Plans have until September 30 to mail every Medicare Advantage and Part D enrollee an Annual Notice of Change for 2027. Open enrollment begins October 15 and runs through December 7, with the resulting coverage effective January 1, 2027. Every year this produces a January in which a share of Medicare patients arrive with a new card, a new payer ID and a set of authorizations that belonged to the old plan. This year we expect a bigger share than usual, and the front desk is where it lands.
Two things make 2027 different. Becker's Hospital Review's tracker, updated September 22, counts at least 33 health systems that have ended or are ending in-network contracts with one or more Medicare Advantage insurers in 2026, and the tracker is not exhaustive. Some terminations are already effective October 1 (Ohio State University Wexner Medical Center with Humana's individual plans; NKC Health and Valley Health System with UnitedHealthcare) and others take effect at year end (Lee Health in Fort Myers with UnitedHealthcare; Endeavor Health in Illinois with Aetna; Fairview Health Services in Minnesota with UnitedHealthcare on January 1). On the insurer side, Humana has said it is leaving plans covering roughly 600,000 members for 2027, and several carriers are narrowing their county footprints after a 2027 rate announcement (a 2.48 percent average increase, finalized April 6) that fell short of what they wanted. When a hospital leaves a plan, or a plan leaves a county, the patients move, and they move to plans whose networks may or may not include you.
Key takeaways
- Open enrollment runs October 15 to December 7; coverage changes take effect January 1, and so do the eligibility failures.
- Know your 2027 participation status by Medicare Advantage product and county, in writing from each carrier, before the first patient asks.
- Re-verify every Medicare patient in January and re-request every January authorization whose plan changed.
- Staff may state facts about your participation and point to 1-800-MEDICARE and SHIP counselors; they may not recommend a plan.
What changes for beneficiaries in 2027
A few facts patients will ask about. The Part D out-of-pocket cap rises to $2,400 in 2027, from $2,100 this year, and the standard Part D deductible rises to $700 from $615. The Part D base beneficiary premium is $41.33, up from $38.99, and CMS announced on July 28 that the temporary demonstration that held down stand-alone Part D premiums in 2025 and 2026 ends after December 31, so some patients will see higher drug plan premiums in their notices. CMS finalized its contract year 2027 Medicare Advantage and Part D rule on April 2, 2026; it trimmed the Star Ratings measure set and, notably, did not finalize a proposed special enrollment period for provider network terminations, so a patient whose hospital leaves a plan mid-year still has only the existing enrollment windows to work with. The Part B premium and deductible for 2027 have not been announced; CMS typically publishes them in November, and the 2026 deductible is $283.
What it means in the practice
| What happens | What breaks | What to set up now |
|---|---|---|
| Patient switches Medicare Advantage plans | Old payer ID on file; claims reject or go to the wrong plan | Re-verify every Medicare patient at the first January visit; scan the new card; check the 271 for the plan and payer ID |
| Patient switches from a plan you participate in to one you do not | Out-of-network payment or no payment; patient surprise | Know your participation status with every plan sold in your county for 2027; check the eligibility response for network status |
| Patient moves from Medicare Advantage to Original Medicare | Authorizations no longer needed; supplemental coverage may have a waiting period | Check for a Medigap or secondary payer and update the coordination of benefits |
| Open authorizations for January procedures | The authorization belonged to the old plan and does not transfer | For every procedure scheduled in January, confirm the patient's plan in the last week of December and re-request authorization with the new plan if it changed |
| Hospital in your area left a plan | Referrals and admissions for patients in that plan need a different facility | Get the list of local terminations and know where you can send those patients |
| Patient's plan left the county | The patient is auto-moved or lands in Original Medicare without a supplement | Watch for CO-27 and CO-31 denials from the old plan in January and re-verify before rebilling |
The January volume problem
Deductible reset and plan changes arrive in the same week. Many practices try to absorb this with the normal front-desk staffing and discover that verifying insurance for every Medicare patient, scanning a new card, and having a conversation about a plan they do not participate in takes four to six minutes per patient. Multiply by the Medicare share of a January schedule. We recommend a dedicated person, or a dedicated block of time each morning, for re-verification in January, plus a batch eligibility run on the whole January schedule during the last week of December so the changes are known before the patient arrives.
The arithmetic for a mid-sized practice: 1,400 Medicare visits in January at five minutes each is about 117 hours, or roughly fifteen working days of one person's time, spread over the month. A batch eligibility run in the last week of December removes most of it, because the 271 responses tell you in advance which patients changed plans and which did not. The desk then spends its minutes on the 15 or 20 percent who changed, not on the whole schedule. Without the batch run, the same 117 hours happen at the window with a line behind them.
The batch run also produces a list you will want for another reason: patients whose new plan you do not participate with. Those patients deserve a call before the visit, not a conversation at check-in, and the call should be made by someone who can offer the options (reschedule after a plan change, see the provider out of network with a written estimate, or transfer care) without improvising.
Patients will ask you which plan to pick
They will, and your staff must not answer. Recommending a plan is a licensed activity, and a practice that steers Medicare patients toward or away from specific plans is asking for a compliance conversation. What the front desk can and should say is factual: "We participate with these plans for 2027" (from a list you have verified with each plan, not from memory), "your plan's network may change on January 1, so check whether we are in it before you decide", and "for help comparing plans, call 1-800-MEDICARE, use the Medicare Plan Finder, or contact your State Health Insurance Assistance Program, which is free." Print that on a card. Put it at every check-in station.
The participation list is the hard part. Payer sales representatives will tell you that you are in-network because you have a contract with the carrier, but Medicare Advantage networks are often product-specific, and a contract that covers the carrier's commercial HMO may not cover its Advantage PPO. Ask each carrier, in writing, for the list of 2027 Medicare Advantage products in your county that include your group's TIN, and keep the answer. If the carrier cannot produce the list by product, check your own group in the plan's online provider directory for each 2027 product once the directories update in October, and screenshot what you find with the date.
Questions we hear
A patient's hospital left their plan. Can we tell them to switch plans?
You can tell them the fact (the hospital is out of network with that plan as of a specific date, according to the hospital's or the plan's notice) and the resources (1-800-MEDICARE, SHIP). You cannot tell them which plan to move to. Write the fact on the card in neutral language and leave the decision to the patient and the counselor.
Do we need to re-credential with a plan a patient moves to?
If your group is not contracted for that product, yes, and a participation request submitted in January is rarely effective before spring. That is why the September credentialing review includes a look at the plans entering your county for 2027.
What about patients who move to Original Medicare?
Verify whether they bought a Medigap policy or have other secondary coverage, update coordination of benefits, and stop requesting authorizations that Original Medicare does not require. Watch for the patient who left an Advantage plan without a supplement and now owes 20 percent coinsurance; the front-desk estimate conversation applies to them too.
What to do this month
- Request the 2027 Medicare Advantage product participation list from each carrier you contract with, by county.
- Pull the Becker's list, or your state hospital association's equivalent, for terminations affecting hospitals your patients use.
- Write the front-desk card: plans you participate with, the plan-comparison resources, and nothing else.
- Build the January re-verification plan: batch eligibility on the whole January schedule in the last week of December, and a daily verification block through January.
- List every procedure scheduled in January for a Medicare Advantage patient and set a reminder to confirm plan and authorization on December 28.
Practices we bill for get the January re-verification as part of the standard billing workflow, and the denials that slip through are categorized by plan so we can see which carrier's changes caused them. The eligibility verification workflow we described earlier this year is the foundation; the January plan-change season is the stress test.
