Medicare faces eligibility and coverage changes in 2027

Medicare is set to undergo significant changes in 2027, impacting eligibility, costs, and plan availability for millions of Americans.

Eligibility requirements will become more specific, requiring beneficiaries to be U.S. citizens, U.S. nationals, lawful permanent residents, Cuban-Haitian entrants, or COFA migrants. Regarding prescription drugs, Medicare Part D costs are expected to rise, with the deductible increasing from a maximum of $615 in 2026 to $700 in 2027, and the annual out-of-pocket maximum rising from $2,100 to $2,400.

Additionally, the landscape for Medicare Advantage plans is shifting. Major insurers, including UnitedHealth Group, Humana, and CVS Health, are adjusting their businesses due to rising medical expenses. This has led to a reduction in available plans; KFF reports the average beneficiary will have access to approximately 35 plans in 2027, down from 39 in 2026. Approximately 3.8 million enrollees may require new coverage as insurers discontinue plans or withdraw from certain markets. Notably, the number of counties expected to have no Medicare Advantage plans available is projected to rise from 67 in 2026 to 181 in 2027.

On the service side, Medicare is launching the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) model, a voluntary option for those on original Medicare to help manage chronic diseases through connected providers.