What is changing in Medicare in 2027

In short: The Part D numbers are final, and the negotiated prices start January 1.

The standard benefit. Once you hit the out-of-pocket cap, covered formulary drugs cost you nothing for the rest of the calendar year. Both figures come from the CMS CY2027 Rate Announcement of April 6, 2026.

Negotiated prices. The second round of Medicare drug price negotiation covers 15 Part D drugs and takes effect January 1, 2027 (effective 2027-01-01). CMS announced the prices November 25, 2025. Against CY2024 list prices, at a 30-day supply:

The full 15 also include Xtandi, Pomalyst, Ofev, Ibrance, Linzess, Calquence, Austedo, Xifaxan, Vraylar, Tradjenta, and Otezla. CMS reports about 5.3 million Part D enrollees used these drugs during 2024, accounting for $42.5 billion, roughly 15% of gross covered Part D drug costs. FINAL

A note on what a negotiated price is and is not. It lowers what Medicare pays. What you pay is your plan's cost sharing on that drug, calculated from a lower base. It is not a price tag you will see at the counter.

The premium subsidy ends. CMS announced on July 28, 2026 that it is discontinuing the Part D Premium Stabilization Demonstration after 2026. That program has been reducing stand-alone drug plan premiums by an average of $26 a month in 2025 and $16 in 2026, at a total federal cost KFF puts at $9.8 billion. Full detail: why 2027 drug plan premiums are likely to jump. FINAL

In short: Telehealth and GLP-1 coverage both run through the end of 2027, and both end there under current law.

Telehealth flexibilities are extended through December 31, 2027. The requirement that a mental health telehealth patient be seen in person first is delayed to January 1, 2028. These came through the federal funding package signed February 3, 2026, after the prior extension lapsed on January 31 and left a gap of a few days. The extended flexibilities include the geographic and originating site rules, expanded practitioner eligibility for occupational therapists, physical therapists, speech-language pathologists and audiologists, federally qualified health center and rural health clinic telehealth, audio-only visits, and hospice recertification by telehealth. December 31, 2027 is a hard cliff under current law: Congress has extended these repeatedly and may again, but as things stand today there is an expiration date on the calendar.

GLP-1 drugs for obesity: covered, through a demonstration. Medicare has been barred by statute from covering weight loss drugs since Part D began, and that has not changed. What exists is the Medicare GLP-1 Bridge, a demonstration that launched July 1, 2026 and now runs through December 31, 2027, providing coverage of select GLP-1 drugs for obesity at a $50 monthly copay outside the normal Part D rules. Three details that cut against the enrollee and are easy to miss:

• The $50 copay does not count toward your out-of-pocket total, so it does not move you toward the $2,400 cap.
• The Part D deductible does not apply, which means the drug sits outside the standard benefit entirely.
• Low income subsidy is not available for it.

A broader program called the BALANCE model was designed to bring GLP-1 coverage into Part D more conventionally. CMS required 80% of Part D plans to participate. That threshold was not met, and in April 2026 CMS indefinitely delayed the model on the Medicare side. The Bridge was extended through 2027 specifically because BALANCE did not launch.

The CY2027 Medicare Advantage and Part D rule was published April 6, 2026 at 91 FR 17384, effective June 1, 2026, and applicable January 1, 2027. Among other things it codifies the Inflation Reduction Act's Part D redesign, adjusts prior authorization documentation requirements, and removes eleven measures from the Star Ratings program in future rating years. FINAL

In short: Medicare Advantage plans get a 2.48% average payment increase, and the path to that number is a story in itself.

CMS's CY2027 Rate Announcement, April 6, 2026:

The interesting part is the gap between proposal and final. The Advance Notice on January 26, 2026 proposed an average payment change of 0.09%. Ten weeks later the final came in at +2.48%. Nearly the entire swing traces to one line: the risk model revision and normalization adjustment moved from down 3.32% to down 1.12%.

CMS also finalized two changes to which diagnoses count for risk adjustment: it excluded diagnoses from audio-only encounters, and excluded unlinked chart review records, with an exception for beneficiaries switching between Medicare Advantage organizations. CMS projected the chart review change alone at a $7.2 billion reduction in 2027 payments. None of this appears on your bill. It shapes what plans can afford to offer, which shows up in benefits and premiums when the landscape files publish in late September.

In short: Part B, Part A, IRMAA, the COLA, and Medigap are all still open.

The Part B projection of $209.50 would be a 3.25% increase, the smallest year-over-year change since Part B premiums fell 3.06% in 2023. Detail, including the competing figure circulating: the 2027 Part B premium page.

The IRMAA thresholds are unusual this year. They are set by a formula that closes at the end of August, so they become arithmetic on September 11, 2026, roughly two months before anyone knows the dollar amounts. Detail: the 2027 IRMAA brackets page. Every figure on this page, and every one CMS has not yet published, is tracked with its source on the 2027 Medicare numbers page.

In short: A group of people currently enrolled in Medicare lose eligibility in January 2027.

The 2025 reconciliation law restricted Medicare eligibility by immigration status. Eligibility is now limited to U.S. citizens, lawful permanent residents, Cuban and Haitian entrants, and migrants under the Compacts of Free Association. That excludes refugees, people granted asylum, holders of Temporary Protected Status, survivors of trafficking, survivors of domestic violence, and humanitarian parolees, regardless of how long they paid Medicare payroll taxes.

The operational deadline matters here. Under the law, the Social Security Administration was required to identify currently enrolled beneficiaries who no longer meet the eligibility definition and notify them by July 2026 that their coverage ends in January 2027.

The same law also imposed a nine-year moratorium, running through 2034, blocking implementation of rules that would have simplified enrollment in Medicare Savings Programs, which help lower income beneficiaries with premiums and cost sharing. The Center for Medicare Advocacy estimates the moratorium saves the government roughly $66 billion by not delivering that help.

If you received a notice from Social Security about your Medicare eligibility ending, that is what it is about, and it takes effect in January.

In short: Not everything about 2027 is new. Several things stay exactly as they were.

• There is still no coverage gap. The Part D donut hole was eliminated in 2025, and it does not come back in 2027.
• Medicare's statutory bar on covering weight loss drugs remains in place. The GLP-1 Bridge is a temporary demonstration exception, not a permanent change to the Part D benefit.
• The BALANCE model has not launched. The program meant to bring GLP-1 coverage into Part D under normal rules stays indefinitely delayed on the Medicare side, because plan participation never reached the 80% threshold CMS required.
• The basic structure of Original Medicare is unchanged. Part A hospital coverage, Part B medical coverage, and Part D drug coverage keep the same overall shape, only the dollar amounts move.
• The Star Ratings program continues, just with eleven fewer measures under the CY2027 final rule.

• Aug 12, 2026Page created.

• CMS, 2027 Medicare Advantage and Part D Rate Announcement, April 6, 2026, and the CY2027 Advance Notice, January 26, 2026
• CMS, Medicare Part D 2027 National Average Monthly Bid Amount Information, July 28, 2026
• CMS, Selected Drugs and Negotiated Prices, and the negotiated price fact sheet for initial price applicability year 2027, November 25, 2025
• CMS, Medicare GLP-1 Bridge, last modified July 13, 2026
• CMS, 2026 Medicare Trustees Report, transmitted June 9, 2026
• Federal Register, 91 FR 17384, CY2027 Medicare Advantage and Part D final rule, April 6, 2026
• KFF, on the BALANCE model for GLP-1s, and on ending the Part D premium stabilization subsidies, July 29, 2026
• Center for Medicare Advocacy, analysis of the 2025 reconciliation law’s Medicare provisions
• 42 CFR 423.2267(e)(3), the Annual Notice of Change deadline