7 Medicare Advantage Changes Virginians Should Read Before They Renew

If your Medicare Advantage plan covers prescription drugs, the most you can pay out of pocket is going up next year.

Virginians weighing whether to renew should consider that and a few other changes.

Here’s what’s changing, and what to check before you decide whether to keep your plan.

Note: This is general information, not insurance advice. Plan rules and dollar amounts are subject to change, so confirm the current details with the Virginia Insurance Counseling and Assistance Program.

1. Higher Drug Spending Cap

Medicare Advantage plans with drug coverage cap your yearly out-of-pocket spending on covered drugs at $2,400 in 2027, up from $2,100 in 2026, according to Medicare.gov.

That’s $300 more.

Once you reach it, you pay nothing out-of-pocket for covered drugs for the rest of the calendar year.

2. Higher Drug Deductible Limit

A Medicare Advantage plan with drug coverage can’t charge you a deductible above $700 in 2027, up from $615 in 2026, according to Medicare.gov.

That’s $85 more.

Some drug plans don’t have a deductible at all.

Yours may be one of them.

3. Lower Average Premiums

Nationwide, the Centers for Medicare & Medicaid Services (CMS) projects the average monthly Medicare Advantage premium will fall 16.5% in 2027, from $14.37 to $12.00.

That’s $2.37 less a month.

At the average, that’s $28.44 a year back in your pocket.

If your plan includes drug coverage, the average monthly Part D premium across such plans is projected to fall from $11.32 in 2026 to $7 in 2027, after rebates.

4. Electronic Prior Authorization

Starting January 1, 2027, your Medicare Advantage plan may be able to process your prior authorization requests electronically, according to Medicare.gov.

Prior authorization is an approval from your plan that you may need for certain services or drugs before your plan covers them.

CMS requires Medicare Advantage plans to add prior authorization information to the data available through their Patient Access application programming interface (API).

Drug requests are left out.

The deadline is January 1, 2027.

CMS says the change will help patients understand their plan’s prior authorization process and its impact on their care.

5. Posted Chronic Illness Criteria

Your Medicare Advantage plan may offer Special Supplemental Benefits for the Chronically Ill.

In its 2025 rule, CMS defined those benefits as provided only to eligible chronically ill enrollees.

Those benefits had to have a reasonable expectation of improving or maintaining health or overall function.

In its 2027 final rule, CMS requires plans to publicly post the eligibility criteria they develop for those benefits.

Plans must post them.

The rule was issued on April 2, 2026, and it also clarifies eligibility requirements for those benefits.

6. Data Sharing Between Plans

CMS requires Medicare Advantage plans to implement a Payer-to-Payer API by January 1, 2027.

The API makes your claims and encounter data available when you change plans, which helps with care continuity.

Plans only have to share data with a date of service within five years of the request.

You must opt in first.

7. Fewer Limits on Agent Outreach

Medicare Advantage agents and brokers face fewer limits on how and when they can talk with you.

CMS removed restrictions on the time and manner of those conversations in a rule that took effect June 1, 2026.

One of those restrictions limited when a marketing event could follow an educational event in the same location.

Another required a wait between a Scope of Appointment form and a personal marketing appointment.

Both are gone.

The rule’s new marketing and communications policies apply to 2027 marketing beginning October 1, 2026.

That start date comes two weeks before Open Enrollment, which Medicare.gov lists as October 15 through December 7.

So the policies are already in place by the time you can switch plans.

What Stays the Same

CMS expects Medicare Advantage hearing, dental and vision benefits to remain stable in 2027.

About eight in 10 Medicare Advantage members will be able to keep their current plan with the same or a lower premium in 2027.

Medicare.gov says your plan sends you an Annual Notice of Change, a document listing changes in coverage and costs that take effect in January.

Medicare Advantage plans slip slightly nationwide, from 5,553 in 2026 to approximately 5,532 in 2027, CMS projects.

That’s about 21 fewer.

Even so, more than 99% of people with Medicare nationwide are projected to have at least one Medicare Advantage plan to choose from, and 97% are projected to have 10 or more.

2026 Limits and Prior Authorization

KFF, a nonprofit health policy research organization, reports that the average out-of-pocket limit for Medicare Advantage enrollees is $5,421 for in-network services in 2026.

If you're in a health maintenance organization plan, the in-network average in 2026 is $4,636.

Preferred provider organization plans average $6,592 in-network in 2026 and $9,825 for in-network and out-of-network services combined.

The in-network gap is $1,956.

In 2026, 99% of enrollees are in plans that require prior authorization for some services, so your plan likely does too.

Plans covering 97% of enrollees require prior authorization for acute inpatient hospital stays, the service most often subject to it.