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KINGWOOD – There's a lot of changes coming to Medicare in 2027, according to Mike Cilella, MBA, Benefits Advisor.
"Carriers are reorganizing and some plans are discontinued. That means the general public can't sign up for that plan. If you are already on a plan and it is not taking anymore enrollees, you can stay in it or choose a different plan," he said.
Cilella has worked in the insurance industry for 14 years and Medicare for 9 years. He said he asks everyone if they have a Medicare advisor.
"As a fellow member of Medicare, I can tell you, don't try to navigate the plans yourself. If you go the wrong way it can cost you money," he said. "We spend a lot of time with clients to find a plan that fits their needs, and it's a lifetime service, it doesn't stop there.
He said Medicare Part D out-of-pocket cap is raising to $2,400 for 2027, up from $2,100 in 2026 While this still provides a strong safety net for those with exceptionally high drug expenses, individuals taking specialty medications could see their out-of pocket costs rise by up to #300 before hitting the threshold.
Temporary federal premium-stabilization subsidy programs that helped artificially limit prescription premium increases over he last two years is scheduled to expire on January 1, 2027. As a result many stand-alone Part D plans are raising premiums or retiring drug lists. For those enrolled in Medicare Advantage with Prescription Drug (MAPD) plans, the stakes are equally high. While the Centers for Medicare and Medicaid Services
Cilella said major carriers like Humana and United Healthcare are cutting hundreds of thousands of members from their roster for 2027 to protect margins. He said if you plan is being eliminated, federal regulations require the carrier to mail you a formal plan Nonrenewable Notice by October 2.
"Although regular open enrollment closes on December 7, individuals whose plans are discontinued qualify for a Special Enrollment Period (SEP), This gives you from December 8, 2026 through February 28,2027 to pick a new plan. However, you should aim to enroll by December 31 to avoid a coverage gap on New Year's Day," he said.
Ciella said there are also special plans for individuals who have Medicare and Medicaid. He said some of these plans provide cards for food, money, gas, utilities, and some even pay for internet and over the counter items.
"If you are satisfied with your plan make sure your doctor is still in the network and drug costs are covered," he said. " If they are you don't have to do anything. Your plan will automatically roll over."
For more information you can email Michael Cilella at lmcilella@BOSTbenefits.com or call his office 304-099-5552 or cell at 304-288-9010.