What Medicare Covers in Senior Care Planning

If a Parent’s Medicare Advantage Plan Is Ending for 2027: Three Coverage Doors

During Open Enrollment (October 15 – December 7, 2026), families whose carrier is discontinuing a Medicare Advantage plan compare three paths: Door 1 (choose a new Medicare Advantage plan to keep network doctors and bundled benefits), Door 2 (return to Original Medicare Parts A & B with a stand-alone Part D drug plan and an optional Medigap policy under the federal 63-day guaranteed-issue window with no health underwriting), or Door 3 (take no action, which defaults to Original Medicare on January 1, 2027 without a Part D drug plan unless enrolled separately). Review the full timeline and 5-step checklist in Medicare Open Enrollment 2026: Key Dates, compare finalized 2027 Part D parameters in 2027 Medicare Costs: Final and Pending, and see the 4 long-term care funding bridges in The Care Decision Ep 2: Medicare Doesn’t Pay for Assisted Living — What Actually Does.

Your Medicare Plan’s Star Rating May Be a Mirage This Year — 3 Things to Check Before Open Enrollment

The window: Medicare Open Enrollment runs October 15 – December 7, 2026, and changes take effect January 1, 2027. This is the one annual window most people have to switch Medicare Advantage or Part D prescription drug plans for 2027.^[2]

What actually changed in the ratings formula: CMS’s Contract Year 2027 final rule removed 11 Star Ratings measures — mostly administrative metrics such as call-center performance (including interpreter and TTY availability) and appeals handling — and reinstated the general reward factor in place of the Health Equity Index (HEI). Because fewer operational metrics can pull a composite score down, a plan can show a higher star rating this year without its care having improved at all. CMS’s own regulatory analysis projects roughly $18.5B ($18.56 billion) flowing to plan sponsors over 10 years from these formula and bonus-payment changes. Only one genuinely new clinical measure was added for the 2027 measurement year: depression screening and follow-up.

What families should do — read under the headline star: Check the underlying categories (drug coverage, care coordination, and member experience with the care itself), then verify the three things that actually determine whether a plan works for your parent in 2027:

1. Their medications are on the plan’s 2027 formulary at a tolerable tier — confirm every routine prescription, tier placement, and any prior-authorization or step-therapy rules (alongside the finalized 2027 Part D $700 maximum deductible and $2,400 annual out-of-pocket cap).
2. Their doctors and hospital are in network for 2027 — provider networks change yearly, so check each primary care physician, specialist, and hospital by name in the plan’s 2027 directory.
3. Their pharmacy is preferred in-network — copays at a standard in-network pharmacy can be substantially higher than at a preferred in-network pharmacy under the same plan.

Check stars last, not first. A high-starred plan that drops your parent’s specialist or moves a daily medication to a non-preferred tier will cost your family far more than a lower-starred plan that covers their actual doctors and prescriptions.

Watch for the marketing surge: Federal broker and agent marketing restrictions were loosened effective October 1, 2026, so families should expect a higher volume of calls, mailers, and ads this season — and should know that a sales call is not advice. For free, unbiased guidance with no sales commission, contact your local State Health Insurance Assistance Program (SHIP) counselor, and review our live Medicare Open Enrollment 2026 key dates explainer, 2027 plan-ending checklist, 2027 Medicare costs guide, and FAQ entry (“When is Medicare Open Enrollment for 2026?”) for the dates and plan-ending rules.

Sources & 2027 rule-change explainers: CMS Contract Year 2027 Medicare Advantage and Part D Final Rule Fact Sheet; Medicare Star Ratings 2027 Rule-Change Explainer (Avidon Health, updated 2026-10-03); and 2027 Star Ratings Measure-Set & Reward-Factor Analysis (RISE Health, updated 2026-10-03).