2027 Medical Practice Insurance Changes: 5 Ways to Prepare

January Starts Now

Every January, medical practices experience a familiar wave of insurance surprises. Deductibles reset, patients arrive with new insurance cards, referrals are missing, and balances that could have been collected at the visit become statements that have to be mailed later.

This year, changes to Medicare Advantage plans and proposed Medicare reimbursement policies give us even more reasons to prepare.

The good news is that we still have time to get ahead of it.
Here are five things I'd encourage every practice to focus on before the new year.

1. Get ready for deductible resets

January 1 means a fresh deductible for many patients, and that can significantly change what they owe at the time of service.

For Original Medicare, the Part B deductible is $283 in 2026. The official 2027 amount hasn't been announced yet, so make sure your team watches for that update. Medicare Advantage plans have their own cost-sharing rules.

For commercially insured patients, this is also the time to make sure your team knows how to calculate patient responsibility using the contracted allowable amounts for the CPT codes being performed.

Here's an example:

Your practice charges $350 for a procedure, but your contracted allowable amount is $225. If the patient still has $1,000 remaining on their deductible, and the service is subject to that deductible with no other cost-sharing adjustments, the estimated patient responsibility is $225, not $350.

That's why having accurate payer fee schedules and understanding each patient's benefits is so important.

What to do now:

• Review your January appointments for services likely to involve deductible-related costs.
• Make sure your contracted fee schedules are current.
• Train your team to calculate and explain estimated patient responsibility.
• Prepare to collect the appropriate amount at the visit, following your financial policies.

Of course, final patient responsibility depends on how the claim is processed. But the closer we can get to an accurate estimate, the fewer surprises there will be for everyone.

2. Pay attention to Medicare Advantage changes

UnitedHealthcare has announced changes to its 2027 Medicare Advantage offerings, including a greater emphasis on HMO plans.

Patients who previously had PPO coverage may face different networks, referral requirements, and coverage rules in January.

And remember, a patient who has been seeing your physician for years may suddenly need a referral because their insurance changed.

Now is the time to identify Medicare Advantage patients scheduled for January and February. Ask whether they're changing plans, review your physicians' network participation, and confirm referral and authorization requirements.

One helpful change: UnitedHealthcare says that beginning in 2027, its Medicare Advantage referrals will be valid for 12 months without a specified number of specialist visits. Practices should still follow applicable referral requirements.

3. Prepare for Medicare reimbursement changes

CMS has finalized changes to Medicare reimbursement for 2027, including one that deserves particular attention from procedure-based specialties.

Under the finalized modifier 25 policy, when a separately identifiable office or outpatient E/M visit and a procedure with a 0-day global period are performed on the same day by the same physician or a physician of the same specialty within the same group practice, the highest-paid applicable service will receive 100% reimbursement, while other applicable services will be paid at 80%.

For practices that regularly perform procedures during office visits, this could have a meaningful financial impact.

This is now a finalized policy, with changes taking effect January 1, 2027.

CMS has also finalized lower Physician Fee Schedule conversion factors for 2027 compared with 2026.

My recommendation is to review how frequently your practice bills E/M services with modifier 25, evaluate the potential financial impact, and prepare your team for the upcoming reimbursement changes.

It's also a good time to make sure your documentation supports every separately identifiable service you bill.

4. Check your MIPS dashboards now

If your practice participates in MIPS, don't wait until December to see how you're doing.

The 2026 performance year ends December 31, and your results can affect Medicare reimbursement in 2028.

Pull your reports and review each provider's performance closely. Are your quality measures where you want them to be? Are there patients who still need screenings, assessments, or follow-up services before year-end? Are completed services being captured correctly?

Review your Promoting Interoperability and Improvement Activities requirements, too.

There's still time to close some gaps, but only if you know where they are.

Assign someone to review your dashboards, identify opportunities for improvement, and monitor progress through the end of December.

5. Prepare in December. Verify again in January.

Here's something I really want your team to understand:

An eligibility check completed in December may not reflect the insurance a patient will have in January.

Even when a patient has selected a new plan for 2027, the payer portal may continue displaying their current coverage until the new plan becomes effective.

Imagine a patient tells your scheduler they've switched to a new Medicare Advantage HMO beginning January 1. Your team checks the portal, but it still shows their existing PPO.

That doesn't necessarily mean the patient is mistaken.

Unfortunately, you may have to pick up the phone and call the payer to find out what you can about the upcoming coverage. Even then, the new plan may not be fully verifiable until its effective date.

Here's what I'd recommend:

• November and December: Review January appointments, ask patients about insurance changes, and flag coverage that can't yet be confirmed.
• Before the holidays: Identify outstanding referrals, authorizations, and financial estimates. Assign responsibility for follow-up.
• Beginning January 4: Recheck eligibility for January appointments, prioritizing the patients scheduled first. Confirm plan details, network participation, and financial responsibility.
• Throughout January: Continue verifying coverage before appointments and resolving discrepancies promptly.

One other item for your planning list: New electronic prior authorization requirements begin taking effect for certain payers in January 2027. Ask your EHR vendor what functionality will be available and whether your team will need any additional training.

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