Three Medicare rumors to ignore this fall
October 15, 2026
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Show Notes
Eddie and Betty's Conversation
Welcome to The American Retirement Advisor. I'm Betty, and Eddie's here with me in the studio today, which means we are about to get into some numbers whether I like it or not.
You always like it by the end.
I tolerate it very warmly. Okay, so today we are talking about Medicare's Annual Enrollment Period, which opens today, October 15th, and runs through December 7th. And the reason we wanted to do this episode right now is that Ian Schaeffer, our COO, just wrote a piece about three things people are getting wrong this fall. Not because they're careless, but because the information traveling around out there is bad.
And some of it is old. A headline about a proposal gets shared, and by the time it reaches your neighbor who hands it to you at the mailbox, nobody remembers that it was just a proposal.
Which is such a specific and accurate picture of how misinformation spreads. So let's go through the three rumors Ian Schaeffer lays out, because I think each one is genuinely surprising in its own way.
The first one surprised me and I follow this stuff.
Okay, lay it on me. What is it?
So people have been hearing that there's a new rule letting you switch Medicare plans if your doctor leaves your plan's network mid-year. Like, your doctor drops your plan in October, you get a special window to move.
That sounds completely reasonable. Why wouldn't that be a rule?
Because it was proposed but never finalized. Medicare actually considered it. They put it forward. And then in the final rule for 2027, published in the Federal Register on April 6th of this year, they explicitly wrote that they are not finalizing the proposal.
Wait, so websites are out there describing it like it passed?
According to Ian Schaeffer's piece, yes. The proposal traveled. The part where it wasn't finalized didn't travel as far.
That is maddening. So what does that mean practically for someone whose doctor just left their plan?
It means the answer is what it's always been. Moving out of your plan's service area opens a special window. Your plan ending its contract with Medicare does too. A significant change to your plan's network can, but Medicare decides those case by case. One doctor leaving? Don't count on it.
So the window you have right now, October 15th to December 7th, that is your moment to check.
And if your doctor isn't in your 2027 network and you miss the Annual Enrollment Period, you can't count on an easy do-over.
The article even mentions they have a piece specifically on how to check whether your doctor is still in network. So go find that.
Don't assume it's the same next year as it is this year. It isn't always.
Okay. Rumor number two. This is the one that I feel like almost everyone has heard by now. The two-thousand-dollar drug cap.
Big deal when it came in. It was real. In 2025, the out-of-pocket cap on covered Part D drugs was that figure.
And now people are planning their 2027 budget around two thousand dollars.
They should plan for twenty-four hundred instead. It went to twenty-one hundred for 2026 and it's twenty-four hundred for 2027. The cap is indexed, it moves every year.
Wait, so people could be off by $400 a year. That's not nothing.
Especially if you're on an expensive medication and you're actually going to hit that cap. If you're building a real budget, that difference matters.
And the deductible went up too, right?
It went up. The maximum a drug plan can charge goes from six hundred fifteen dollars in 2026 to seven hundred dollars in 2027.
So both the floor and the ceiling moved.
Correct. More coming out of pocket before the coverage kicks in, and a higher cap before you're fully protected.
And the article is careful to point out that the cap only covers your out-of-pocket spending on covered drugs. Your monthly premium is a separate number.
Right. And if your household income puts you in the bracket where you pay an income-based surcharge, that's separate too. The cap is not a total Medicare cost ceiling. It's specific to your drug costs.
So when someone says I'm protected once I hit two thousand, they might be off on the number and off on what it covers.
Two things wrong for the price of one.
Ha. Okay. The cap is still a meaningful protection though. I don't want people to hear this and panic.
No, it's good. Before there was a cap at all, someone on a very expensive drug could spend unlimited amounts out of pocket. The cap exists. It helps. It just isn't two thousand dollars anymore.
Twenty-four hundred for 2027. Write that down. Okay, third rumor. And this is one I think causes a lot of unnecessary stress.
The re-enrollment question.
People think they have to actively re-enroll every year or they'll lose their coverage.
And Medicare is pretty clear about this. Their yearly review guide says, and I'm pulling from Ian Schaeffer's piece here: if you've reviewed your options and you're happy with your current coverage, you don't need to do anything. Your coverage continues automatically.
So the fear is unfounded?
That's the case for most people, yes. But there are two words in that quote I want people to hear.
Which ones?
Reviewed your options. Medicare says it's fine to do nothing IF you have reviewed your options. Doing nothing as a choice is fine. Doing nothing as a default because you're busy and you'll get to it is a different thing.
Because the plan you're rolling into might not be the same plan you signed up for.
Premiums change. Drug formularies change. Networks change. And your plan sends you an Annual Notice of Change every year that spells out what's different for 2027. That document is the one to read.
And honestly most people put that envelope on the counter and never open it.
It goes under the other mail.
Right next to the thing from the car dealership. Okay so there's also a real exception to the automatic continuation, isn't there?
Yes, and this one matters. If your plan doesn't renew its contract with Medicare, you can't just roll over. You have to pick new coverage. The good news is Medicare gives you a special window to do that. But you have to pay attention to the notice when it comes.
So the rule isn't you'll automatically lose coverage if you don't act. The rule is you might have to act and not know it if your plan is exiting.
Which is exactly why checking your Annual Notice of Change isn't optional, even if you love your current plan.
I want to go back to something the article talks about, which is how to tell good information from bad, because I think that's almost as useful as the three specific answers.
He lays out some habits that I thought were very practical.
The first one is the one that would have cleared up everything we just talked about.
Ask whether something is a proposal or a final rule. Because only one of those changes anything. The special enrollment period for provider terminations was a proposal. The final rule didn't adopt it. Two totally different things, same headline.
And if you don't know to ask that question, you'd never catch it.
The second habit is check the year. A number that was accurate in 2025 can be flat wrong for 2027. We just showed you that with the drug cap.
Two thousand dollars was right. Then it wasn't.
And the third is go to the source. Medicare.gov, your plan's Annual Notice of Change, the plan's Evidence of Coverage. Those documents settle most questions faster than a forwarded article will.
I love that framing. Because that's exactly how most of this stuff arrives. Someone texts you a screenshot.
And it's got no date on it.
And no source. And it's already been shared forty times.
By the time it gets to you, nobody knows where it started.
Medicare.gov. That's the antidote.
That and your actual plan documents.
Okay, I want to ask you about the Certified Medicare Planner piece, because the article talks about what that kind of advisor does differently, and I think it's worth naming.
The way Ian Schaeffer puts it, they start from the documents, not the headlines. So they're reading your Annual Notice of Change. They're checking your specific doctors and your specific prescriptions against the 2027 networks and drug lists. And only after all of that do they tell you whether staying in your current plan makes sense.
So it's not generic advice. It's your plan, your prescriptions, your doctors.
Right. Because two people with the same plan can have very different answers about what they should do in 2027, depending on what medications they take and which doctors they see.
And there are rules around some of this that get pretty specific. Like I imagine there are details about how a particular drug formulary change affects what you'd pay, and that's not something I'd want to eyeball on my own.
I'd write that down and bring it to one of the advisors. The specific mechanics of how a tier shift like that flows through to your cost-sharing, that's a question for someone who reads those documents every day.
Which is the other thing I want to say: this stuff is complicated. Not because Medicare is trying to confuse you, but because it's a big system and it changes every year. Nobody should feel embarrassed for not knowing all of it.
And that's part of why the Annual Enrollment Period exists. You get a window each year to look at it fresh and make a decision with current information.
October 15th to December 7th. And changes take effect January 1st.
So you're not that far out from a change affecting your coverage. That window closes fast.
Let me just recap the three things because I think they're worth saying plainly one more time before we close.
Go for it.
The special enrollment period for when your doctor leaves your network: proposed, not finalized, not a real rule. Do not count on it.
Check that now while you still can.
The drug cost cap: not two thousand dollars for 2027. It's twenty-four hundred, and the maximum deductible is up to seven hundred.
Update your budget.
And re-enrollment: you don't have to actively re-enroll to keep your coverage, but you do need to look at what your plan is doing next year. The automatic continuation is not permission to ignore the paperwork.
Open the envelope.
Ha. He's very firm about it.
Years of watching people not open the envelope.
Fair enough. Okay, if you want to sit down with someone who does this every day, the advisors at American Retirement Advisors are there. The number is 602-281-3898. They'll walk through your plan, your prescriptions, your situation.
And given that the window closes December 7th, sooner is better.
It comes up faster than you think. Trust me.
Like every year.
Thank you so much for spending this time with us. Go check your plan, check your network, update that budget number, and if you have questions, don't let them sit. Get them answered by someone who knows. Take care of yourselves, and we'll see you soon.