Medicare Open Enrollment begins Oct. 15, giving beneficiaries an opportunity to review their current coverage and compare their options for 2027. For residents in assisted living and long-term care (LTC) communities, this is especially important.

These residents often take multiple medications, their healthcare needs can change throughout the year, and differences among plans can have a significant impact on both medication access and out-of-pocket costs.

Even residents who are satisfied with their current plan should take another look. Plans can change their premiums, deductibles, formularies, copays, and pharmacy or provider networks from one year to the next. At the same time, a resident may have started or stopped medications, received new diagnoses, or experienced other changes that make a different plan a better fit.

The potential financial impact is significant. According to U.S. News & World Report, Medicare beneficiaries who compare their options and switch plans could save $500 to $1,000 a year.

For long-term care providers, encouraging residents and responsible parties to compare plans during Open Enrollment is a simple step that can help prevent unexpected medication costs and coverage frustrations in the year ahead.

What’s Changing for Medicare Part D in 2027?

Medicare Part D coverage phases change each year. For 2027, the standard Part D deductible will increase from $615 to $700 and the annual out-of-pocket threshold will rise from $2,100 to $2,400. Once a resident reaches the $2,400 threshold, covered Part D medications will be $0 for the remainder of the year.

Those changes don’t affect every resident in the same way. Actual costs depend on the plan selected, medications taken, and other individual circumstances—another important reason to compare plans based on a resident’s specific needs.

What to Consider When Comparing Plans

While it can be tempting to focus on the monthly premium when comparing plans, a lower premium doesn’t necessarily mean lower overall healthcare costs. A meaningful comparison should consider the resident’s complete healthcare and medication needs, including:

• Are their current medications on the plan’s formulary?
• What are the deductibles, copays, and coinsurance?
• Are any medications subject to prior authorization or other coverage requirements?
• Are their physicians and other healthcare providers in-network?
• Is their long-term care pharmacy in-network?
• What are their estimated total annual out-of-pocket costs?

Choosing a different plan could create significant savings, especially if a resident’s plan cost or coverage changes, or if their health condition, medication therapy, financial circumstances, address, care setting, or care level changes.

Finding an LTC Pharmacy in a Plan’s Network

Pharmacy network participation can be surprisingly difficult to verify for residents of assisted living and LTC communities. But this deserves special attention: choosing a plan without verifying pharmacy participation can lead to unexpected coverage gaps or higher costs after the plan takes effect.

Medicare.gov pharmacy searches often focus on retail and mail-order pharmacies. LTC pharmacies operate differently, providing specialized pharmacy services to residents of senior living and other LTC communities. As a result, an LTC pharmacy may not appear in a Medicare.gov pharmacy search even when it participates in the plan’s network.

Residents and responsible parties shouldn’t assume a missing search result means their LTC pharmacy is out-of-network. Instead, use the insurance plan’s own pharmacy finder to verify network participation. Search using the LTC pharmacy’s ZIP code rather than the resident’s community ZIP code and, if necessary, expand the search radius to approximately 20–25 miles. Residents can also contact their LTC pharmacy directly for help confirming network status.

That extra step is important. Choosing a plan without verifying pharmacy participation can create unexpected coverage or cost issues after the new plan takes effect.

What Open Enrollment Looks Like This Year

Now through September: Watch for your plan’s Annual Notice of Change or Evidence of Coverage. Review what’s changing for 2027 and take stock of any changes in medications, healthcare providers, or healthcare needs.

Oct. 1: Medicare’s 2027 plan information becomes available for comparison.

Oct. 15–Dec. 7: Compare available plans and make any desired changes during Medicare Open Enrollment.

Jan. 1, 2027: New coverage takes effect.

The goal isn’t necessarily to change plans every year. It’s to make an informed decision about whether the current plan still makes sense.

Make Plan Comparison Part of the Annual Routine

Open Enrollment is an opportunity for assisted living and LTC operators to encourage residents and responsible parties to take an active role in understanding their coverage. While community staff don’t need to become Medicare experts, they should remind families that plans and healthcare needs change, encourage them to compare options each year, and point them toward resources that can help.

LTC pharmacies are another important resource. Because pharmacy teams understand residents’ medication regimens and prescription coverage, they can help residents and responsible parties identify potential coverage issues and understand how available plans may affect medication costs.

Guardian Pharmacy offers personalized Medicare plan comparisons for residents they serve that evaluate available options based on each resident’s medications and coverage needs. To better understand their options for 2027, residents and their responsible parties can request a personalized Medicare plan comparison by visiting guardianpharmacy.com/medicareoptions.

By Walt Rowland
Director of Medicare Plan Optimization and Services at Guardian Pharmacy Services