Medicare Open Enrollment is usually framed as a consumer story: older adults comparing plans at the kitchen table.. But anyone who has worked a front desk in the first week of January knows who really feels it. When patients switch plans, practices inherit the fallout: eligibility mismatches, out-of-network surprises, prior authorizations that start from scratch and claims that bounce.
This year’s window opens today, October 15, and closes December 7, 2026. And 2027 is shaping up to be a busier year than most. Insurers are pulling Medicare Advantage plans out of hundreds of counties, and drug costs are shifting again. Here’s what that means for your practice and what to do about it now, while there’s still time.
The dates that hit your practice
| Date | What happens | What it means for you |
| Oct 15 to Dec 7, 2026 | Open Enrollment | Patients ask staff which plans you accept |
| Jan 1, 2027 | New coverage takes effect | Insurance cards on file may be out of date |
| Jan 1 to Mar 31, 2027 | Medicare Advantage Open Enrollment | A second wave of switches, so coverage can change again mid-quarter |
That January to March window is the one practices tend to forget. Medicare Advantage members can make one more change during it, either to another Advantage plan or back to Original Medicare. A patient verified in January isn’t guaranteed to have the same coverage at their March follow-up.
What’s changing in 2027, from the provider side
some version of: “Here’s the list of plans we accept. For help choosing, call 1-800-MEDICARE or your local SHIP counselor.” SHIP counselors are free and unbiased and don’t sell anything. If you’re unsure where a line falls, check with your compliance team before posting materials in the waiting room.
Medicare Advantage plans are leaving markets.
On the surface, CMS says the program looks stable. The national plan count barely moves, from 5,553 to about 5,532, and average premiums are projected to fall. Underneath, there’s a lot of churn. Becker’s reports that Centene is leaving 344 counties, UnitedHealthcare 140 and Aetna 123. Humana says its exits will affect about 600,000 members. Eleven insurers are leaving the individual Advantage market entirely, seven of them owned by health systems.
Every one of those members has to land somewhere. Some patients will end up in a plan you’re contracted with, while others may choose a different option. Others may return to Original Medicare without realizing it, as members who don’t select a new plan are moved to Original Medicare on January 1.
Coverage gaps in some counties.
KFF found that in 193 counties, there will be no general-enrollment Advantage plan at all in 2027. If you practice in or near one of them, expect a noticeable shift back to Original Medicare and supplemental coverage
Higher drug cost-sharing early in the year.
The Part D out-of-pocket cap rises from $2,100 to $2,400, and the maximum deductible climbs from $615 to $700. Patients paying full price in January may delay fills or skip doses. That’s worth knowing when a patient with a chronic condition comes back with numbers that slipped.
Stand-alone drug plans lose a subsidy.
A temporary federal program that steadied stand-alone Part D premiums ends after 2026. CMS projects the average premium will rise less than a dollar, but individual plans will vary, and formularies will change along with them.
Telehealth stays put for now.
Congress extended the core Medicare telehealth flexibilities through December 31, 2027, so you can plan virtual visits for another full year.
What to do before January
1. Pull the 2027 plan landscape for your service area.
CMS publishes the full list of Advantage and Part D plans by county. Compare it against your payer contracts. Which plans are you in, which ones are leaving, and which new entrants are showing up?
2. Confirm your contract status in writing.
Don’t assume a renewal happened. Ask each Advantage payer you work with to confirm your network participation for 2027, including any new plan products they’ve launched.
3. Give your front desk a one-page cheat sheet.
List the plans you accept for 2027, the ones you don’t and the ones that are ending. When patients call in November asking “do you take this plan?”, staff should be able to answer in ten seconds.
4. Re-verify every Medicare patient in January.
Not just new patients. Run eligibility checks at scheduling and again at check-in, and ask patients to bring their new card. Plan switches are the biggest source of preventable January denials
5. Restart prior authorizations early.
When a patient changes plans, their existing authorizations usually don’t follow them. Flag patients on ongoing treatments, such as infusions, therapy, or specialty drugs, and get new authorizations moving the first week of January.
6. Watch your A/R in Q1.
Track denials by reason code through March. A spike in eligibility or out-of-network denials tells you where your verification process is leaking. If your in-house team is stretched during the January rush, a partner that offers medical billing services can help keep claims moving while your staff focuses on patients.
Reduce Open Enrollment Denials with Revantage Healthcare Business Solutions LLC
Plan changes, new eligibility rules and restarted authorizations make the first quarter one of the hardest times for any practice’s revenue cycle. Revantage Healthcare Business Solutions LLC helps healthcare providers stay ahead of these challenges with denial management services built to find the root cause of rejected claims, correct errors quickly and file timely appeals. Our team works as an extension of your billing staff, so eligibility mismatches and out-of-network denials get resolved instead of piling up in your A/R. If you want to protect your revenue before the January surge, Revantage can help you build a stronger, more predictable claims process.
Talking to patients about plans
Patients trust their doctors, so they’ll ask you which plan to pick. You can help, but CMS marketing rules draw a line around how. In general, providers can share objective information, tell patients which plans they accept, display materials for plans they contract with and point out people to neutral help. What you shouldn’t do is steer a patient toward a specific plan because it benefits the practice.
The safest, most useful answer is usually some version of: “Here’s the list of plans we accept. For help choosing, call 1-800-MEDICARE or your local SHIP counselor.” SHIP counselors are free and unbiased and don’t sell anything. If you’re unsure where a line falls, check with your compliance team before posting materials in the waiting room.
The bottom line
Patients make their Medicare choices between now and December 7. Practices live with those choices from January 1 on. The work you do in the next eight weeks, such as checking contracts, briefing staff, and planning January verification, is what keeps the first quarter from turning into a denial cleanup project.
The practices that handle open enrollment well aren’t the ones with the biggest billing teams. They’re the ones that see it coming.
This article is general information, not legal, compliance or billing advice. Plan availability varies by county; confirm details with your payers and the CMS landscape files.
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