Important Medicare Changes for 2027: Eligibility, D-SNPs and Prescription Costs
Here are five important Medicare changes to review before choosing coverage for 2027. These updates draw on Medicare.gov and CMS materials; confirm your personal eligibility and coverage with the appropriate agency and plan.
1. Changes to noncitizen eligibility
Beginning in January 2027, Medicare narrows the immigration categories that can qualify. Alongside U.S. citizens, the eligible noncitizen categories include lawful permanent residents, Cuban/Haitian entrants and qualifying COFA residents.
The official materials describe a five-year continuous U.S. residence requirement for these noncitizens before applying. Confirm how the eligibility requirements apply to your circumstances with Medicare or Social Security.
Some previously eligible categories, including refugees, people granted asylum and trafficking survivors, will no longer qualify on those statuses. Coverage for existing members relying on a status that no longer qualifies begins ending in January 2027.
2. New D-SNP enrollment alignment rules
D-SNPs serve eligible people with both Medicare and Medicaid. Beginning in 2027, affected new full-benefit dual-eligible members must be enrolled in, or enrolling in, the affiliated Medicaid MCO when the organization offers both plans in the same service area.
This does not mean every D-SNP member must use the same organization for both programs. Do not automatically apply Full Dual requirements to QMB Only or other partial-benefit categories. Options depend on your state, service area and Medicaid category.
Existing unaligned members are not universally required to leave in 2027. Further full-alignment requirements for affected plans take effect in 2030.
3. Part D drug prices and out-of-pocket costs
The maximum standard Part D deductible increases to $700 in 2027, from $615 in 2026. The annual out-of-pocket threshold rises to $2,400, from $2,100. Once you enter the catastrophic phase, your cost sharing for covered Part D drugs is $0.
Negotiated Medicare prices for the second group of 15 Part D drugs take effect January 1, 2027. Your actual prescription costs still depend on your Part D plan or Medicare Advantage plan with drug coverage.
For 2027 Part A and Part B premiums and deductibles, use CMS’s official releases when available. Do not substitute national plan premium averages for these amounts.
4. Medicare Advantage prior authorization
Beginning January 1, 2027, prior authorization processes become more electronic, and patients may be able to track decisions through patient portals. Ask your plan or provider how its process works.
5. Telehealth flexibility
Certain telehealth flexibilities extend through December 31, 2027. Eligible Medicare-covered services may be received in different U.S. locations, including at home. Not every service qualifies; check your provider’s availability, coverage and costs before scheduling.
What to do next
The Medicare Annual Election Period runs October 15–December 7. Even if you intend to keep your plan, recheck doctors, hospitals, prescriptions and next year’s out-of-pocket costs against the official plan materials.
Questions about your Medicare choices?
Review eligibility, doctors, medications and available coverage in light of your needs.
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