Your Medicare Drug Plan May Cost More in 2027 — Even If Your Prescriptions Haven't Changed
You take the same prescriptions. You use the same pharmacy. Nothing about your health has really changed. So your Medicare drug costs should stay about the same next year, right?
Not necessarily.
Medicare Part D plans can change from one year to the next, and 2027 brings another important change to the Part D landscape. That means even if your prescription list looks exactly the same, what you pay for those medications could look different.
A temporary Part D premium program is ending
For 2025 and 2026, Medicare used a temporary program called the Part D Premium Stabilization Demonstration for participating standalone prescription drug plans. The program was introduced as Medicare Part D underwent major changes and was designed to help limit volatility in standalone Part D premiums.
For 2026, participating plans received a $10 reduction to the base beneficiary premium, and the demonstration limited how much a plan's total Part D premium could increase from the prior year.
CMS announced that the demonstration will end after 2026. Beginning in 2027, standalone Part D plans will return to operating under the traditional market structure without those temporary protections. That doesn't mean every Part D premium will suddenly jump. But it does mean you shouldn't assume that what you paid in 2026 will be what you pay in 2027.
For some people, that change may barely be noticeable. For others, it could make the difference between keeping the same plan and finding that another option fits their prescriptions and budget better. The important part is not to panic over a headline or assume your plan will become expensive. It's simply to know that 2027 is a year worth reviewing carefully.
The Medicare Part D base premium is also changing
For 2027, the national base beneficiary premium for Medicare Part D is $41.33, up from $38.99 in 2026. Federal law currently limits the annual increase in this base amount to 6% through 2029.
Here's an important distinction: $41.33 is not necessarily the premium you will pay for your Part D plan. It's a figure Medicare uses as part of the formula for calculating plan-specific premiums. Actual premiums can vary significantly from one plan to another.
So while that number helps explain what's happening behind the scenes, the number that matters most to you is the actual 2027 premium for your specific plan.
Does everyone pay the same amount for Medicare, or does my premium depend on my situation?
No, everyone does not necessarily pay the same amount for Medicare.Most people pay $0 for Part A because they or their spouse worked and paid Medicare taxes long enough.
For Part B, the standard premium in 2026 is $202.90 per month, but some people pay more based on their income. Medicare calls the additional amount IRMAA. For 2026, IRMAA can apply if your 2024 income was above $109,000 for an individual or $218,000 for a married couple filing jointly.
Your costs can also depend on the coverage you choose. Part D prescription drug plans, Medicare Advantage plans, and Medicare Supplement plans can all have different premiums and out-of-pocket costs. Higher-income beneficiaries may also pay an additional IRMAA amount for Part D.
There are also programs that may help people with limited income and resources pay Medicare premiums and other costs.
So when someone asks, “How much does Medicare cost?” there really isn’t one number that applies to everyone. Your work history, income, prescriptions, coverage choices, and eligibility for assistance can all affect what you pay.
Before choosing coverage based only on the monthly premium, I recommend looking at the total cost of the coverage... including premiums, deductibles, copays, prescriptions, doctors, and potential out-of-pocket expenses.
Your prescription can stay the same while your cost changes
Let's say you've taken the same medication for years. Your plan might still cover that medication in 2027, but other things could change. For example, the plan could:
- move the drug to a different formulary tier,
- change the copay or coinsurance,
- change which pharmacies offer preferred pricing,
- change its deductible or how that deductible applies,
- add or change certain coverage requirements, or
- change the overall plan premium.
Medicare Part D plans use formularies, or lists of covered drugs, and those formularies may include different cost-sharing tiers and coverage rules. That's why seeing your medication listed as "covered" doesn't tell you the whole story. Covered is important, but I also want to know: covered at what cost and under what rules?
A simple example
Imagine you take three prescriptions every month. In 2026, all three are covered at relatively low copays, and you fill them at a pharmacy your plan treats as preferred.
Then 2027 arrives. The medications are still on the formulary, so at first glance, everything looks fine. But maybe one drug moved to a higher tier. Another now has coinsurance instead of a flat copay. Your pharmacy is still in the network, but it is no longer considered preferred.
Nothing changed about the medications you take. But several things changed about how the plan covers them.
That is why comparing plans based only on whether a medication appears on the formulary can give you an incomplete picture. The details around the drug matter too.
The cheapest premium isn't always the cheapest plan
This is one of the biggest mistakes I see people make when comparing prescription drug coverage. They sort plans by monthly premium and assume the least expensive premium means the least expensive option. Sometimes it does. Sometimes it doesn't.
Imagine one plan costs a little more each month but gives your medications better formulary placement and preferred pricing at the pharmacy you already use. Another plan might advertise a very low premium but leave you paying considerably more for your prescriptions during the year.
The better question isn't simply: "What does this plan cost per month?" It's: "What could this plan cost me based on the prescriptions I actually take?" Those are two very different questions.
When reviewing drug coverage, I like to look beyond the premium and think in terms of the total picture. That includes the monthly premium, deductible, copays, coinsurance, pharmacy pricing and the medications you realistically expect to fill throughout the year.
A low monthly premium can certainly be attractive. Just make sure you're not saving a few dollars each month only to spend much more later at the pharmacy.
What is the biggest mistake seniors make when enrolling in Medicare?
I'd say the biggest mistake is choosing too quickly and assuming it will be easy to change later. People often focus on the monthly premium or extra benefits without checking their doctors, prescriptions, and what they'll pay when they actually need care. They may also not realize that getting a Medicare supplement later isn't always guaranteed. I encourage people to look beyond what works today and think about what may work for them long term.Your pharmacy matters too
A pharmacy that offered preferred pricing through your plan in 2026 may not necessarily have the same status in 2027. That means two people enrolled in the same drug plan and taking the same medication could potentially pay different amounts depending on where they fill their prescriptions. And sometimes the difference between pharmacies can be enough that it's worth comparing before the new year begins.
This doesn't necessarily mean you have to switch pharmacies. It simply means you should know whether the pharmacy you prefer is still a good fit with the plan you're considering. It's another reason I recommend reviewing the combination of: your medications + your plan + your pharmacy. Not just one of the three.
Don't forget about coverage rules
Price isn't the only thing that can change. Some medications may have coverage requirements such as prior authorization, step therapy or quantity limits. These rules determine how a plan covers certain prescriptions and may require additional steps before the medication is covered under the plan's terms.
A drug can technically remain on the formulary while the rules surrounding that drug change. That's why a thorough review should ask, "Are there any new restrictions or requirements attached to it?"
That small question can help prevent an unpleasant surprise after January 1.
What should you check for 2027?
Before automatically keeping your current drug coverage, take a few minutes to review the things that actually affect you. Look at:
- Your 2027 monthly premium
- Whether each of your prescriptions is still on the formulary
- The tier and cost-sharing for each medication
- Whether your preferred pharmacy still has favorable pricing
- Any deductible or coverage-rule changes
Your plan should send information explaining changes for the upcoming year. Don't toss that packet aside just because the plan name on the front looks familiar. The name may be the same. The coverage underneath it may not be.
And if you review everything and find that your current plan still works well for you, that's valuable information too.
A Medicare review doesn't automatically mean changing plans. Sometimes the best outcome is confirming that what you already have still makes sense.
Can I change my Medicare Part D drug plan during the Open Enrollment Period (OEP)?
Yes... but it's during Medicare’s Annual Open Enrollment, October 15 through December 7, you can change your Part D drug plan for the following year.Just keep in mind, the January 1 through March 31 Medicare Advantage Open Enrollment Period works differently and doesn’t normally let you switch from one standalone Part D plan to another.
If you’re unsure which enrollment period applies to you, I’m happy to help you sort it out.
What matters most for 2027
One of the easiest Medicare mistakes to make is assuming that nothing changed because you didn't change anything.
Your prescriptions may be the same. Your pharmacy may be the same. You may even stay enrolled in the exact same plan.
But the plan itself can still change.
Medicare's Annual Enrollment Period runs from October 15 through December 7, giving people with Medicare an opportunity to review and make changes to Medicare Advantage and Part D coverage for the following year. The goal isn't to change plans every year. It's to make sure the one you have still makes sense for the year ahead.
About the Author: Jon Cavanaugh is a licensed Nevada Medicare broker, U.S. Army veteran, husband, and father serving the Las Vegas community. He specializes in Medicare Advantage, Medicare Supplement insurance, and Medicare prescription drug plans. His work focuses on education and helping people understand how Medicare coverage options may interact with their doctors, medications, budgets, and health care preferences.