Medicare open enrollment starts October 15 and continues through December 7. Everyone who has Medicare, in whatever form, should pay close attention to their coverage for the year ahead. You may be surprised at how much is about to change — in both costs and coverage.

Here’s a look at the headline changes seniors will be forced to confront. And in next week’s column, I’ll show you how to find trusted advice to guide you through the process. Ignoring Medicare during open enrollment is not an option for any senior.

—Part B premiums: Part B premiums will rise again for 2027. The amount will announced in late October or early November, along with the income-related monthly adjustment amounts (IRMAA), which are a surcharge for higher earners.

—Medicare supplements: Monthly premiums for supplements are certain to rise, as well. If you have traditional Medicare, you need a supplement to cover costs and co-pays that are not covered by traditional Medicare. Changing Medicare supplements because of pricing might require qualifying based on current health.

—Part D drug plans: If you sign up for traditional Medicare, you must also sign up for a Part D drug plan, even if you are not currently taking meds. (If you don’t sign up, you’ll pay significantly higher premiums in the future, when you will certainly need drugs.) Part D premiums are expected to rise significantly in 2027. The government has ended its premium subsidies, which were designed to make Part D more affordable, so there will be few “free” or “zero-premium” plans — and fewer Part D plan choices.

The annual part D deductible will rise to $700 from $615 in 2027. The annual out-of-pocket cap for prescriptions covered by Part D will increase to $2,400 from $2,100 in 2027. But in 2027, Part D plans will cover some GLP-1 drugs for weight loss.

During open enrollment you must review your Part D drug coverage because plans frequently change drugs that are covered, costs, and participating pharmacies. If you don’t review your Part D now, you could face an expensive surprise in January. (Compare Part D plans at Medicare.gov or HeyMoe.com.)

—Medicare Advantage plans: Advantage plans are undergoing huge changes in 2027, in costs and provider networks. More than half of all seniors — 35 million people — are now enrolled in Advantage Plans, which are basically private insurance subsidized by a per-enrollee payment from the government. Insurers are private companies trying to make a profit from the spread between the money they receive from the government and the healthcare services they pay for.

Advantage plans have historically offered low premiums along with services such as vision, hearing and dental coverage, which are not offered by traditional Medicare and supplements. Now, that is changing as profits are squeezed. If you have an Advantage plan, you’ll soon receive an “ANOC” — annual notice of change — describing the coverages, networks and pricing for 2027 coverage.

During open enrollment, you can switch from traditional Medicare and a supplement to Advantage plans. Big commissions trigger annoying commercials and sales calls. But Advantage plans limit your access to care, acting as HMOs or PPOs with coverage restricted to physicians and hospitals in their network. Advantage plans often require (and routinely deny) pre-approvals for doctor-recommended treatments. Most, but not all, Advantage plans include drug coverage, but you need to check to make sure your prescriptions are included and any additional costs.

You must review your Advantage plan during open enrollment to make sure your physician and hospital are still included. Do that at the plan’s website. For 2027 several major insurers, including UnitedHealthcare and Humana, are canceling plans for more than 1 million people, while other plans are limiting networks.

Bottom line: The low monthly Advantage premium works well if you remain healthy. But expect to pay steep out-of-pocket costs for some service or out-of-network services if you are in poor health. The maximum Advantage out-of-pocket cost for 2027 will be $9,850 for covered in-network services, and a total of $14,800 for combined in-network and out-of-network services, such as those offered by a PPO. Individual plans may have lower limits, but these costs can easily wipe out the “advantage” of lower premiums and extra services.

And don’t count on switching back to traditional Medicare and a supplement during open enrollment. If you already have a health issue, you will pay more for a less-comprehensive supplement if they will accept you — except for in a few states which require acceptance without medical underwriting, or if your current plan ends and you are not offered an alternative.

If you’re feeling overwhelmed or intimidated, you’re not alone. In my next column I’ll show you how to get trusted help in these decisions, and how to search and compare coverages. Seniors: Your health and your wealth are at stake. And that’s The Savage Truth.

©2026 Terry Savage. Distributed by Tribune Content Agency, LLC.