Prescription costs could be a major factor in this year’s Medicare annual enrollment periods. Many seniors struggle to afford their prescriptions, and recent policy changes are raising concerns about possible premium hikes. Agents who understand the changes will be better positioned to help clients compare options, control Medicare Part D costs and make informed enrollment decisions.
What’s Driving Medicare Part D Changes in 2027?
The Inflation Reduction Act included changes to Medicare Part D designed to lower costs for enrollees. However, these changes also increased costs for insurers, leading to concern that insurers would raise premiums to compensate. In 2025, CMS introduced the Part D Premium Stabilization Demonstration, which provided subsidies to carriers as a way of preventing large premium hikes.
Now the program is set to end effective calendar year 2027.
CMS says the program is no longer needed. Insurance carriers have had time to redesign their Part D benefits, so they no longer need the subsidy support provided by the program.
According to Healthcare Dive, premiums are expected to increase by less than $10 for most beneficiaries, and some enrollees could actually see lower prices. However, final figures are not available yet, and some enrollees could see steeper premium increases than they’re used to. CMS has also announced a 6% increase to the base premium.
How to Help Clients Navigate Higher Costs This AEP
For retirees already struggling with prescription costs, even a moderate premium hike could be concerning. Rising prescription costs are likely to become a key discussion point during AEP. Agents can use this as an opportunity to demonstrate their value by helping clients compare total costs and available assistance programs.
- Calculate total costs when comparing plan options. Although premium hikes can be concerning, the premium is not the only cost to consider, and a plan with a higher premium may still be the best deal once you factor in deductibles and copays. Guide clients through a comparison of their total expected costs under various Medicare Part D and Medicare Advantage options.
- Encourage your clients to apply for Extra Help. The elimination of the Part D Premium Stabilization Demonstration does not affect Medicare’s Extra Help program, and people can still apply for support with premiums and out-of-pocket costs. If your clients are having trouble with costs, encourage them to apply through the Social Security Administration.
- Help your clients make the most of their benefits. Some Medicare enrollees leave benefits on the table because they don’t realize they’re available. For example, some of your clients may qualify for the new GLP-1 Bridge program, which makes weight-loss drugs available for just $50 a month. Your clients may also be able to fill their prescriptions through a mail-order pharmacy at a lower cost.
- Offer alternatives to drug rationing. Some seniors skip doses when they can’t afford their medication, but that can put their health in danger. Instead of rationing their medication, encourage your clients to talk to their doctors about more affordable alternatives. For certain prescriptions, it may be cheaper to use a discount program like GoodRx and pay cash rather than using your Medicare plan, but this means your costs won’t contribute to your deductible or out-of-pocket maximum, so this isn’t always the best option.
As Medicare prescription coverage continues to evolve, clients will rely on knowledgeable agents more than ever. PTT equips agents with the resources, carrier relationships and support needed to deliver that guidance and grow their business. Learn how PTT can help you succeed.