How 2027 Medicare cost increases could lead patients to defer care — and what practices should do

Medicare’s 2027 changes are likely to push many beneficiaries to skip follow-ups, abandon prescriptions or postpone referrals. To health plans and enablement companies, that may look like good news, but it’s not.

For risk-bearing practices and Medicare Advantage (MA) plans, deferred care is a timing problem disguised as a promising financial result. Fee-for-service practices feel it immediately as lost revenue. Risk-bearing practices face a subtler danger: lower utilization that looks like improved performance. A patient who skips a follow-up does not get healthier. An unmonitored chronic condition eventually costs more than the missed visit.

What changes in 2027

The headline numbers look unremarkable. The Centers for Medicare & Medicaid Services (CMS) projects the average standalone Part D premium will rise less than a dollar. But KFF estimates that if enrollees keep their current plans, the average standalone premium will rise 50%, from $34 to $51 a month, with 2.4 million people facing increases of more than $50.

The standard Part D deductible rises 13.8% to $700 and hits at the start of the plan year, when patients with chronic conditions refill maintenance medications. The out-of-pocket cap rises from $2,100 to $2,400. The premium stabilization demonstration, which capped increases and made $0-premium standalone plans possible, ends after 2026. In 2026, 4 million non-Extra Help enrollees paid nothing for a standalone drug plan. KFF puts their increases at roughly $5 to $31 a month. The more than 2 million non-Extra Help enrollees in UnitedHealthcare’s AARP-branded plans face increases of $50 or more in most states if they stay.

There is no reliable national 2027 Medigap figure yet because carriers file by state. For context, the average Plan G premium rose 38% between 2020 and 2025, to $194 a month. Early 2026 filings from six large carriers ranged an additional 12% to more than 26%, according to Telos Actuarial.

The Part B premium is projected to rise $6.60 to $209.50, and its deductible from $283 to $292.

For a traditional Medicare beneficiary with Plan G who was in a $0-premium drug plan, the increase is roughly $41 to $67 a month: $6.60 for Part B, about $29 for a 15% Plan G increase and $5 to $31 for the drug plan. The 3.6% Social Security cost-of-living adjustment (COLA), about $75 a month on average, covers that on paper, but a $1,500 benefit gains only $54, and the COLA offsets inflation already paid, including a 34.2% jump in gasoline prices that hits rural patients hardest. Then, in January, a Plan G enrollee can owe up to $992 in Part B and Part D deductibles.

Why 2027 savings can equate to 2028 costs

As with the rebound after elective procedures were delayed during COVID-19, the central financial risk for risk-bearing organizations is a timing mismatch that the claims system will never flag on its own.

Faced with nearly $1,000 in January deductibles, many patients on fixed incomes will wait until spring. In Medicare Part D, Chandra, Flack and Obermeyer found that modest cost-sharing increases led patients, including the highest-risk, to cut back on statins, antihypertensives and other drugs with proven mortality benefits, and raised mortality. A patient who abandons an anticoagulant, an SGLT2 inhibitor or a brand-name inhaler in January may present with something more serious in June. For practices in total-cost-of-care arrangements, lower 2027 utilization could reflect better health, better care management or patients rationing care they can’t afford.

CMS is compounding this by excluding diagnoses from unlinked chart reviews and audio-only encounters in 2027 MA risk scoring. A visit that doesn’t happen is a diagnosis that doesn’t get captured, and a phone check-in no longer fills the gap. The result is lower revenue the following year, just as deferred care drives utilization back up.

Who is exposed and who is not

The roughly 13.6 million Part D enrollees who receive Extra Help are largely shielded because the program eliminates the deductible, covers drug premiums up to a benchmark and caps copays. Dual eligibles and Medicare Savings Program enrollees are automatically deemed eligible.

Beneficiaries just above those thresholds are exposed, as are many MA enrollees: about 70% will face higher out-of-pocket maximums in 2027. KFF projects the average MA drug deductible will rise from $360 to $489, so a high-utilization MA patient faces the same January rationing impulse as a traditional Medicare patient. The same practice can see one patient whose costs are largely covered and another facing $60 to $100 or more in monthly premium increases plus a higher deductible. Year-round screening for Extra Help and Medicare Savings Program eligibility among patients who may not realize they qualify is now a clinical workflow question, not just a social work referral.

What practices should do

Before Dec. 7, identify patients whose coverage changes put their care at risk: those on expensive maintenance drugs, those just above Extra Help thresholds and rural patients with transportation barriers. Direct patients to their State Health Insurance Assistance Program or 1-800-MEDICARE for neutral counseling, or to their trusted benefits advisors. Patients considering MA should check networks, prior authorization rules and out-of-pocket costs for their own medications, not just premiums. MA covers about 55% of eligible beneficiaries, and enrollment growth is slowing, in part because lower premiums do not always mean lower costs. CMS marketing rules bar providers from steering patients toward a specific plan, but nothing prevents an honest conversation about total cost.

In January, build a first-quarter outreach list of patients with chronic conditions who miss a prescription refill or follow-up visit, and assign an owner, whose time chronic care management or advanced primary care management billing can help fund. Make sure staff know that patients new to a plan are entitled to a temporary transition supply of current medications the plan does not cover. Explain the Medicare Prescription Payment Plan: it does not lower what patients owe, but spreading that $700 deductible across the year can be the difference between a fill and abandonment. MA enrollees can still switch plans or return to traditional Medicare once between Jan. 1 and March 31.

For finance and contracting professionals, do not treat early 2027 medical cost ratios as durable. Ask whether favorable first-quarter results reflect better health or unmet need, and hold apparent savings in reserve rather than building them into 2028 assumptions. Review how total-cost-of-care benchmarks rebase and how quality gates treat suppressed utilization. Track prescription abandonment, no-shows and procedure deferrals monthly by payer and patient vulnerability. If you can distinguish deferred care from improved health in real time, you will be positioned to intervene before the gap becomes an admission.

Jenn Block, PhD, MBA, and Bhargav Raman, MD, MBA, lead the Value-Based Care initiative at Ten Ten Ten, a nonprofit focused on improving U.S. health outcomes while reducing health care spending. Access the open-source VBC Playbook at https://tententen.org/our-work/value-based-care