15 Medicare Drugs Get Negotiated Prices on January 1, 2027: Ozempic Falls to $274

Direct answer: On January 1, 2027, negotiated prices take effect for 15 Medicare Part D drugs, including Ozempic, Rybelsus, and Wegovy. The negotiated price for a 30-day supply of those three semaglutide drugs is $274, down from a 2024 list price of $959, a 71% reduction, according to the Centers for Medicare & Medicaid Services (CMS), November 2025. CMS projects that people with Medicare drug coverage will save about $685 million in out-of-pocket costs in 2027 under the standard benefit design.

Which drugs get lower prices?

The 15 drugs cover diabetes, asthma, COPD, cancer, psoriasis, and other conditions. About 5.3 million of the 53 million people with Medicare Part D coverage were dispensed one of these drugs in 2024, according to CMS, November 2025.

These 15 drugs accounted for $42.5 billion in total Part D gross covered prescription drug costs in 2024, about 15% of all Part D gross costs. In the same year, people with Part D coverage spent $1.7 billion out of pocket on these drugs, according to CMS, November 2025.

The full list is Ozempic, Rybelsus, and Wegovy (one selected drug), Trelegy Ellipta, Xtandi, Pomalyst, Ofev, Ibrance, Linzess, Calquence, Austedo and Austedo XR, Breo Ellipta, Xifaxan, Vraylar, Tradjenta, Janumet and Janumet XR, and Otezla and Otezla XR, according to CMS, November 2025.

How much does each drug cost now?

The table below shows the negotiated price, called the maximum fair price, for a 30-day supply, next to the 2024 list price. All figures come from CMS, November 2025.

Drug	Negotiated price, 2027	List price, 2024	Reduction
Ozempic; Rybelsus; Wegovy	$274	$959	71%
Trelegy Ellipta	$175	$654	73%
Xtandi	$7,004	$13,480	48%
Pomalyst	$8,650	$21,744	60%
Ofev	$6,350	$12,622	50%
Ibrance	$7,871	$15,741	50%
Linzess	$136	$539	75%
Calquence	$8,600	$14,228	40%
Austedo; Austedo XR	$4,093	$6,623	38%
Breo Ellipta	$67	$397	83%
Xifaxan	$1,000	$2,696	63%
Vraylar	$770	$1,376	44%
Tradjenta	$78	$488	84%
Janumet; Janumet XR	$80	$526	85%
Otezla; Otezla XR	$1,650	$4,722	65%

The largest cut by percentage is Janumet, down 85%. The largest cut in dollars for a widely used drug is semaglutide: $685 less per 30-day supply. Prices vary by dosage form and strength. For example, one Ozempic 4 mg/3 mL pen is $276.78, and four Wegovy 2.4 mg/0.75 mL pens are $385.63, according to CMS, November 2025.

Who qualifies?

The negotiated prices apply to people with Medicare Part D prescription drug coverage who are dispensed one of the 15 selected drugs. The drug company must make the negotiated price available to eligible people and to the pharmacies that dispense the drug, according to CMS, November 2025.

The prices do not apply to people without Medicare drug coverage. They also do not apply to drugs outside the selected list, even if the same company makes them.

Does the negotiated price change what you pay at the pharmacy?

Not directly. The negotiated price is a ceiling on what the manufacturer may charge a Part D plan. Your own share still comes from your plan's deductible, the drug's tier, and its copay or coinsurance.

Two people on the same drug can pay different amounts under different plans. The $685 million in projected savings is a CMS estimate under the standard benefit design, not a promise about any single plan, according to CMS, November 2025.

One related change helps in 2027 regardless of plan: the Part D out-of-pocket cap rises from $2,100 to $2,400, and the maximum standard deductible rises from $615 to $700, according to the CMS 2027 Rate Announcement, April 2026. After you reach the cap, you pay nothing more for covered drugs for the rest of the calendar year, according to Medicare.gov.

When does it start?

The negotiated prices take effect on January 1, 2027. CMS published the prices on November 25, 2025, after the negotiation period ended on November 1, 2025.

Medicare open enrollment runs October 15 to December 7, 2026, and any plan change takes effect January 1, 2027, according to Medicare.gov. Your plan must receive your request by December 7. This is the window to check whether your 2027 plan covers your drugs and what your share will be.

What should you check before December 7?

• Check your plan's 2027 formulary to confirm each of your drugs is still covered, and at which tier.
• Compare your total yearly drug cost, not just the monthly premium, using the Plan Finder at Medicare.gov.
• Read the Annual Notice of Change your plan mailed in September or October for 2027 premium and cost changes.
• Ask your pharmacist or plan whether the negotiated price changes your copay for a drug you take.
• Check Extra Help and Medicare Savings Programs if costs are a burden. Extra Help can be applied for at any time, according to Medicare.gov.

Frequently asked questions

Will Ozempic cost $274 at my pharmacy?
Not necessarily. $274 is the negotiated price for a 30-day supply that caps what the manufacturer charges the plan. Your copay depends on your plan's tier, deductible, and pharmacy. Check your plan's 2027 costs to see your own share.

How much will Medicare save overall?
If the negotiated prices had applied in 2024, they would have saved an estimated $12 billion in net covered prescription drug costs, about 44% lower net spending, according to CMS, November 2025. Including Coverage Gap Discount Program spending, the estimate is about $8.5 billion, about 36% lower.

Are more drugs coming?
Yes. CMS named 15 drugs for the third negotiation cycle on January 27, 2026, plus one drug for renegotiation, with any negotiated prices becoming effective in 2028. Together with the first two rounds, 25 drugs carry a negotiated price, according to CMS.

Do I need to do anything to get the lower price?
No separate application is needed. The drug company must make the negotiated price available to eligible people with Part D coverage and to dispensing pharmacies, according to CMS, November 2025. Your plan still sets your copay, so comparing plans during open enrollment is the step that affects your cost.

What if my plan does not cover my drug in 2027?
A negotiated price does not force a plan to cover a drug. If your drug is not on your plan's formulary, the price does not help you. Use open enrollment, which ends December 7, 2026, to find a plan that covers your medicines.

Key Takeaway

Fifteen Part D drugs, led by Ozempic at $274 instead of $959, get negotiated prices on January 1, 2027, with about $685 million in projected out-of-pocket savings. The price caps what the manufacturer charges, not your copay, so the move that matters now is comparing your 2027 plan before open enrollment ends on December 7, 2026.

Sources: Centers for Medicare & Medicaid Services, “Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability Year 2027” (fact sheet, November 2025); CMS, “Announcement of Calendar Year 2027 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies” (April 6, 2026); Medicare.gov, “Joining a plan” and “How much does Medicare drug coverage cost?”

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This post was created with the help of AI tools and reviewed for accuracy against the sources cited above. It is general information only, not medical advice. For decisions about your own medicine or coverage, please talk to your doctor, pharmacist, or a licensed Medicare counselor.

Part D Premiums in 2027: What the $36 Average Leaves Out

Of all the 2027 Medicare numbers, the stand-alone Part D premium looks like the calmest: an average of about $36 a month, barely a dollar more than this year. It is tempting to read that as "nothing is changing" and let your drug plan renew itself. That would be a mistake.

The average is calm because it blends plans moving in opposite directions. What your premium will be in 2027 depends on your plan — and what you will actually spend depends on three things the premium never shows: the deductible, your drug list, and your pharmacy. Here is how to check all of them before December 7.

1. The $36 Average, and the Program That Used to Hold It Down

The Centers for Medicare & Medicaid Services (CMS) projects the average premium for stand-alone Part D plans at about $36 a month in 2027, up from $35.09 in 2026. Behind that gentle slope is a policy change: a temporary federal demonstration program that paid plans to keep premiums down in 2025 and 2026 has ended.

Without that support, plans are repricing on their own. Some premiums are nearly flat; others are rising sharply. Analysts also note there will be no stand-alone Part D plans with a $0 premium in 2027 for people who do not receive Extra Help. If your plan's 2027 premium, printed in your Annual Notice of Change, jumped well beyond a dollar or two, that is your signal to compare — the average says other plans priced this year differently.

2. What the Premium Hides, Part One: The $700 Deductible

Under the standard Part D benefit, the maximum deductible rises to $700 in 2027, up from $615 in 2026. Until you have paid that amount for covered drugs, you are paying the plan's negotiated prices largely out of your own pocket.

Plans differ in how they apply it. Some charge less than $700, a few charge none, and some apply the deductible only to drugs on higher tiers, so your everyday generics may be covered from the first fill of the year. Two plans with identical premiums can therefore treat your January very differently. When you compare, find the deductible line and check which of your medications it applies to — especially if you fill an expensive prescription early in the year.

3. What the Premium Hides, Part Two: Your Drugs and Their Tiers

Every Part D plan keeps a formulary — its list of covered drugs, sorted into tiers with different costs. Lower tiers usually mean fixed, modest copays. Higher tiers often mean coinsurance, a percentage of a price that can be startling for specialty medicines. Plans may also require prior authorization or step therapy before covering a drug.

Formularies change every year. A drug that sat comfortably on a low tier in 2026 can move up, gain a restriction, or leave the list. The only reliable check is personal: take your actual medication list, with dosages, and look up each drug in each plan you are considering. The Plan Compare tool at Medicare.gov does this arithmetic for you once you enter your list — it is the single most useful half hour of this enrollment season if you take regular prescriptions.

4. What the Premium Hides, Part Three: Your Pharmacy's Status

Part D plans negotiate with pharmacy networks, and most plans sort pharmacies into preferred and standard cost-sharing levels. The same prescription, in the same plan, can cost noticeably more at a standard pharmacy than at a preferred one. Mail-order pharmacies sometimes offer the preferred price on 90-day supplies.

Networks change, too. If your neighborhood pharmacy drops from preferred to standard status in your plan for 2027, every refill quietly costs more all year — a change no premium headline will ever mention. When you run a comparison, enter the pharmacy you actually use, and check its status in each plan. If another plan keeps your pharmacy preferred, that fact alone can outweigh a difference in premiums.

5. Compare on Total Yearly Cost: A Short Checklist

• Premium: The plan's 2027 monthly premium, multiplied by 12
• Deductible: Up to $700 in 2027 — and which of your drugs it applies to
• Drug costs: Your medications, at their 2027 tiers, across a full year
• Pharmacy: Your pharmacy's preferred or standard status in the plan
• Total: Add the four lines. That sum — not the premium — is the price of the plan

If comparing feels overwhelming, your local State Health Insurance Assistance Program (SHIP) offers free, unbiased help, and counselors there work with these exact questions every day. Bring your medication list and your current plan's notice, and they will help you run the numbers for your situation.

Key Takeaway

The projected $36 average stand-alone Part D premium for 2027 is only the entry fee. The real cost of a drug plan lives in its deductible — up to $700 next year — in the tiers your personal medications land on, and in whether your pharmacy keeps its preferred status. Before December 7, compare plans on your estimated total yearly cost using your own drug list at Medicare.gov. A plan with a slightly higher premium regularly wins that comparison, and a plan with a bargain premium regularly loses it.

This article was written with the help of generative AI.

For general information only, not medical advice.

Consult a qualified professional for your situation.

FDA Adds Eye Warning to Ozempic, Wegovy, Mounjaro and Zepbound: What to Watch For

FDA Adds Eye Warning to Ozempic, Wegovy, Mounjaro and Zepbound: What to Watch For

Direct answer: On November 9, 2026, the U.S. Food and Drug Administration (FDA) required all GLP-1 medicines — including Ozempic, Wegovy, Mounjaro, and Zepbound — to add a warning about a potential increased risk of NAION, a rare eye condition that can cause sudden, painless vision loss in one eye, including permanent vision loss. In the FDA's review of 126 clinical trials covering 134,253 patients, 15 probable NAION cases appeared: 10 in people taking a GLP-1 drug and 5 in people taking a placebo. The rate was 6.4 cases per 100,000 person-years with a GLP-1 drug, compared with 3.8 per 100,000 person-years in comparison groups, according to the FDA, November 9, 2026.

What is NAION?

NAION stands for non-arteritic anterior ischemic optic neuropathy. It happens when blood flow to the front part of the optic nerve drops. The result is sudden, painless vision loss in one eye, sometimes in both eyes.

Vision loss from NAION is often noticed on waking. Other signs include blurred or missing areas of vision, color distortion, and reduced central sharpness, according to the FDA communication. The condition can lead to permanent vision loss. Its underlying cause is not completely understood, according to the FDA.

Risk factors the FDA lists for NAION include smoking, diabetes, high blood pressure, sleep apnea, anemia, and kidney disease. These conditions often overlap with the reasons people take GLP-1 medicines in the first place.

Which medicines are affected?

The warning applies to the whole GLP-1 receptor agonist class, not to one brand. NAION cases have been reported for all currently marketed GLP-1 RA products, according to the FDA, November 9, 2026.

The medicines include semaglutide (Ozempic, Rybelsus, Wegovy), tirzepatide (Mounjaro, Zepbound), dulaglutide (Trulicity), liraglutide (Victoza, Saxenda), exenatide, lixisenatide combinations (Soliqua), liraglutide plus insulin degludec (Xultophy), and orforglipron (Foundayo), approved in 2026. These medicines are prescribed for type 2 diabetes, for weight management, or for both.

What did the FDA find?

The FDA began its review after a July 2024 study in JAMA Ophthalmology reported a link between semaglutide and NAION. The agency then reviewed clinical trial data, animal data, and postmarketing data, including observational studies and case reports.

The animal data did not identify a mechanism for how GLP-1 use could raise NAION risk, according to the FDA. The agency still concluded that the combined evidence supports a potential increased risk of rare NAION events in people taking GLP-1 medicines.

Group	Patients	Person-years	Probable NAION cases	Rate per 100,000 person-years
GLP-1 drug	78,217	156,947	10	6.4
Comparator (placebo or other diabetes drug)	56,036	131,932	5	3.8

The table above comes from the FDA meta-analysis of 126 randomized trials, published November 9, 2026. All 5 comparator cases were in people who received a placebo. No cases appeared in people who received another non-GLP-1 glucose-lowering medicine.

What did the FDA's real-world study show?

The FDA also ran a retrospective study using its Sentinel real-world data system. It covered adults with type 2 diabetes who started a GLP-1 drug, an SGLT-2 inhibitor, or a DPP-4 inhibitor between 2019 and 2024.

NAION rates in that study ranged from 26 to 32 events per 100,000 person-years: 30 to 32 for GLP-1 drugs, 31 for SGLT-2 inhibitors, and 26 for DPP-4 inhibitors. The risk increase was not statistically significant compared with SGLT-2 inhibitors (hazard ratio 1.19, 95% CI 0.91 to 1.54). Compared with DPP-4 inhibitors, the hazard ratio was 1.43 (95% CI 1.02 to 2.01), according to the FDA, November 9, 2026.

Published observational studies that the FDA reviewed also reported an increased NAION risk in people with type 2 diabetes who started a GLP-1 drug, compared with those who started a DPP-4 inhibitor or an SGLT-2 inhibitor. The FDA noted that no single data source settled the question on its own.

Is this a recall?

No. No GLP-1 product is being withdrawn, recalled, or restricted. The FDA is requiring only a labeling change: application holders must add NAION risk information to the Warnings and Precautions section of each product's labeling.

Europe moved earlier on the same concern. In 2025, the European Medicines Agency's safety committee said NAION may affect up to 1 in 10,000 people taking semaglutide, according to Reuters, November 9, 2026. Warnings about semaglutide and NAION were added to European labels for Wegovy and Ozempic in June 2025.

What should you do if you notice vision changes?

• Report sudden, painless vision loss, a visual field deficit, or any other visual change in one eye to your clinician right away.
• Ask for a prompt referral to an ophthalmologist if NAION is suspected. The FDA advises clinicians to refer patients with suspected NAION promptly to an eye specialist.
• Do not stop a prescribed GLP-1 medicine on your own. The FDA did not tell patients to stop these medicines.
• Bring a list of your medicines, including the brand name and dose, to the eye appointment.

Frequently asked questions

Does this warning mean GLP-1 drugs cause blindness?
No. The FDA concluded there is a potential increased risk of a rare condition, not proof that the drugs cause it. The agency found signals pointing to a possible association, but it did not determine whether GLP-1 drugs can cause NAION.

How rare is NAION with these medicines?
In the FDA's trial analysis, 15 probable cases appeared among 134,253 patients across 126 trials. The rate was 6.4 cases per 100,000 person-years with a GLP-1 drug, versus 3.8 per 100,000 person-years in comparison groups, according to the FDA, November 9, 2026.

Should I stop taking my GLP-1 medicine?
Do not stop a prescribed medicine without talking to your clinician. The FDA's action is a labeling change, not a stop-use order. Your clinician can weigh the vision warning against the medicine's benefits for your diabetes or weight.

What symptoms should I watch for?
Sudden, painless loss of vision in one eye, a missing area in your field of vision, blurred vision, color distortion, or reduced central sharpness. These changes are often noticed on waking. Report them immediately and ask for an ophthalmology referral.

Does the warning cover compounded GLP-1 products?
The FDA requirement applies to approved GLP-1 medicines and their labeling. Compounded products are not FDA-approved medicines, and they do not carry FDA-approved labeling. If you use a compounded product, ask your prescriber or pharmacist what applies to you.

Key Takeaway

The FDA's new warning covers every GLP-1 medicine, but NAION remains rare — 10 cases versus 5 in 126 trials. The one action that matters is speed: sudden, painless vision loss in one eye should be reported right away and checked by an eye specialist.

Sources: U.S. Food and Drug Administration, Drug Safety Communication, “FDA Requires Safety Labeling Changes for Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs) Due to Potential Increased Risk of Rare But Serious Eye Condition,” published November 9, 2026; Reuters, “US FDA orders new eye risk warnings for Ozempic, Zepbound,” November 9, 2026; USA Today, “FDA says popular GLP-1 drugs linked to rare risk of vision loss, blindness,” November 9, 2026.

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This post was created with the help of AI tools and reviewed for accuracy against the sources cited above. It is general information only, not medical advice. For decisions about your own medicine, please talk to your doctor or pharmacist.

49,420 Bottles of a Common Antibiotic Recalled: Check These 6 Lots

49,420 Bottles of a Common Antibiotic Recalled: Check These 6 Lots

Direct answer: The U.S. Food and Drug Administration (FDA) classified a Class II recall of 49,420 bottles of the antibiotic ciprofloxacin on November 3, 2026, after tests found levels of a nitrosamine impurity above the FDA-recommended limit. Only six lots are affected — three lots of 500 mg tablets and three lots of 750 mg tablets, all expiring December 31, 2026. If your bottle matches one of those lots, contact your pharmacist to check — and do not stop a prescribed antibiotic on your own.

What was recalled?

The recall covers ciprofloxacin tablets made by Hikma Pharmaceuticals and distributed in the United States by Hikma Pharmaceuticals USA Inc. Ciprofloxacin is a prescription antibiotic used to treat a range of bacterial infections, including urinary tract infections, kidney infections, certain gastrointestinal infections, and some respiratory infections.

The FDA reason is listed as “N-nitroso-ciprofloxacin results above the FDA-recommended interim control limit.” The FDA classified the recall as Class II on November 3, 2026 (recall numbers D-0165-2027 and D-0166-2027). A Class II recall means use of the product may cause temporary or medically reversible health consequences, or that the probability of serious harm is remote, according to the FDA definition.

N-nitroso-ciprofloxacin is a type of nitrosamine, an impurity also found in water and some foods. The FDA sets limits on nitrosamines in medicines to help keep potential health risks low. Some nitrosamine impurities may increase cancer risk when people are exposed to levels above acceptable limits over long periods of time, though not all nitrosamines carry the same risk.

Which lots should you check?

Strength	Bottle size	Lot numbers	NDC	Bottles recalled	Expiration
500 mg	100 tablets	CB496A, CB497A, CB498A	0143-9928-01	29,085	Dec 31, 2026
750 mg	50 tablets	CA083A, CA084A, CA085A	0143-9929-50	20,335	Dec 31, 2026

The recalled bottles were distributed nationwide in the United States. Check three things on your bottle: the medicine name, the manufacturer (Hikma), and the lot number.

Is my bottle affected if it looks different?

Only the six lots above are in scope. If your bottle shows a different lot number, a different manufacturer, or a different strength or bottle size, it is not part of this recall listing. One practical catch: if your medicine was transferred into a plain pharmacy bottle, the manufacturer lot number may not appear on the label. In that case, call the pharmacy that filled the prescription and ask whether your medicine came from one of the recalled lots.

The recall is limited to the wholesale, distributor, and retail pharmacy levels, according to the notice published by the California State Board of Pharmacy. A medical assessment of the affected lots concluded that the observed N-nitroso-ciprofloxacin levels are “not expected to adversely impact patient safety.”

What should you do if your lot matches?

• Contact your pharmacist or prescribing clinician and ask what to do next.
• Ask whether to keep taking the medicine while a replacement is arranged.
• Follow any return or disposal instructions your pharmacy provides.
• Do not stop a prescribed antibiotic without first talking to your doctor or pharmacist — stopping an antibiotic early can carry its own risks, and the FDA notes that patients can generally continue using a medicine in a Class II recall unless the company or the agency directs otherwise.

How is this different from other recent recalls?

Not every recall means contamination. This one is about an impurity found above the FDA's interim limit, not a reported contamination finding, and not a tablet that fails to dissolve. It is also narrow: 49,420 bottles in six lots, rather than every bottle of this antibiotic on the market. That is why the lot number — not just the medicine name — is the deciding detail.

Frequently asked questions

Is all ciprofloxacin recalled?
No. The FDA listing covers only the six Hikma lots above. Other manufacturers' ciprofloxacin, and other Hikma lots, are not part of this recall.

Does a Class II recall mean the medicine is dangerous?
Class II is the FDA's middle severity tier. It means temporary or reversible health consequences are possible, while the probability of serious harm is remote. It is not a reason to change your routine without professional guidance.

What if I already took tablets from one of these lots?
Talk to your pharmacist or prescriber about it. The medical assessment published with the recall notice concluded the observed impurity levels are not expected to adversely impact patient safety. You can also report a medication-quality problem through the FDA MedWatch program or by calling 800-FDA-1088.

Where can I verify this myself?
Search the FDA Enforcement Reports for recall numbers D-0165-2027 and D-0166-2027, or check the lot number and NDC on your bottle against the table above.

Key Takeaway

Check the lot number, not just the medicine name: only six Hikma ciprofloxacin lots (49,420 bottles, expiring December 31, 2026) are recalled, and your pharmacist is the right first call if yours matches.

Sources: FDA Enforcement Report, Event 100142, recalls D-0165-2027 and D-0166-2027, Class II classified November 3, 2026; The Healthy, “FDA: Nearly 50,000 Bottles of Common Antibiotic Recalled Nationwide,” November 4, 2026; California State Board of Pharmacy recall notice, Hikma Pharmaceuticals USA Inc. ciprofloxacin tablets.

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This post was created with the help of AI tools and reviewed for accuracy against the sources cited above. It is general information only, not medical advice. For decisions about your own medicine, please talk to your doctor or pharmacist.

 

4.3 Million Medicare Plans End on December 31: Check Yours Before December 7

4.3 Million Medicare Plans End on December 31: Check Yours Before December 7

Direct answer: A KFF analysis of federal plan data finds that 4.3 million Medicare beneficiaries will have their Medicare Advantage or stand-alone Part D drug plan terminated on December 31, 2026 — 3.1 million in Medicare Advantage drug plans and 1.2 million in stand-alone drug plans. If your plan is ending and you do nothing, you will be moved to Original Medicare, generally without prescription drug coverage. Medicare open enrollment ends December 7, 2026, so check your plan now.

What is happening?

Private insurers change their Medicare offerings every year, but the scale of this year's exits is large. KFF analyzed Centers for Medicare & Medicaid Services (CMS) plan data, based on June 2026 enrollment, and published its findings on October 27, 2026. The terminations include plans that end entirely and plans that stop serving specific counties.

This is a different story from premiums. Earlier this fall we covered the 2027 average Medicare Advantage premium of $12 and the possible Part D average of $51 if enrollees stay put. Those were price stories. This one is about whether your plan exists at all next year — and a low premium means nothing if the plan is gone.

Group	People affected	Share of that group
Medicare Advantage drug plans (MA-PD)	3.1 million	14% of general-enrollment MA-PD enrollees (2.8 million), plus about 300,000 in special needs plans
Stand-alone Part D plans (PDP)	1.2 million	6% of PDP enrollees — double last year's 3%
Plans consolidating, not ending	1.4 million	Moved automatically to another plan from the same insurer

The 1.4 million people in consolidating plans are not losing coverage — their insurer moves them to a different plan. But they should still review the new plan, because costs, benefits, networks, and drug lists can change. The average beneficiary will have 28 Medicare Advantage drug plans and 9 stand-alone drug plans to choose from in 2027; the drug-plan choice count is down from 11 in 2026.

Which insurers are ending the most plans?

Four parent organizations account for half of the people losing an individual Medicare Advantage drug plan:

Insurer	Share of affected MA-PD enrollees	People
Humana	19%	530,000
UnitedHealth Group	13%	367,000
CVS Health	9%	254,000
Aware Integrated (Blue Cross plans in Minnesota)	9%	249,000

On the drug-plan side, the concentration is even sharper: 81% of the 1.2 million people losing a stand-alone Part D plan — about 950,000 people — are in the SilverScript Choice plan sponsored by CVS Health, which is ending in 13 drug-plan regions. Another 190,000 people (16%) are in HealthSpring Extra Rx, ending in 16 regions.

What happens if you do nothing?

If your Medicare Advantage plan ends and you do not choose another plan, you will be switched automatically to Original Medicare (Parts A and B). That switch does not include prescription drug coverage, so you would need to enroll in a stand-alone Part D plan separately if you want drug coverage. Your insurer may instead assign you to another Medicare Advantage plan it offers — check your mail for a notice explaining which outcome applies to you.

There is one protection worth knowing: people whose Medicare Advantage coverage is terminated generally qualify for a special enrollment period for Medigap with guaranteed issue rights, meaning they cannot be denied a Medigap policy or charged more because of a pre-existing condition, according to KFF. The exact window is in your termination notice — ask 1-800-MEDICARE if it is unclear.

Minnesota: the sharpest example

Minnesota shows how concentrated the exits can be. On November 2, 2026, Minnesota Attorney General Keith Ellison warned that nearly 400,000 Minnesotans — nearly one-third of the state's 1.2 million Medicare beneficiaries — will lose their current Medicare Advantage plan for 2027.

In 18 Minnesota counties, there will be no Medicare Advantage coverage in 2027. In 15 of those counties, Medicare Cost plans and Original Medicare remain available. In three counties — Crow Wing, Lake of the Woods, and Wadena — there will be no Medicare Advantage or Medicare Cost plan at all, so Original Medicare is the only option, and residents there must select a Part D drug plan to keep drug coverage. Minnesota Aging Pathways, the state's free counseling service, can be reached at 800-333-2433.

What should you do before December 7?

• Open the Annual Notice of Change letter from your plan. It states whether your plan continues, changes, or ends for 2027.
• Log in at Medicare.gov and use the Plan Finder: enter your prescriptions and your pharmacy to compare the plans available in your county.
• Check three things in any new plan: whether your doctors are in network, whether your prescriptions are covered, and what your total out-of-pocket costs would be.
• If your plan is ending, enroll in a new plan by December 7 so coverage starts January 1, 2027. Call 1-800-MEDICARE (available 24/7) or your state's free SHIP counseling program for help.
• Keep your termination letter. It documents your right to a special enrollment period and to Medigap guaranteed issue rights.

What if you miss December 7?

Missing open enrollment is not the end of the road if your plan is ending. People whose plan is not renewed get a special enrollment period that runs from December 8, 2026 through February 28, 2027. To have new coverage start on January 1 with no gap, enroll by December 31. Enrolling in January means coverage starts February 1, and enrolling in February means it starts March 1 — so December 7 is still the simplest deadline to aim for.

Frequently asked questions

Have I lost Medicare?
No. Your plan is ending, not your Medicare. Your Part A and Part B coverage continues through Original Medicare unless you enroll in a new Medicare Advantage plan.

How do I know if my plan is ending?
Your insurer was required to send an Annual Notice of Change and, if the plan is ending, a non-renewal notice. You can also check your plan's 2027 status by logging in at Medicare.gov.

What is the difference between a terminated plan and a consolidated plan?
A terminated plan ends and you must choose a replacement. A consolidated plan moves you automatically to another plan from the same insurer — about 1.4 million people are in this group — but you should still review the new plan's costs and coverage.

I am in Minnesota. What is different for me?
Nearly 400,000 Minnesotans are affected, and in 18 counties there will be no Medicare Advantage plan in 2027. In Crow Wing, Lake of the Woods, and Wadena counties, Original Medicare is the only option, so a Part D plan is needed for drug coverage. Free help is available from Minnesota Aging Pathways at 800-333-2433.

Can I still buy Medigap if my plan ends?
According to KFF, people whose Medicare Advantage coverage is terminated generally qualify for a special enrollment period for Medigap with guaranteed issue rights. Check the window in your termination notice or call 1-800-MEDICARE.

Where can I verify this myself?
See the KFF analysis, “More Than 4 Million Medicare Beneficiaries Will Have Their Medicare Advantage or Stand-Alone Prescription Drug Plan Terminated at the End of 2026” (October 27, 2026), and the Minnesota Attorney General's November 2, 2026 alert on Medicare Advantage changes.

Key Takeaway

4.3 million Medicare beneficiaries — 3.1 million in Medicare Advantage drug plans and 1.2 million in stand-alone Part D plans — lose their plan on December 31, 2026. If yours is one of them, choose a replacement by December 7 for coverage starting January 1; doing nothing leaves you on Original Medicare without drug coverage.

Sources: KFF, “More Than 4 Million Medicare Beneficiaries Will Have Their Medicare Advantage or Stand-Alone Prescription Drug Plan Terminated at the End of 2026,” October 27, 2026 (analysis of CMS plan data, June 2026 enrollment); Office of Minnesota Attorney General Keith Ellison, press release, November 2, 2026; Medicare.gov special enrollment period rules for non-renewed plans (December 8, 2026 – February 28, 2027).

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This post was created with the help of AI tools and reviewed for accuracy against the sources cited above. It is general information only, not medical advice. For decisions about your own coverage, please talk to a licensed Medicare counselor, your State Health Insurance Assistance Program (SHIP), or 1-800-MEDICARE.

 

Check Your Blood Pressure Bottle: 3,744 Bottles Recalled After Tablets Fail Dissolution Test

Check Your Blood Pressure Bottle: 3,744 Bottles Recalled After Tablets Fail Dissolution Test

Direct answer: The U.S. Food and Drug Administration (FDA) classified a Class II recall of 3,744 bottles of a generic three-in-one blood pressure tablet made for Macleods Pharma USA, after the tablets failed dissolution specifications. Only two lots are affected, both expiring May 31, 2027. If your bottle matches one of those lots, contact your pharmacist or prescriber for guidance — and do not stop a prescribed blood pressure medicine on your own.

What was recalled?

The recall covers olmesartan medoxomil, amlodipine, and hydrochlorothiazide tablets, 40 mg / 10 mg / 12.5 mg — a single tablet that combines three blood pressure medicines. It is a generic version of the brand-name drug Tribenzor. The FDA recall listing does not include brand-name Tribenzor.

The company, Macleods Pharma USA, voluntarily initiated the recall on October 7, 2026. The FDA classified it as Class II on October 26, 2026 (recall number D-0077-2027). A Class II recall means use of the product may cause temporary or medically reversible health consequences, or that the probability of serious harm is remote, according to the FDA definition.

The FDA reason is listed as “failed dissolution specifications.” In plain terms, the tablets did not break down and release their ingredients as required in laboratory quality testing, so they may not work as expected.

Which lots should you check?

30-tablet bottles: lot 12251163A, NDC 33342-246-07, 3,528 bottles, expires May 31, 2027. 90-tablet bottles: lot 12251163B, NDC 33342-246-10, 216 bottles, expires May 31, 2027. The recalled bottles were distributed nationwide in the United States. Check three things on your bottle: the medicine name, the manufacturer (Macleods), and the lot number.

Is my bottle affected if it looks different?

Only the two lots above are in scope. If your bottle shows a different lot number, a different manufacturer, or the brand-name product, it is not part of this recall listing. One practical catch: if your medicine was transferred into a plain pharmacy bottle, the manufacturer lot number may not appear on the label. In that case, call the pharmacy that filled the prescription and ask whether your medicine came from one of the recalled lots.

What should you do if your lot matches?

Contact your pharmacist or prescribing clinician and ask what to do next. Ask whether to keep taking the medicine while a replacement is arranged. Follow any return or disposal instructions your pharmacy provides. Do not stop a prescribed blood pressure medicine without first talking to your doctor or pharmacist — stopping suddenly can carry its own risks, and the FDA notes that patients can generally continue using a medicine in a Class II recall unless the company or the agency directs otherwise.

How is this different from other recent recalls?

Not every recall means contamination. This one is a quality failure in how the tablet dissolves, not a reported contamination finding. It is also narrow: 3,744 bottles in two lots, rather than every bottle of this medicine on the market. That is why the lot number — not just the medicine name — is the deciding detail.

Frequently asked questions

Is brand-name Tribenzor recalled? No. The FDA listing covers only the two Macleods generic lots above.

Does a Class II recall mean the medicine is dangerous? Class II is the FDA's middle severity tier. It means temporary or reversible health consequences are possible, while the probability of serious harm is remote. It is not a reason to change your routine without professional guidance.

What if I already finished a bottle from one of these lots? Talk to your pharmacist or prescriber about it, and mention any concerns about how well your blood pressure has been controlled. You can also report a medication-quality problem through the FDA MedWatch program or by calling 800-FDA-1088.

Where can I verify this myself? Search the FDA Enforcement Reports for recall number D-0077-2027, or check the lot number and NDC on your bottle against the details above.

Key Takeaway

Check the lot number, not just the medicine name: only Macleods lots 12251163A and 12251163B (3,744 bottles, expiring May 31, 2027) are recalled, and your pharmacist is the right first call if yours matches.

Sources: FDA Enforcement Report, recall D-0077-2027, classified October 26, 2026; AARP, “Blood Pressure Drug Recall: Check These Lots,” November 3, 2026; Becker's Hospital Review, November 2026, citing the FDA enforcement report.

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This post was created with the help of AI tools and reviewed for accuracy against the sources cited above. It is general information only, not medical advice. For decisions about your own medicine, please talk to your doctor or pharmacist.

Medicare Part D Premiums Could Jump to $51 in 2027 If You Stay Put: What to Compare Before December 7

Direct answer: A KFF analysis published October 30, 2026 projects that the average monthly premium for a stand-alone Medicare Part D prescription drug plan (PDP) will rise from $34 in 2026 to $51 in 2027, an increase of 50%, if current enrollees keep the same plan. Medicare Open Enrollment for 2027 coverage runs October 15, 2026 through December 7, 2026. That $51 figure is a "stay put" average, not a bill every enrollee will receive: KFF itself expects the actual average to be lower once people switch plans during open enrollment, so comparing your own plan before December 7 matters more than ever this year.

Why are there two different 2027 premium averages?

Two widely quoted numbers describe different questions. The Centers for Medicare & Medicaid Services (CMS) projected a national average stand-alone Part D premium of $36 for 2027, up by less than $1 from $35. KFF projected $51, based on June 2026 enrollment and assuming enrollees keep their current plans. KFF notes that CMS did not explain its calculation method and that CMS may have assumed switching to lower-cost plans, which would produce a lower average. In other words, the CMS figure describes the market if people shop around; the KFF figure describes what happens if they do not. Neither number is your plan's price. Your premium depends on your plan, your region, and the drugs you take.

Measure	2026	2027 (projected, if you stay in the same plan)
Stand-alone Part D plan (PDP), average monthly premium, KFF	$34	$51 (up 50%, a $17 increase)
Stand-alone Part D plan, national average monthly premium, CMS	$35	$36 (up less than $1)
Drug coverage inside a Medicare Advantage plan (MA-PD), average monthly premium, KFF	Not given as a single comparable average in the KFF summary	About $9 (up less than $2)

For clarity: the MA-PD drug premium is estimated at about $9 per month in 2027, more than five times lower than the $51 PDP average. That gap is one reason the same "Part D premium" headline can sound very different depending on whether drug coverage comes from a stand-alone plan or from a Medicare Advantage plan.

Who faces a higher premium if they make no change?

KFF estimates that, among 13.6 million stand-alone plan enrollees who do not receive Part D Low-Income Subsidies (LIS), 10.4 million (76%) will pay a higher monthly premium in 2027 if they keep their current plan. That group includes 4.1 million people enrolled in zero-premium plans in 2026 who will face a higher premium next year because no zero-premium stand-alone plans are available in 2027 for enrollees without LIS. Of the 10.4 million facing an increase, 2.4 million would see their monthly premium rise by more than $50 if they stay put, compared with only 38,000 enrollees who faced an increase larger than $50 per month in 2026.

At the same time, the average hides a wide spread. If enrollees without LIS keep their current plans, more than half (55%, or 7.5 million) will pay less than $20 per month, while nearly 30% (3.9 million) will pay $100 per month or more. Among the eight national stand-alone plans, average monthly premiums for 2027 are projected to range from around $6 to $204: Centene's Wellcare Value Script Rx averages $6.50 (up from $5.80 in 2026), while United's AARP Medicare Rx Preferred averages $204.50 (up from $126.00 in 2026). Averages also vary by region for the same plan, so a national average is only a starting point.

Why did the stay-put average rise so much?

A major reason is the end of the Part D Premium Stabilization Demonstration after 2026. That program provided additional premium subsidies to plan sponsors and capped the maximum allowable monthly premium increase at $50 for 2026. With the demonstration discontinued, that cap and those subsidies no longer hold 2027 premiums down in the same way. KFF also notes that the average beneficiary has 9 stand-alone plans and 28 Medicare Advantage drug plans to choose from, so shopping is possible, but only if you compare before the deadline.

What else should you check besides the premium?

• Your deductible. The average Part D deductible in 2027 is projected at $643 for stand-alone plan enrollees (up from $540 in 2026) and $489 for Medicare Advantage drug plan enrollees (up from $360). The standard Part D deductible rises from $615 to $700. Virtually all stand-alone plan enrollees (99.8%) and 85% of Medicare Advantage drug plan enrollees will be in plans that charge a deductible in 2027, if they do not switch.
• Your drug list and cost sharing. Virtually all stand-alone plan enrollees will face coinsurance rather than a fixed copayment for preferred brands (median 25%) and non-preferred drugs (median 35%) in 2027. Coinsurance is a percentage, so your cost moves with the drug price.
• Your Annual Notice of Change. Compare your 2027 premium, deductible, drug tiers, and pharmacy network with your 2026 coverage, not just the headline average.
• Help with costs. People with limited income and resources may qualify for Extra Help (the Part D Low-Income Subsidy), which changes the premium picture substantially. Check eligibility even if you did not qualify before.

How can you compare 2027 drug plans?

Use the Medicare Plan Finder at Medicare.gov: enter your medicines and pharmacies, then compare total yearly cost, not premium alone. You can also call 1-800-MEDICARE, available 24 hours a day, 7 days a week, or contact your local State Health Insurance Assistance Program (SHIP) for free, individual help. People who want to keep their current coverage generally do not need to re-enroll, but this year, doing nothing is itself a choice with a projected average cost: $51 per month for stand-alone drug coverage, versus a lower average if you switch to a cheaper plan.

Frequently asked questions

Will my stand-alone drug plan premium really be $51 in 2027?
Not necessarily. $51 is KFF's projected enrollment-weighted average if current enrollees keep the same plan. Your premium could be well below $20, or $100 or more, depending on your plan and region. Check your plan's 2027 premium in your Annual Notice of Change or on Medicare.gov.

Why does CMS say the average is only $36?
CMS projected a national average of $36 based on September 2026 enrollment, without explaining its method. KFF suggests CMS may have assumed that enrollees switch to lower-cost plans. The two figures answer different questions, so they are not a contradiction to pick a side on: they are a reason to check your own plan.

Are zero-premium stand-alone drug plans gone in 2027?
For enrollees without Low-Income Subsidies, KFF finds no zero-premium stand-alone plans available in 2027. That is why 4.1 million people in zero-premium plans in 2026 face a higher premium next year if they stay put.

When does 2027 coverage start?
Medicare Open Enrollment runs October 15 through December 7, 2026, for coverage starting January 1, 2027. Changes made by December 7 apply to 2027 coverage.

Key takeaway

KFF projects that stand-alone Part D premiums will average $51 per month in 2027, up 50% from $34, if enrollees stay in the same plan, while CMS projects a national average of $36, a difference explained largely by whether switching is assumed. About 10.4 million stand-alone plan enrollees without low-income subsidies face a higher premium if they make no change, including 2.4 million facing an increase of more than $50 per month, and no zero-premium stand-alone plans are available for that group in 2027. The practical point is simple: before December 7, 2026, compare your own plan's premium, deductible, drug list, and total cost on Medicare.gov, because the average you end up paying depends on whether you shop.

Sources

• KFF, Medicare Part D Premiums and Cost Sharing in 2027, published October 30, 2026 — https://www.kff.org/medicare/medicare-part-d-premiums-and-cost-sharing-in-2027/
• KFF press release, The Average Monthly Premium for Medicare Part D Stand-Alone Plans Is Projected to Increase by 50% From $34 to $51 in 2027 Unless Enrollees Switch to Lower-Cost Plans, published October 30, 2026 — https://www.kff.org/medicare/the-average-monthly-premium-for-medicare-part-d-stand-alone-plans-is-projected-to-increase-by-50-from-34-to-51-in-2027-unless-enrollees-switch-to-lower-cost-plans/
• CMS press release, Medicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2027, published September 28, 2026 — https://www.cms.gov/newsroom/press-releases/medicare-advantage-medicare-prescription-drug-programs-expected-remain-stable-2027

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This post was created with the help of AI and is for general information only. It is not medical, legal, or financial advice, and it does not replace guidance from a licensed professional, a Medicare counselor, or an official source such as Medicare.gov, CMS, or KFF. If a detail affects your coverage or your premium, please confirm it with Medicare or a qualified professional before acting.

Medicare Advantage Premiums in 2027: What the $12 Average Really Means

The headline sounds like a gift: Medicare Advantage premiums are falling to an average of $12 a month in 2027. If your own plan's premium is heading up instead, you might wonder whether you are in the wrong plan — or whether the headline is wrong. Neither is necessarily true. The $12 figure is real, but it is an average, and averages have fine print.

This article unpacks what that average is made of, what it leaves out, and the numbers in your own plan that deserve more attention than the headline. Your premium check for 2027 starts with understanding what "average" actually means.

1. Where the $12 Figure Comes From

On September 28, the Centers for Medicare & Medicaid Services (CMS) projected that the average monthly premium across Medicare Advantage plans will fall from $14.37 in 2026 to about $12 in 2027 — a drop of roughly 16.5 percent. The average is weighted by enrollment, so big plans count more than small ones, and it covers all Medicare Advantage plans, including plans with drug coverage and Special Needs Plans.

One ingredient matters most: a large share of Medicare Advantage plans charge no additional plan premium at all — the premium is $0, on top of the Part B premium everyone pays. All those zeros pull the average down. So the $12 figure does not describe a typical bill so much as a blend: many people paying nothing extra, some paying a little, and some paying considerably more.

2. Why an Average Is Not a Price Tag

CMS also estimates that about 8 in 10 Medicare Advantage members can stay in their current plan for 2027 at the same premium or a lower one. Turn that around: roughly 2 in 10 cannot. Their premiums rise, or their plan leaves their area entirely, even while the national average falls.

Premiums are set plan by plan and county by county. Your premium depends on your plan's costs, your local market, and the benefits your plan chose to fund. A falling national average can comfortably coexist with a rising premium in your mailbox — which is why the only premium that should drive your decision is the 2027 figure printed in your own Annual Notice of Change.

3. What the Premium Never Includes

Even a genuinely lower premium is only one line of your yearly cost. The $12 average says nothing about:

• Your Part B premium, which you continue to pay in almost all cases, with or without a Medicare Advantage plan
• Copays for doctor visits, specialists, hospital stays, and therapy
• The drug deductible and drug copays if your plan includes Part D coverage
• Coinsurance — the percentage of a bill you owe for some services

A plan can trim its premium and quietly recover the money through higher copays elsewhere. The premium is the price of admission; it is not the cost of the year.

4. The Number That Matters More: Your Out-of-Pocket Maximum

Every Medicare Advantage plan has a maximum out-of-pocket limit (MOOP) — the most you can pay in a year for covered in-network medical services. Once you reach it, the plan pays 100 percent of covered in-network care for the rest of the year. Original Medicare has no such cap, which is one of the genuine protections Advantage plans offer.

When you compare plans, put the MOOP next to the premium. A plan charging $0 extra per month but carrying a high out-of-pocket maximum may cost a healthy person nothing and a sick person thousands. A plan with a modest premium and a low maximum can be the cheaper plan in the year you actually need care. Check whether your plan's MOOP is changing for 2027 — it is listed in your Annual Notice of Change, and it moves more quietly than premiums do.

5. Check the Extras Before You Celebrate a Lower Premium

Medicare Advantage plans compete on extras: dental allowances, vision and hearing benefits, over-the-counter cards, and in some plans a Part B giveback that returns part of your Part B premium. These extras are also where plans adjust quietly. A premium can fall while a dental allowance shrinks, an over-the-counter benefit is cut, or a giveback amount drops.

None of that makes a plan bad. It means the honest comparison for 2027 is a short checklist, not a headline:

• Your plan's 2027 premium, from your Annual Notice of Change
• Your plan's 2027 out-of-pocket maximum
• Copays for the doctors and services you actually use
• Your prescriptions, still covered, at workable tiers
• The extras you genuinely use, at their 2027 amounts

The Plan Compare tool at Medicare.gov gathers most of this in one place, and your local SHIP program can walk through it with you for free if the paperwork feels heavy.

Key Takeaway

The projected $12 average Medicare Advantage premium for 2027 is good news about a trend, not a promise about your plan. It blends millions of members, including many who pay no additional premium at all, and it excludes your Part B premium, your copays, and your out-of-pocket maximum. Before December 7, read your own plan's 2027 premium alongside its out-of-pocket maximum, your copays, your drug coverage, and the extras you actually use. That comparison — not the headline average — tells you whether to stay or to shop.

This article was written with the help of generative AI.

For general information only, not medical advice.

Consult a qualified professional for your situation.

Medicare Advantage Premiums Fall to $12 on Average in 2027: What to Check Before December 7

Direct answer: The Centers for Medicare & Medicaid Services (CMS) projects the weighted average monthly Medicare Advantage premium will fall from $14.37 in 2026 to $12.00 in 2027, a decline of 16.5%. Medicare Open Enrollment for 2027 coverage runs October 15, 2026 through December 7, 2026. These are national averages and projections, not the price of any single plan, so check your own plan's 2027 costs before the deadline.

What did CMS project for 2027?

CMS announced the 2027 projections on September 28, 2026, ahead of open enrollment. The headline figures are averages across all Medicare Advantage plans, including plans with prescription drug coverage and Special Needs Plans.

Coverage	2026	2027 (projected)
Medicare Advantage, weighted average monthly premium	$14.37	$12.00 (down 16.5%)
Part D inside a Medicare Advantage drug plan, average monthly premium after rebates	$11.32	$7.00 (down 38%, a $4.32 drop)
Stand-alone Part D plan, average monthly premium	$35.09	$36.00 (up less than $1)

CMS also projects that supplemental benefits such as hearing, dental, and vision coverage will remain stable in 2027, and that about 8 in 10 Medicare Advantage beneficiaries will be able to stay in their current plan with the same or a lower premium.

Why does the average fall not mean every plan gets cheaper?

A weighted average blends many plans together, including plans with a $0 premium, and weights them by enrollment. Your own plan's premium, deductible, copayments, provider network, and drug list can still move in either direction. CMS itself urges beneficiaries to review their current coverage and compare 2027 options, because plan costs and benefits can change from year to year.

The total number of Medicare Advantage plans nationally is projected to stay nearly flat, from 5,553 in 2026 to about 5,532 in 2027. More than 99% of beneficiaries are projected to have access to at least one Medicare Advantage plan, and 97% to 10 or more choices. CMS estimates 2027 Medicare Advantage enrollment at 34 million, about 47.4% of all people enrolled in Medicare.

What should you check before December 7?

• Your plan's Annual Notice of Change. Compare the 2027 premium, deductible, copayments, and out-of-pocket maximum with your 2026 costs.
• Your doctors and pharmacies. Check whether they are still in network for 2027.
• Your medicines. Check the 2027 drug list and tier for each prescription, and the Part D premium that applies to your plan type.
• Extra benefits you actually use. Dental, vision, and hearing benefits are projected to stay stable nationally, but the details vary by plan.
• Help paying costs. Medicare Savings Programs may help pay premiums, deductibles, and copayments for people with limited income and resources, and Extra Help may help with Part D costs.

How can you compare 2027 plans?

Use the Medicare Plan Finder at Medicare.gov to compare premiums, costs, benefits, and drug coverage side by side. You can also call 1-800-MEDICARE, available 24 hours a day, 7 days a week, for help comparing plans and costs. People who want to keep their current Medicare coverage generally do not need to re-enroll, but CMS still recommends a yearly review during open enrollment.

Frequently asked questions

Is my Medicare Advantage premium $12 in 2027?
Not necessarily. $12.00 is the projected national weighted average. Your premium depends on your plan, your location, and your enrollment choices.

When does 2027 coverage start?
Medicare Open Enrollment runs October 15 through December 7, 2026, for coverage starting January 1, 2027.

Did stand-alone drug plan premiums fall too?
No. CMS projects the average stand-alone Part D premium will rise by less than $1, from $35.09 to $36.00. The larger drug-premium drop applies to drug coverage inside Medicare Advantage plans, from $11.32 to $7.00.

Where can I get help with my own plan?
Medicare.gov, the Medicare Plan Finder, and 1-800-MEDICARE publish plan-by-plan 2027 information. A local State Health Insurance Assistance Program counselor can also help with an individual comparison.

Key takeaway

CMS projects lower average Medicare Advantage premiums for 2027, led by a 16.5% drop in the weighted average monthly premium to $12.00 and a 38% drop in the average Part D premium inside Medicare Advantage drug plans to $7.00, while stand-alone Part D averages rise by less than $1 to $36.00. The averages are good news in general, but they do not describe any one plan, so use the open enrollment window ending December 7, 2026 to check your premium, network, drug list, and extra benefits before 2027 coverage begins.

Sources

• CMS press release: Medicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2027, published September 28, 2026 — https://www.cms.gov/newsroom/press-releases/medicare-advantage-medicare-prescription-drug-programs-expected-remain-stable-2027

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This post was created with the help of AI and is for general information only. It is not medical, legal, or financial advice, and it does not replace guidance from a licensed professional, a Medicare counselor, or an official source such as Medicare.gov or CMS. If a detail affects your coverage or your premium, please confirm it with Medicare or a qualified professional before acting.

 

Verify First, Then Subsidies: CMS Proposes ACA Eligibility Checks Before 2028 Coverage

Direct answer: On October 23, 2026, the Centers for Medicare & Medicaid Services (CMS) proposed a rule (CMS-9873-P) that would require Affordable Care Act (ACA) marketplaces to verify four eligibility items before paying premium subsidies, starting with plan year 2028. The public comment deadline is November 27, 2026. This is a proposed rule, not a final rule, and it does not change 2027 open enrollment, which runs November 1, 2026 through January 15, 2027.

What is changing, and what stays the same?

Today, when a marketplace cannot confirm something on an application electronically, the applicant enters an inconsistency period and generally keeps receiving advance premium tax credits (APTC) and cost-sharing reductions (CSRs) while they submit documents. Under current rules, that period is generally 90 days for income questions and 95 days for citizenship or immigration status questions.

The proposal would reverse that order for plan year 2028: financial assistance would start only after the listed items are verified. If verification is still pending, a person could still enroll, but without financial assistance until eligibility is confirmed. CMS also proposes that, for people already enrolled when verification succeeds, financial assistance would apply retroactively for the months they were enrolled during the inconsistency period.

What are the 4 things that must be verified first?

Under the proposed rule, marketplaces would have to verify these four criteria before providing advance premium tax credits or cost-sharing reductions:

Item to verify	What it covers
1. Household income and family size	The income and household size used to calculate financial help
2. Citizenship or eligible immigration status	Status as a citizen, U.S. national, or eligible noncitizen, including lawfully present immigrants
3. Other qualifying coverage	Eligibility for or enrollment in other coverage, such as Medicaid or a job-based plan
4. Place of residence	Where the applicant lives

What happens if your information cannot be verified right away?

Three options in the proposal are worth knowing:

• Enroll without assistance while verification is pending. Coverage can start, but the premium is paid without subsidies until verification clears.
• Choose a contingent plan. A plan selection that becomes effective only if the person is found eligible for financial assistance, even if open enrollment has ended by then.
• Receive retroactive assistance once verified. For people already enrolled, CMS proposes that financial assistance would cover the months of enrollment during the inconsistency period once eligibility is confirmed.

One proposed exception: for certain family-size changes, such as birth, adoption, marriage, or loss of a dependent through divorce, separation, or death, CMS proposes waiving the new verification requirements so financial assistance is based on the attested application information during inconsistency periods.

What changes for people who auto-renew?

Under the proposal, currently enrolled consumers would only be automatically re-enrolled with financial assistance if they return to the marketplace each year to confirm certain eligibility criteria and have them re-verified. People who do not return and have their information re-verified would be automatically re-enrolled without financial assistance. In other words, passive renewal would no longer be enough to keep subsidies in place.

What is the August 1 early verification window?

CMS proposes a pre-open-enrollment verification period starting August 1 each year, so people can submit eligibility information early and have it verified before the next coverage year. The first window would start August 1, 2027, for 2028 coverage. The idea is to give people time to gather documents before open enrollment, rather than resolving mismatches after coverage starts.

What can you do now?

• For 2027 coverage, shop as usual. This proposal does not affect the 2027 open enrollment window (November 1, 2026 to January 15, 2027). Enroll by December 15, 2026 for coverage starting January 1, 2027.
• Keep your documents in one place. Income records, household information, proof of residence, and information about any other coverage are the four areas the proposal targets.
• Mark August 1, 2027. That is the proposed start of the first early verification window for 2028 coverage.
• Comment by November 27, 2026, if you want your view on record. Comments on proposed rule CMS-9873-P can be submitted through Regulations.gov (docket CMS-2026-3367) or by mail to CMS at the addresses in the Federal Register notice.

Frequently asked questions

Does this proposal affect my 2027 health plan?
No. The proposed requirements would be effective starting with eligibility determinations for plan year 2028. The 2027 open enrollment period is not changed by this proposal.

Is this rule final?
No. It is a proposed rule published in the Federal Register on October 27, 2026. CMS must review public comments before issuing a final rule, and the proposal could change.

What if my documents take time to gather?
The proposal adds the August 1 early verification window for that reason, and the contingent-plan option lets a plan choice take effect once eligibility is confirmed, even after open enrollment ends.

Where can I check my own situation?
HealthCare.gov and your state marketplace publish document guides and application checklists. A licensed navigator or broker can help with an individual application.

Key takeaway

Starting with 2028 plans, CMS proposes a "verify first, then subsidies" order for ACA marketplaces: income and family size, citizenship or eligible immigration status, other coverage, and residence would all need to be confirmed before premium tax credits and cost-sharing reductions are paid. The change would not touch 2027 enrollment, but it would end subsidy payments during unresolved verification mismatches and require an annual return to the marketplace to keep subsidies on renewal. The first early verification window would open August 1, 2027, and public comments are due November 27, 2026.

Sources

• CMS fact sheet: Exchange Pre-Eligibility Verification Proposed Rule (CMS-9873-P), published October 23, 2026 — https://www.cms.gov/newsroom/fact-sheets/exchange-pre-eligibility-verification-proposed-rule-cms-9873-p
• Federal Register, Patient Protection and Affordable Care Act, Exchange Pre-Eligibility Verification (CMS-9873-P), published October 27, 2026; comments due November 27, 2026 — https://www.federalregister.gov/public-inspection/2026-21891/patient-protection-and-affordable-care-act-exchange-pre-eligibility-verification
• CMS press release, October 23, 2026 — https://www.cms.gov/newsroom/press-releases/cms-proposes-new-verification-requirements-implement-law-combats-exchange-fraud-protects-taxpayer

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This post was created with the help of AI and is for general information only. It is not medical, legal, or financial advice, and it does not replace guidance from a licensed professional, a marketplace navigator, or an official source such as HealthCare.gov or CMS. If a detail affects your coverage or your premium, please confirm it with the marketplace or a qualified professional before acting.