5 Things to Check Before Renewing Your Medicare Advantage Plan
By Dr. Harman Virk, DO — Board‑Certified Internal Medicine, The Modern Medicine Group (Fresno, CA)
Medical disclaimer: This article is educational and not medical advice. If symptoms are severe, worsening, or you’re worried—seek urgent care or call 911.
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Quick Take
If you do nothing during Open Enrollment, your Medicare Advantage plan usually renews automatically, with all of its 2027 changes.
Many plans are raising costs and trimming benefits for 2027, so a quick review matters this year.
The 5 checks: doctors and hospital, drugs and pharmacy, total yearly cost, extra benefits, and prior authorization rules.
You can't switch plans mid-year just because your doctor leaves the network. Check now.
Open Enrollment runs October 15 – December 7, 2026.
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Table of Contents
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1) Why Auto-Renewal Can Cost You
Renewing your plan is easy. You don't have to do anything. But the plan you renew into for 2027 may not be the same plan you had in 2026.
For 2027:
Many insurers are raising out-of-pocket maximums and adding or increasing drug deductibles.
Some are cutting extra benefits or leaving counties entirely.
California's average Medicare Advantage premium is going up, from $13.77 to $14.12.
A 20-minute review now can save you money and stress all year.
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2) Check #1: Your Doctors, Medical Group and Hospital
This is the most important check, and the one most people skip.
Is your primary care doctor in network for 2027?
In California, many Medicare Advantage HMOs work through a medical group. Is your doctor's medical group still contracted?
Are your specialists (cardiologist, endocrinologist, lung doctor, etc.) in network?
Is the hospital you'd want to use in network?
Why it matters in Fresno: In 2026, contract disputes between Community Health System and some health plans temporarily left Fresno patients out of network. And a proposed rule that would have let patients switch plans mid-year when a doctor leaves was not approved.
Tip: Don't rely only on the online directory. Call your doctor's office and ask, "Will you accept my plan and medical group in 2027?"
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3) Check #2: Your Drugs and Pharmacy
Is every drug you take still on the plan's 2027 drug list (formulary)?
Did any drug move to a higher tier or get new prior authorization or step therapy rules?
Is your pharmacy still in network, and is it "preferred" (lower copays)?
What's the plan's drug deductible? It can be up to $700 for 2027.
2027 good news:
The yearly out-of-pocket cap for covered drugs is $2,400.
15 more drugs get lower Medicare-negotiated prices on January 1, 2027, including Ozempic, Janumet, Tradjenta, Trelegy and Breo.
Tip: Enter your exact drugs and doses into the Medicare Plan Finder to see real yearly costs.
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4) Check #3: Your Total Yearly Cost
A $0 premium isn't the whole story. Add up:
Monthly plan premium × 12
Your Part B premium (you still pay it, projected at about $209.50/month in 2027)
Drug deductible and copays
Copays for doctor visits, specialists, labs and imaging
The plan's out-of-pocket maximum: your worst-case cost for a bad health year
If you have a chronic condition or a planned surgery, the out-of-pocket maximum matters more than the premium.
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5) Check #4: Extra Benefits and Flex Cards
Extra benefits are often why people choose Medicare Advantage. For 2027, check whether yours changed:
Dental (yearly limit, covered services)
Vision and hearing (glasses, hearing aids)
Over-the-counter allowance
Transportation to medical appointments
Gym or fitness benefit
Flex cards are changing in 2027. Cards must now be limited to eligible items, and other purchases will be declined at the register. Plans must publish what qualifies. Some extra benefits for chronic conditions also now require proof that you qualify.
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6) Check #5: Prior Authorization and Referrals
Medicare Advantage plans often require approval before certain care: MRIs, procedures, some medications, home health and skilled nursing.
Ask: Which services I use need prior authorization?
Ask: Do I need a referral to see a specialist?
Since 2026, plans must decide urgent requests within 72 hours and standard requests within 7 days, and explain any denial.
Many insurers have also pledged to honor existing approvals for 90 days if you switch plans. Confirm this with any new plan.
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7) Frequently Asked Questions
What happens if I don't do anything during Open Enrollment?
Your plan usually renews automatically, with its 2027 changes. If your plan is leaving your area, you'll need to choose a new one.
How do I find out what changed in my plan?
Read your Annual Notice of Change, which should have arrived by September 30. See How to Read Your ANOC in 7 Minutes. Then check details on Medicare Plan Finder.
Should I switch plans if my costs went up a little?
Not always. A small cost increase may be worth it to keep your doctors and drugs covered. Look at the full picture.
What if I renew and later find a problem?
From January 1 to March 31, 2027, Medicare Advantage members can make one plan change.
Where can I get free help comparing plans?
HICAP for Fresno and Madera Counties: (559) 224-9117 or 1-800-434-0222.
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Fresno CTA — The Modern Medicine Group
Open Enrollment is a good time to review your coverage, and an equally important time to review the healthcare you actually use.
Before you renew, make sure your plan still covers your doctors, medical group, hospital, and medications for 2027.
The Modern Medicine Group helps Fresno seniors with medication lists, prior authorizations, chronic-condition care, and Annual Wellness Visits. Call us to confirm whether a specific plan and medical group are accepted by our office before December 7.
Visit: 7053 N. Cedar Ave., Fresno, CA 93720
Phone: 559-369-7787
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