The Wall Street Journal ran a piece this week with a blunt headline: new Medicare plans have fewer benefits and higher costs, and seniors need to pay attention to who is in network and what extra charges they might face.
I am not going to pretend I have not seen it. I sell these plans. I look at them every single day during enrollment season, and I would rather tell you what I am actually seeing than act like nothing has changed.
What I am seeing in the 2027 plans
Dental is the clearest one. Some carriers offered genuinely good PPO dental coverage in 2025. By 2026 several of those had dropped back to preventive only, meaning cleanings and x-rays and not much else. For 2027 I am watching allowances get cut in half, a plan that carried a thousand dollars of coverage last year coming in at five hundred.
Over-the-counter allowances have largely disappeared, especially on the PPO plans from the biggest carriers. That was the quarterly card you used at the pharmacy for everyday items. On a lot of plans it is simply gone.
Deductibles are showing up on plans that never had one. Not everywhere, and not on every plan, but the direction is unmistakable.
Networks are getting tighter. This is the one the Journal’s subheadline is pointing at, and it is the one that hurts the most when it goes wrong, because a shrinking network is how you find out in February that the doctor you have seen for a decade is no longer covered.
So the tradeoff people are facing for 2027 is increasingly this: a plan with a narrower network, or a plan with fewer extra benefits. A few years ago you could often have both.
For what it is worth, the national data backs up the direction even if it lags what I am seeing in the plan documents. The share of Medicare Advantage plans offering an over-the-counter allowance fell from 73 percent to 66 percent in a single year, and analysts tracking benefit value found dental, vision and over-the-counter benefits declined more than anything else. The average Medicare beneficiary has 28 Medicare Advantage drug plan options for 2027, down from 32.
So why is this happening?
The easy answer is that executives got greedy. I looked into it, and that is not what the numbers show. The real answer is more interesting, and once you understand it you can predict what happens next.
Extra benefits are paid for out of something called rebate dollars. Here is how that works. Every year a plan submits a bid saying what it expects to cost to cover you. The government has a benchmark number for your county. If the plan bids below that benchmark, it gets a share of the difference back as a rebate, and by law that rebate has to be spent on you. It cannot be kept as profit. It pays for dental, the over-the-counter card, the gym membership, lower copays, and money back on your Part B premium.
That pot of money did not shrink. This is the part that surprised me. The Medicare Payment Advisory Commission, the independent body that advises Congress, reports that rebate dollars reached a record high in 2026, roughly $222 per member per month.
What changed is where the money goes.
In 2022 Congress passed the Inflation Reduction Act, which redesigned Medicare drug coverage. The headline piece is a cap on what you pay out of pocket for prescriptions each year, which is a genuinely good thing and has saved some people thousands of dollars. But capping your costs does not make the drugs cheaper. It moves who pays, and a large share of that liability moved onto the insurance plans.
Plans still want to advertise a low drug premium, because that is what sells. So they take rebate dollars and spend them buying that drug premium down. In 2026 that came to about $53 per member per month.
Rebate dollars are finite. Every dollar spent buying down your drug premium is a dollar not sitting in your dental allowance. The Commission says this outright: using more rebate money to buy down drug premiums requires plans to reduce their other rebate-funded benefits, and it names dental as the example.
Here is where every rebate dollar went in 2026:
| Where it goes | Share |
|---|---|
| Lowering what you pay at the doctor and hospital | 35% |
| Drug coverage | 26% |
| Dental, vision, hearing and other extras | 22% |
| Money back on your Part B premium | 9% |
| Administration and profit | 8% |
Eight percent. That is what is available for administration and profit out of the pot that funds your extras, and that share is set by rule rather than by anybody’s generosity. I am not going to tell you insurance companies are charities. But the dental money did not go into a bonus pool. It went into capping your drug costs.
Which means the honest way to describe this is a tradeoff rather than a theft. Your dental allowance got smaller in part because your prescription costs got capped. If you take an expensive medication, you came out well ahead on that trade and you probably did not notice the dental. If you are healthy and you used the dental benefit twice a year, you paid for someone else’s cap and got nothing back. Both of those people exist. Both of them are my clients.
There is one more factor worth mentioning because you will hear it blamed. In 2024 the government changed how it scores how sick each member is, which reduced what plans could collect. That one turned out to be mostly absorbed by the insurers rather than passed to you. Researchers found only about 17 to 24 percent of the lost revenue showed up as reduced benefits or higher costs for members.
What this tells you about next year: as long as drug liability keeps sitting on the plans, the pressure on dental and over-the-counter benefits does not let up. This is a trend, not a blip, and I would plan accordingly rather than hoping it reverses.
The part I will not say
I am not going to tell you Medicare Advantage is a scam, or that everybody should run to a Medicare Supplement. That would be easy and it would be wrong.
For a great many people Advantage is genuinely the right product, and for some it is the only workable one. A Medicare Supplement carries a monthly premium that a lot of households simply cannot absorb, and that premium generally goes up with age. Telling someone on a fixed income to just buy a Supplement is not advice, it is a shrug.
What I am saying is narrower and more useful: the plan is changing underneath you, it does not change its name when it does, and nobody is going to walk you through what moved unless you ask them to.
Three things to check, and check against 2027
Not last year’s version. The 2027 version.
1. Your doctors. Every one of them, by name, against the plan’s 2027 network. Not “do they take Medicare,” which is a different question with a different answer. Call and get a reference number.
2. Your prescriptions. Every one, by name and dose, against the plan’s 2027 drug list. Drugs move tiers between plan years, and a drug that cost you a small copay in December can cost real money in January without the plan doing anything wrong.
3. What you actually pay for what you actually use. Not the premium. The premium is the number carriers advertise because it is the number that looks best. Look at the copay for the specialist you see four times a year, the deductible if there now is one, and the out-of-pocket maximum.
There are still moves available
This is the part that gets lost in the doom coverage. The benefits picture got worse, and there are still things worth doing about it.
Some plans give back part of your Part B premium. That is real money back in your Social Security check every month, and for someone who wants better dental than any Advantage plan is offering now, that giveback can fund a standalone dental policy bought outside Medicare that covers considerably more than the built-in benefit does. Whether that math works depends on your county and your plan, and it is exactly the sort of thing worth running the numbers on rather than guessing at.
That is one example. The point is that “the benefits got worse” and “there is nothing to be done” are two different statements, and only the first one is true.
One piece of timing most people do not know
Carriers sometimes pull plans from broker access partway through the enrollment season. They do it to manage risk and keep enrollment in a given plan from running past what they planned for. It is not announced and it is not predictable.
What it means practically is that a plan I can walk you through in October may be a plan I cannot help you with by Thanksgiving. You would still be able to enroll on your own, but you would be doing it without anyone checking your doctors and your drugs against it first.
If you have been meaning to get this looked at, earlier in the season is genuinely better than later, and that is not a sales line. It is just how the season works.
What This Means for You
I will review your plan at no cost, and I will do that whether you bought it from me or not.
If what you have still fits, that is what I will tell you, and that is the answer a fair number of people get. Switching for the sake of switching is how people end up out of network.
What being your agent of record adds is everything after that. I can call the carrier on your behalf, I can get claim detail released, and I can check this again next year before the plan changes under you a second time. That is the part that is hard to do for a stranger, and it is the honest reason to move a policy.
Medicare open enrollment runs through December 7.
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