By Justine Suba-Cohen, DO
Optum Nevada
Medicare’s Annual Enrollment Period (AEP) runs from Oct. 15 through Dec. 7, giving people with Medicare an opportunity to sign up for a plan, review existing coverage and make changes for the coming year.
As a physician, I see how Medicare plan choices can affect patients long after enrollment ends. A plan that looks good on paper may not fit how you actually use health care.
As you review Medicare options for 2027, here are five mistakes to avoid.
1. Don’t assume your 2026 plan will be the same in 2027.
Your plan’s coverage, costs and provider network may change for the coming year. Each fall, your Medicare Advantage plan sends an Annual Notice of Change explaining what will change in January.
Read the notice closely. Confirm that your doctors, hospitals and prescriptions will still be covered at costs you can afford. If not, use open enrollment to compare other options.
2. Don’t assume your doctors and hospitals are in every Medicare Advantage plan.
If a particular physician, specialist or hospital matters to you, check before enrolling.
Medicare Advantage plans can have provider networks. Confirm that the physicians, specialists and hospitals you use participate in the specific plan you are considering. Don’t assume a doctor who accepts Medicare participates in every Medicare Advantage plan.
3. Don’t switch plans during active treatment without a transition plan.
Medicare Advantage coordinated care plans must provide at least a 90-day transition period when someone receiving an active course of treatment switches to a new plan. During that period, the new plan cannot disrupt the treatment or require reauthorization.
This protection matters if you are in the middle of chemotherapy, rehabilitation or another course of care. Before changing plans, confirm how the new plan will handle your doctors, scheduled treatments, medications and existing approvals after the transition period ends.
4. Don’t confuse spreading out prescription costs with lowering them.
The Medicare Prescription Payment Plan allows anyone with Medicare drug coverage, including a Medicare Advantage plan with drug coverage, to spread eligible out-of-pocket prescription costs across the calendar year, at no additional cost, rather than paying those costs at the pharmacy when prescriptions are filled.
This can make higher prescription expenses easier to budget, but Medicare makes an important distinction: the program does not save money or lower drug costs.
For some patients, spreading costs over several months may help. Just understand what the program does and doesn’t do.
5. Don’t overlook prior authorization.
Prior authorization means a health plan may require approval before covering certain medical items or services. Medicare notes that Medicare Advantage enrollees will typically need prior authorization before a plan covers certain services or supplies.
Before enrolling, find out which services or supplies require prior authorization and how quickly the plan must respond. Beginning with the 2026 plan year, Medicare Advantage plans and other affected insurers generally must decide expedited requests within 72 hours and standard requests within seven calendar days. Starting in 2027, affected plans also must use electronic prior authorization systems that allow doctors and insurers to exchange coverage requirements, documentation and decisions electronically.
Medicare choices are personal. Your health conditions, medications, physicians, finances and priorities may differ from someone else’s. During open enrollment, ask how a plan will work for the health care you actually use. A little homework now can help prevent surprises after January.
