Pharmacist Niki Salomon shares what Medicare Part D beneficiaries should know before the Dec. 7 enrollment deadline.

As Medicare beneficiaries prepare for another enrollment season, understanding coverage options and upcoming changes can play an important role in managing health care costs and prescription expenses. According to Niki Salomon, PharmD, RP, at Gothenburg Health, several updates to Medicare Part D prescription drug plans are expected in 2027, making it especially important for beneficiaries to review their coverage before the Dec. 7 open enrollment deadline. 

"One of the biggest mistakes people make is assuming the Medicare Part D plan they selected for 2026 will automatically be the best choice for 2027," Salomon said. Drug formularies, participating pharmacies and plan offerings can change from year to year, which may affect both costs and coverage. 

Key Medicare Part D Changes for 2027

Salomon encourages beneficiaries to be aware of several important updates for the coming year: 

• Monthly premiums are expected to increase as a federal subsidy that helped prevent premium increases expires. Dawson County premiums currently range from $5.30 to $222.90 per month. 
• The 2027 annual deductible will increase from $615 to $700. Some plans may offer lower deductibles, but beneficiaries should carefully evaluate whether those options best meet their needs. 
• The annual out-of-pocket cap for covered medications will increase from $2,100 to $2,400, excluding monthly premiums. 
• The Medicare Prescription Payment Plan will remain available, allowing beneficiaries to spread out-of-pocket prescription costs throughout the year rather than paying larger amounts at the pharmacy counter. This is an especially great option for patients that have expensive medications and cannot afford the deductible the first months of the year.
• Copays for covered insulin products will remain capped at $35 per month or 25% of the plan's price, whichever is less. 
• Vaccines covered under Medicare Part D will continue to have no out-of-pocket costs, including RSV, shingles, and Tdap. 

Salomon also reminds beneficiaries not to overlook programs that may help reduce prescription costs.

"Extra Help" may be available to qualifying individuals based on income and can significantly lower prescription costs by eliminating deductibles and limiting copays for covered medications. Individuals who are new to Medicare should also be aware that enrollment opportunities begin three months before and extend three months after becoming eligible. In many cases, delaying enrollment can result in a lifetime late-enrollment penalty. 

When comparing plans, Salomon recommends confirming that a preferred pharmacy accepts the plan being considered and ensuring all medications, dosages and quantities are entered accurately when using Medicare's plan comparison tools. Even small errors can affect estimated costs and plan recommendations. 

Fortunately, several local resources are available to help individuals understand their options and make informed decisions. Beneficiaries can seek assistance from their pharmacist, visit Medicare.gov, contact Amber Auld, a SHIP representative at the Gothenburg Senior Center, or meet with trained Medicare advisors, including Will Rahjes at Flatwater Bank and Mike Messersmith at Dayspring Bank.

As part of these community education efforts, Will Rahjes will present two free Medicare Lunch & Learn sessions on Nov. 12 and Nov. 18 from 11:30 a.m. to 12:30 p.m. in the Larry Gill Board Room at the YMCA entrance of Gothenburg Health. The presentations will cover Medicare enrollment, plan changes and local coverage options. Lunch will be provided. 

For Salomon, the message is simple: don't assume last year's coverage is still the best fit.

Taking time to review options, verify prescription coverage and ask questions can help beneficiaries avoid unexpected costs and choose a plan that best meets their health care needs in the year ahead. 

For more information about local Medicare resources or the upcoming Lunch & Learn sessions, contact Gothenburg Health or one of the community resources listed above.