Medicare rarely stands still. Just as beneficiaries have adjusted to what changed in 2026, the Centers for Medicare & Medicaid Services (CMS) has already laid out the rules that will shape coverage in 2027. The CY 2027 final rule, published in April 2026, together with the 2027 Rate Announcement, touches nearly every corner of the program — from what you may pay for prescription drugs to how plans are rated, marketed, and structured.
Most of these changes take effect January 1, 2027, but several will influence what you see and hear during this fall's Annual Enrollment Period. Here is an early look at the most significant changes and what they may mean for you.
Part D Costs Adjust Upward
The Part D annual out-of-pocket cap — the yearly limit on what you pay for covered prescription drugs — is expected to rise from $2,100 in 2026 to $2,400 in 2027, based on figures announced by CMS. The cap was introduced by the Inflation Reduction Act and is indexed annually, which means it generally adjusts each year alongside drug spending trends. If you want a refresher on how the cap works, see our guide to the Part D out-of-pocket cap.
Alongside the cap, the maximum Part D deductible is expected to rise from $615 in 2026 to $700 in 2027. Not every plan charges the full deductible — some charge less or waive it for certain drug tiers — but plans that use the maximum may ask you to pay more before coverage kicks in.
Two things are worth keeping in perspective:
- The cap still provides a hard annual limit on covered Part D drug costs. Once you reach it, your plan generally pays the full cost of covered medications for the rest of the year.
- The Medicare Prescription Payment Plan remains available in 2027, letting you spread out-of-pocket costs into monthly installments rather than paying large amounts at the pharmacy counter.
Five More Negotiated Drug Prices Take Effect
The second cycle of Medicare drug price negotiation — known as IPAY 2027 — adds 5 more Part D drugs to the program. Combined with the first cycle, that brings the total to 15 drugs with negotiated prices effective January 1, 2027.
If you take one of the negotiated drugs, your cost-sharing may be lower starting in 2027, depending on how your plan structures its benefits. Even if you do not, the lower prices Medicare pays may influence plan costs across the program over time. The program continues beyond 2027 as well — CMS has already begun work on the third round of drug price negotiation, which will add more drugs in future years.
Star Ratings Are Being Streamlined
If you have ever compared Medicare Advantage or Part D plans on Medicare.gov, you have seen Star Ratings — the 1-to-5-star quality scores CMS assigns to plans based on measures like preventive care, member experience, and customer service. Higher-rated plans generally perform better on these measures, and the ratings are one tool beneficiaries can use when comparing options. Our guide to Medicare Star Ratings explains the system in detail.
For 2027, CMS is making several changes to how these ratings are calculated:
- 11 administrative-process measures are being removed. CMS is trimming measures that track internal plan processes rather than health outcomes, with the stated goal of focusing ratings on clinical care and member experience.
- A new Part C Depression Screening and Follow-Up measure is being added. This measure begins with the 2027 measurement year, which means it will first affect the 2029 Star Ratings.
- The "reward factor" is being reinstated. This is a scoring adjustment that benefits plans with consistently high performance across measures.
For beneficiaries, the practical takeaway is that Star Ratings may shift somewhat as the measure set changes. A rating moving up or down between years may reflect the new methodology as much as any change in quality, so it may help to look at the underlying measures that matter most to you rather than the overall score alone.
Marketing Rules Are Loosening
Effective October 1, 2026 — in time for contract year 2027 marketing — CMS is relaxing several rules that govern how Medicare Advantage and Part D plans and their agents market to beneficiaries:
- Call-recording retention is reduced from 10 years to 3 years. Agents and brokers must still record sales calls, but they are required to keep the recordings for a shorter period.
- Agents are no longer required to refer callers to State Health Insurance Assistance Programs (SHIPs) during sales conversations.
- Disclaimer timing is relaxed. Agents may now provide required disclaimers at any time before discussing plan benefits, rather than within the first 60 seconds of a call.
- Some restrictions on superlative language in plan marketing are relaxed, meaning you may see stronger promotional wording in plan advertisements than in recent years.
These changes describe how plans and agents may communicate — they do not change your benefits or your rights. The practical takeaway: screen sales calls carefully, take your time before enrolling, and remember that SHIP remains available for free, unbiased counseling even if an agent does not mention it. You can find your local SHIP at shiphelp.org.
Supplemental Benefit Transparency
Many Medicare Advantage plans offer Special Supplemental Benefits for the Chronically Ill (SSBCI) — extras such as food assistance or transportation available only to enrollees with certain chronic conditions. Starting in 2027:
- Plans must make SSBCI eligibility criteria publicly available, so you can see up front whether you may qualify for a benefit before enrolling.
- Rules for supplemental benefits administered through debit cards (such as flex cards for groceries or over-the-counter items) are formally codified, clarifying how these benefits must operate.
- The mid-year notice that plans previously sent to enrollees who had not used a supplemental benefit is eliminated.
That last change means you will no longer receive a mid-year reminder about unused benefits — which makes reviewing your plan's Annual Notice of Change (ANOC) and Evidence of Coverage even more important. It is generally up to you to understand a benefit's eligibility rules and use it.
D-SNP Alignment Rules
Beginning in 2027, enrollment in certain Dual Eligible Special Needs Plans (D-SNPs) — Medicare Advantage plans designed for people with both Medicare and Medicaid — is limited to people who are also enrolled in an affiliated Medicaid managed care organization. The goal is closer coordination between a member's Medicare and Medicaid coverage. If you are dually eligible and enrolled in a D-SNP, your plan or state Medicaid agency may contact you about how these rules affect your options, and SHIP counselors can help you understand them.
Background: Plan Payments in 2027
CMS projects that payments to Medicare Advantage plans will increase by 2.48% — over $13 billion — in 2027, part of the financial backdrop for the benefits and premiums plans will offer next year.
What to Do During This Fall's AEP
The 2027 changes will show up in the plan materials and comparisons you see this fall. Here is a simple game plan:
- Review your Annual Notice of Change in September. Your plan must send this document explaining how your premiums, deductibles, cost-sharing, formulary, and supplemental benefits will change for 2027. Our AEP checklist walks through what to look for.
- Compare plans during the Annual Enrollment Period, October 15 – December 7. Use the official plan finder at Medicare.gov/plan-compare to compare 2027 premiums, drug costs, and Star Ratings side by side.
- Get free counseling if you want help. Call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, or contact your local SHIP through shiphelp.org for free, unbiased, one-on-one guidance.
Summary and Next Steps
The 2027 rules bring cost adjustments, expanded drug price negotiation, and changes to how plans are rated and marketed. Key points to remember:
- The Part D out-of-pocket cap is expected to rise to $2,400 and the maximum deductible to $700 in 2027, per announced CMS figures
- 15 drugs will have negotiated prices effective January 1, 2027, after the second negotiation cycle adds 5 more
- Star Ratings are being streamlined, with 11 measures removed, a new depression screening measure added, and the reward factor reinstated
- Marketing rules loosen on October 1, 2026 — screen sales calls carefully and remember SHIP is always available for free help
- SSBCI eligibility criteria become public, but the mid-year unused-benefit notice goes away — read your ANOC closely
- Certain D-SNP enrollment is limited to people in an affiliated Medicaid managed care plan starting in 2027
Nothing requires action from you today. Watch for your Annual Notice of Change in September, then use the October 15 – December 7 Annual Enrollment Period to confirm your coverage still fits your needs for 2027 — with help from Medicare.gov, 1-800-MEDICARE, or your local SHIP counselor if you want it.
