Medicare 2026

What's Already Locked In for Medicare in Late 2026 and 2027 — Dates, Dollars, and Rules to Know

If you're trying to get your bearings on Medicare for the coming year, a surprising amount is already settled in law. Several changes for 2027 were written into statute in 2025 and 2026, and a few familiar deadlines on the calendar haven't moved. Here's a plain-English tour of what's confirmed, what's still coming, and what it may mean for you as you plan.

The enrollment calendar

The Medicare Annual Enrollment Period — often called Open Enrollment — runs October 15 through December 7, 2026. Anything you choose during that window takes effect January 1, 2027. This is the main time of year to review your Part D prescription drug plan or Medicare Advantage plan and decide whether to stay put or switch.

From January 1 through March 31, 2027, people already in a Medicare Advantage plan have the Medicare Advantage Open Enrollment Period to make one change — either switch to a different Advantage plan or go back to Original Medicare (and pick up a stand-alone Part D plan if they want drug coverage).

What's confirmed for 2027 drug coverage

Part D has a few national figures already set:

• $2,400 — the most any enrollee will pay out of pocket for covered Part D drugs in 2027 (up from $2,100 in 2026).
• $700 — the highest deductible any Part D plan is allowed to charge in 2027. Many plans set a lower deductible; this is just the ceiling.
• $41.33 — the national "base beneficiary premium" used to calculate the Part D late-enrollment penalty. This is not what you'll pay for a plan; actual plan premiums are set plan by plan.

If you continue to spread your Part D out-of-pocket costs across the year through the Medicare Prescription Payment Plan, you can re-elect that option for 2027. Details are on Medicare.gov.

What's not announced yet

Two important 2027 numbers have not been released: the Part B standard premium and annual deductible, and the IRMAA income brackets that determine higher Part B and Part D premiums for higher-income enrollees. CMS typically announces these in the fall. Until then, please don't rely on estimates or projections — wait for the official figures.

A piece of related news from Social Security: on October 14, 2026, SSA announced a 3.6 percent cost-of-living adjustment (COLA) for benefits payable beginning January 2027. Because Part B premiums are often deducted from Social Security checks, your net deposit will depend on both the COLA and the Part B premium when it's published.

Rules changing for 2027

Eligibility narrows. Under the 2025 budget reconciliation law (Public Law 119-21), Medicare entitlement or enrollment is limited to U.S. citizens and nationals, lawful permanent residents, Cuban and Haitian entrants, and people lawfully residing under a Compact of Free Association. For people already enrolled when the law passed on July 4, 2025, who don't meet the new criteria, CMS's 2027 physician fee schedule final rule says coverage will be terminated effective February 1, 2027. If this could affect you or a family member, contact Medicare for guidance on your situation.

Home infusion gets broader. Beginning April 1, 2027, Medicare will treat an external infusion pump and its home infusion drug as durable medical equipment even when the drug must be given by or supervised by a health professional — as long as a qualified home infusion therapy supplier administers or supervises it in your home and the FDA prescribing information calls for infusion at least 12 times a year.

Telehealth and rural ambulance add-ons extended. The telehealth flexibilities first introduced during the COVID-19 pandemic, along with the ground ambulance add-on payments (3 percent for rural origin, 2 percent for other areas, and 22.6 percent for "super rural" areas), continue through December 31, 2027.

Physician payment update. CMS's 2027 physician fee schedule final rule takes effect January 1, 2027. CMS estimates the 2027 conversion factor at $32.9548 for qualifying alternative payment model participants and $32.6286 for other clinicians. A temporary 2.5 percent increase in physician payments that applied during 2026 under the 2025 reconciliation law does not continue into 2027.

A funding deadline in December. The Continuing Appropriations and Extensions Act, 2027 (Public Law 119-103), signed September 2, 2026, keeps federal activities funded at fiscal year 2026 rates through December 11, 2026, unless full-year 2027 appropriations are enacted first. Some narrowly targeted Medicare payment provisions — including the Medicare-Dependent Hospital program, current low-volume hospital payment criteria (fewer than 3,800 discharges a year and at least 15 road miles from another acute care hospital), and the 1.00 floor on the geographic index for physician work — run through December 31, 2026 under the Consolidated Appropriations Act, 2026. The 2026 Medicare Trustees Report notes the low-volume criteria revert to their original parameters if that provision isn't extended.

If you have Medicaid or Extra Help

Since 2025, you've had a monthly Special Enrollment Period to move from Medicare Advantage to Original Medicare and pick up a stand-alone Part D plan, or to switch from one stand-alone Part D plan to another. If you're a full-benefit dual-eligible, you can also join an integrated Dual Eligible Special Needs Plan (D-SNP) in any month. The older rule that limited these changes to once per quarter is gone — you no longer need to wait for a new quarter.

Weighing your choices

When you compare Original Medicare (often paired with a Medigap policy and a stand-alone Part D plan) to Medicare Advantage, there are genuine trade-offs on both sides — provider access, out-of-pocket exposure, extra benefits, premiums, referrals, and travel coverage all look different. There's no single right answer; the fit depends on your health, your doctors, your budget, and your preferences. Take the time to compare plans available to you before you decide.

Where to go next

For plan comparisons in your area, coverage rules, and official 2027 figures as they're published, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users can call 1-877-486-2048.

This article is for general education. It is not from the federal government and is not affiliated with Medicare or any government agency.