CMS released a preview of 2027 Medicare Part D and Medicare Advantage prescription benefit changes, including tighter notice windows when plans move drugs to higher cost-sharing tiers midyear.
Highlights for counselors
- The $35 insulin cap and recommended vaccines at zero cost-sharing continue in standard Part D designs.
- Medication therapy management (MTM) programs must flag polypharmacy earlier for dual-eligible enrollees.
- Formulary change letters will require plain-language alternatives when a drug is removed entirely.
Open enrollment for 2027 coverage runs October 15, 2026 through December 7, 2026. Advocates should begin comparing plan formularies in September when the Medicare Plan Finder updates.
September preparation steps
Pull current Part D formulary tiers, confirm whether clients use insulin or vaccines covered at zero cost-sharing, and list drugs that changed tiers in the prior plan year.
For dual-eligible clients, screen MTM program letters early—new triggers may flag polypharmacy before year-end transitions.
Guides on patientadvocates.io
For step-by-step help, start with our Medicare Part D basics guide or browse related topics including Medicare Part D & Rx, Formularies & tiers.
Common questions
When is Medicare open enrollment for 2027 coverage?
Open enrollment for 2027 Part D and Medicare Advantage plans runs October 15 through December 7, 2026.