Medicare Open Enrollment: 7 Steps for Medical Practices

What Medicare Open Enrollment Changes for Your Practice

Medicare’s annual open enrollment period runs from October 15 to December 7. During this window, people with Medicare can switch from Original Medicare to a Medicare Advantage plan, move back, change from one Advantage plan to another, or pick a new Part D drug plan. Whatever they choose takes effect on January 1.

There’s also a second window many practices forget about. The Medicare Advantage open enrollment period runs from January 1 to March 31. Anyone already in an Advantage plan can make one more change during those three months, either to a different Advantage plan or back to Original Medicare. So coverage can keep shifting well into spring.

For your practice, that means a patient’s insurance on December 30 may not be their insurance on January 2, and it may change again by March.

Why This Year Deserves Extra Attention

Two things make 2027 worth planning for.

First, Medicare Advantage is now the bigger half of Medicare. According to KFF, 55% of eligible Medicare beneficiaries were enrolled in Medicare Advantage in 2026. Every one of those patients is billed to a private plan with its own network, prior authorization rules and cost-sharing, not to traditional Medicare.

Second, a lot of plans are changing. KFF’s 2027 analysis found that several large insurers are pulling Medicare Advantage plans out of hundreds of counties. Health Care Service Corporation, the parent company of Blue Cross and Blue Shield of Texas, is exiting 498 counties, UnitedHealth Group 228, Centene 359 and CVS Health 186. Some companies, such as Devoted Health, are expanding into new areas.

When a plan leaves a county, its members have to choose new coverage. That means new member IDs, new networks and possibly new rules for the services you provide. If even a handful of your Medicare patients are affected, January can get busy fast.

7 Things Your Practice Should Do Before January

1. Find Out Which of Your Patients Could Be Affected

Start with your own data. Pull a report of active Medicare and Medicare Advantage patients from your practice management system, then sort it by plan. Look for:

• Patients in Advantage plans that are leaving your area or changing networks
• Patients with visits already booked for the first two weeks of January
• High-value patients, such as those on infusions, regular imaging or recurring procedures

You don’t need to call everyone. You need to know where the risk is so your team can focus there first.

2. Flag Every January Visit for Re-Verification

This is the single most useful step. Add a flag or alert in your scheduling system so every Medicare patient’s first visit of 2027 gets a fresh eligibility check, no matter how long they’ve been coming to you.

Do it 48 to 72 hours before the appointment, not at check-in. That gives your team time to call the patient if something has changed. Our insurance eligibility and benefits verification checklist walks through each step, from active coverage to visit limits.

Because of the Medicare Advantage open enrollment window, keep checking through the end of March. A patient who was verified in January could switch plans again in February.

3. Remind Patients to Bring Their New Card

Most patients don’t think to tell their doctor’s office that their insurance changed. A simple reminder helps a lot. Try adding a line to your December appointment reminders, a sign at the front desk, or a short post on your social pages:

“Did you change your Medicare plan for 2027? Please bring your new insurance card to your next visit.”

At check-in in January, ask every Medicare patient directly, “Has anything changed with your insurance this year?” Scan the card again even if it looks the same. Advantage cards from different plans can look surprisingly similar.

4. Review Medicare Advantage Prior Authorization and Network Rules

Original Medicare and Medicare Advantage handle prior authorization very differently. A service that never needed approval under traditional Medicare may need it the moment a patient moves to an Advantage plan. Referral requirements and network rules can change too, especially with HMO-style plans.

For your most common procedures and tests, check what each major Advantage plan in your area requires for 2027. Keep a simple one-page cheat sheet at the front desk.

There’s some good news here. Under the CMS Interoperability and Prior Authorization Final Rule, Medicare Advantage plans now have to respond to prior authorization requests within 72 hours for urgent requests and seven calendar days for standard ones. That only helps if the request is complete and submitted on time. Our guide on how to reduce prior authorization denials covers the most common mistakes.

5. Update Patient Cost Estimates for the New Year

Deductibles reset on January 1. For reference, the standard Part B deductible was $283 in 2026. CMS usually announces the next year’s Part B premium and deductible in the fall, so update your estimates as soon as the 2027 figures are published.

Medicare Advantage plans set their own copays and out-of-pocket limits, and those can change from year to year. A patient who paid a small copay in December may owe a lot more in January.

Two things help here:

• Check the patient’s deductible status during verification so your estimate is accurate
• Tell patients what they’re likely to owe before the visit, and collect it at check-in

Patients are far less upset about a cost they were told about than one that shows up in the mail weeks later.

6. Prepare Your Front Desk Team

Your front desk will feel January first. Spend 20 minutes in a December staff meeting going over:

• The new year’s verification process and who owns it
• How to spot a changed or new Advantage card
• What to say when a patient’s coverage has ended or their plan dropped your practice
• Where the prior authorization cheat sheet lives
• When to stop and escalate instead of checking the patient in

It also helps to agree on a script for difficult conversations. Something like: “It looks like your plan changed for the new year. Let’s check your new coverage together so there are no surprises on your bill.”

7. Plan Extra Hands for the First Weeks of January

The first two or three weeks of January bring a spike in phone calls, verification work and coverage questions. If your team is already stretched, this is when things slip.

Look at your January schedule now. Consider lighter appointment templates for the first few days, staggering staff time off over the holidays, or bringing in outside help. A virtual medical assistant can take on eligibility checks, patient calls and appointment reminders during the rush, so your in-office staff can focus on the patients in front of them.

What If You Can’t Confirm a Patient’s Coverage?

It will happen at least once in January. A patient arrives, the old plan shows as terminated, and the new plan isn’t showing up in the payer portal yet. New enrollments can take a little while to appear in eligibility systems, especially in the first days of the year.

Don’t guess, and don’t just bill the old plan and hope. A few options work better:

• Ask for the new card or the plan’s welcome letter. Most Advantage plans mail a member ID before January 1, and the welcome letter usually lists the member number and effective date.
• Call the plan directly. Member services can often confirm an enrollment that the portal hasn’t picked up yet. Write down the representative’s name and a call reference number.
• Check Medicare’s own eligibility system if your practice has access through your clearinghouse or the Medicare Administrative Contractor portal. It can show whether the patient is enrolled in an Advantage plan and which one.
• Reschedule non-urgent visits if coverage truly can’t be confirmed, and explain why. Most patients prefer a short delay to a surprise bill.

Whatever you decide, document it on the account. If a claim is denied later, that note is your proof that the office did its part.