in your network in 2027, says Emily Whicheloe, director of education at the Medicare Rights Center. If the answer is no, find out which Advantage plans they’ll be working with, and consider switching.

If your doctor of choice won’t be participating in any Advantage plan next year, you may still have another option. Look for Private Fee-for-Service, or PFFS, Advantage plans, which don’t have set doctor networks. Instead, you ask your preferred providers if they’ll accept the plan’s terms and payment rates. Or consider a Preferred Provider Organization (PPO) Advantage plan, some of which offer limited coverage for out-of-network providers.

But perhaps the best way to continue seeing a newly out-of-network doctor is to switch to traditional Medicare with a supplemental plan, a decision we discuss in Step 4.

Why it matters: Medicare Part D plans cover prescription medications, either as stand-alone plans under traditional Medicare or bundled within Advantage plans. But no Part D plans cover all drugs. Instead, they determine which medications they will and will not cover, and—to control costs—divide the covered drugs into tiers, from low-cost generics (which you pay a smaller copay for) to high-cost specialty drugs (for larger copays or percentages). What’s tricky is that those determinations—known as formularies—can change every year, with plans deciding to stop covering some drugs and moving others from one tier to another. These changes can significantly affect how much you’ll pay out of pocket.

Other developments could significantly increase your 2027 out-of-pocket drug costs as well. For one thing, a growing number of Part D plans are switching from flat copays to amounts based on a percentage of a drug’s price, says Stacie Dusetzina, PhD, a professor of health policy at the Vanderbilt University School of Medicine in Nashville, Tenn., and an expert on Medicare prescription drug policies.

And in late July, the Trump administration ended a 2-year-old subsidy that reduced Medicare drug plan premiums, potentially adding at least $120 per year to your Part D premium. (On the other hand, Medicare recently negotiated large discounts on 15 popular and pricey drugs that don’t have generic equivalents, which may save you a bundle if you take one of them and your plan charges percentage-based copays.)

What to do: To find out whether your drugs were dropped from your plan or moved to a more expensive tier, refer to your Annual Notice of Change, or log on to your medicare.gov account.

If the news is bad, search for a better Part D plan using medicare.gov’s Plan Finder. You enter a list of all your meds with the strengths and dosages, select up to five local pharmacies, and hit “Enter.” Then narrow the results to plans that rate well in terms of customer service and price by selecting “Star Ratings” and “3 Stars or Higher.”

Finally, select up to three plans at a time to compare premiums and deductibles. Select “Plan Details” and then "Drug Coverage" to compare the total annual cost of your meds at the various pharmacies. The lowest prices will be at pharmacies designated as "Preferred."

Why it matters: Medicare plans frequently make you cover copayments and deductibles, which can add up to huge amounts in the event of a hospitalization or serious illness. Out-of-pocket maximums set annual limits on these expenses, after which plans cover 100 percent. But these limits should be manageable in a worst-case scenario, or you could be stuck with unexpected debt. It’s also important to know that each Medicare component—medical, prescription drug, and supplemental coverage—can have its own out-of-pocket costs, and you could be on the hook for all of them.

What to do: Understanding your exposure is crucial. Many Medicare users don’t realize how much they could have to shell out until it’s too late, says Jack Hoadley, PhD, a Medicare expert and research professor emeritus at the Health Policy Institute at Georgetown University in Washington, D.C.

Traditional Medicare has no out-of-pocket max: It covers 80 percent, and you’re responsible for the rest. So it’s essential to purchase a supplemental plan, Hoadley says. (About 13 percent of people on traditional Medicare go without one, according to a 2025 Kaiser analysis.) But supplemental plans can have their own out-of-pocket maximums. Of the 10 plan types (known by the letters A-D, F, G, and K-N), K and L are expected to have out-of-pocket limits of $8,400 and $4,200, respectively, while the others will cover 100 percent of medical costs.

Medicare Advantage plans are allowed to set out-of-pocket limits as high as an estimated $9,850 for HMOs and $14,800 for PPOs, but some often set them lower. To find your plan’s limit, log on to medicare.gov, follow prompts for “Find Health or Drug Plans,” and select Medicare Advantage (Part C).

Part D prescription drug plans have out-of-pocket maxes of $2,400 for 2027, whether they’re stand-alone plans under traditional Medicare or bundled within Advantage plans. (It’s still important to compare Part D plans because most people don’t reach that limit.) If your maximums are too high for your budget or comfort, shop for a different plan at medicare.gov.

Why it matters: We’ve explained why you might want to switch plans within a Medicare category (Advantage, Part D, or supplemental). But some situations might merit switching from an Advantage plan to traditional Medicare or the other way around.

▶ Medicare Advantage to traditional Medicare. Advantage plan premiums often cost less than traditional Medicare plus a supplemental plan. Even so, you might consider this switch if, for example, one of your doctors no longer accepts your Medicare Advantage plan. Or maybe you’ve received a complex diagnosis and want to seek care at an out-of-state healthcare center like the Mayo Clinic. Or perhaps you’d like treatments or tests without waiting for prior authorization from your insurer. (Two recent federal studies—here and here—found that Advantage plans routinely deny authorizations for services that traditional Medicare would have covered. A separate KFF analysis found that prior authorizations are the top consumer frustration in healthcare.)

Consider this switch only if you can find an affordable supplemental plan, Hoadley says. That may be difficult: The time windows during which supplemental plans must accept you without “medical underwriting” may have closed. The process usually includes a physical exam and can raise your rates or cause an insurer to deny coverage. Still, Hoadley says it’s worth trying despite the conventional wisdom that it’s difficult or expensive. That’s especially true if you’ve moved outside your Advantage’s plan coverage area and qualify for a special enrollment period.

▶ Traditional Medicare to Medicare Advantage. The case for this switch is narrow and applies if you’re on traditional Medicare without a supplemental plan, then realize you should protect yourself from potentially huge out-of-pocket medical bills but can’t find an affordable supplemental plan.

What to do: Log on to your medicare.gov account and click on “Find Health & Drug Plans” to search for a supplemental plan. Or get help from one of the resources listed below.

Why it matters: Medicare charges an extra fee, known as IRMAA (for Income-Related Monthly Adjustment Amount), for people with high incomes. It’s levied on a sliding scale based on your annual income from two years before. (See above for details.) One-off events like a home sale or 401(k) withdrawal can also trigger it. Conversely, those who live on less than $18,000 a year and hold less than about $9,500 in assets (not including a home, a car, and certain personal items) might qualify for assistance with Part B and Part D premiums.

What to do: IRMAA is applied automatically to your monthly premiums based on IRS data. You can appeal if the info used is incorrect. And you can seek an adjustment or waiver if, among other reasons, your income declines, your spouse dies, or you lose your job.

To find out whether you’re eligible for lower Part B or D payments, use the questionnaire at the Patient Advocacy Network (panfoundation.org/extrahelp). If you qualify, work with a Medicare adviser below to apply.

You become eligible for Medicare at age 65. But you should take these steps as soon as you enter the seven-month period starting three calendar months before the month of your birthday. (If you’re still covered by an employer plan after 65, you have eight months after you stop working to enroll.)

▶ Go to socialsecurity.gov to create an account and sign up for Medicare Part A (hospital coverage, which is usually free) and Medicare Part B (doctor coverage, which will cost about $210 a month in 2027). Do this whether you’re choosing traditional Medicare or Medicare Advantage.

▶ Next, head to medicare.gov to set up an account and search for Medicare Advantage plans, supplemental plans (if you choose traditional Medicare), and Medicare Part D drug coverage in your area. Coverage usually starts the month you sign up.

▶ Get help if you can’t decide on a plan. And keep in mind that if you initially sign up for an Advantage plan and aren’t satisfied for any reason, you can go back to traditional Medicare with a guaranteed supplemental plan within the first 12 months. (After that, you’ll probably have to go through medical underwriting.)

What if you don’t sign up within your seven-month window? You’ll face a surcharge of up to 10 percent on Part B and Part D premiums for every year you delay. And because Medicare might not cover any medical bills retroactively, you’ll be on the hook for 100 percent of most medical costs that you incur before you sign up.

Three good sources of general Medicare information are the nonprofit Medicare Rights Center (medicarerights.org, 800-333-4114); the federally funded State Health Insurance Assistance Program, or SHIP (shiphelp.org; 877-839-2675); and Medicare itself (medicare.gov; 800-633-4227 ). These organizations connect you with advisers trained to help choose Medicare plans.

The National Association of Benefits and Insurance Professionals (nabip.org) has a directory of local, independent insurance brokers, and most don’t charge a fee.

The Patient Advocate Certification Board (pacboard.org) has a directory of certified patient advocates. They usually charge a fee but offer highly personalized service and sometimes help with billing disputes.

Chapter is a free, independent Medicare adviser that partners with Consumer Reports (askchapter.org/crmag; 855-684-4488). CR may receive compensation when members use the service.