You can read a plan brochure twice and still miss the one thing you need to know. Does it cover your doctor next year?

That question is the work of the next few weeks. Medicare's enrollment window closes on Monday, December 7, and the plan you pick decides who you can see in 2027.

Our September/October blog post explained what Open Enrollment is and how HMO and PPO plans differ. This one is narrower and more useful: how to hold a specific plan up against your own doctors, your own prescriptions, and your own pharmacy before you sign.

Everything below applies whether you live here in North Kingstown or anywhere else in Washington County.

A Rhode Island rule that changes your options this fall

In most states, an insurer can ask about your health before selling you a Medicare Supplement policy, then decline you based on the answers. Rhode Island does not allow that during this window.

State law gives Rhode Islanders an annual Medicare Supplement enrollment period on the same October 15 to December 7 dates as the federal one. A law signed on June 22, 2026 widened who gets to use it. You can now establish eligibility through a Medicare Supplement policy, a Medicare Advantage plan, or another form of creditable coverage, and then move into any Medicare Supplement policy sold in this state.

The Office of the Health Insurance Commissioner laid out the rules for carriers in Bulletin 2026-02, issued September 4, 2026. Carriers cannot condition the policy on your health status, and they cannot bury you in paperwork beyond what it takes to prove you qualify.

Two conditions come with it. You need to have held qualifying coverage without a gap longer than 90 days. You also have to act inside the window.

That matters for anyone who wants Original Medicare with a Supplement policy, which is the cleanest fit alongside a membership practice like ours. Somebody sitting in an HMO who would rather not be has a door open this fall. Talk to a counselor or a licensed agent about your own situation before you move, because dropping a Medicare Advantage plan also means picking up prescription coverage separately.

Five steps to check a plan properly

1. Write your list first. Every prescription with its dose, the pharmacy you actually use, and the name of every doctor and hospital you want to keep.
   
2. Price your real drugs. Enter that list into Medicare's plan finder. It estimates what each 2027 plan would cost you for your medications at your pharmacy, which is a different number from the premium on the brochure.
3. Look up each doctor in the plan's 2027 provider directory, then call the office. Directories carry errors and go stale. A phone call to the front desk is the only confirmation worth having.
4. Read the formulary line by line. Find each of your drugs, note its tier, and note whether the plan requires prior approval or wants you to try a cheaper drug first.
5. Ask about primary care outside the network before you enroll. Get the answer in writing if the plan will give it to you.

The 2027 drug numbers worth knowing

Part D coverage moves through three stages now. You pay the deductible, then you share costs with the plan, then your covered drugs cost you nothing for the rest of the year.

Medicare sets the outer limits on two of those numbers. No drug plan may charge a deductible above $700 in 2027, up from $615 this year, and some plans charge none at all. Once your out-of-pocket spending on covered drugs reaches $2,400, you stop paying for them until January. That ceiling was $2,100 in 2026.

Those are ceilings, not your actual costs. What you pay before you reach them depends entirely on your plan's formulary and its tiers, which is why step four above is worth the half hour.

Five questions to ask before you enroll

Bring these to a plan representative, a broker, or a counselor. Write down the answers.

• Does this plan cover primary care from a physician outside its network, and what is my share of that cost?
• Which of my doctors and which hospital are in network for 2027, by name?
• Which of my prescriptions are on the 2027 formulary, on what tier, and which ones need prior approval?
• Do I need a referral to see the specialists I already see?
• What is the out-of-pocket maximum for 2027, and does out-of-network spending count toward it?

What a plan change does to your membership here

Your membership with us and your Medicare coverage are two separate things. We do not bill insurance for your primary care, so switching plans does not change your membership, your fee, or your access to us. What it changes is how the rest of your care gets paid for: your labs, your imaging, your specialists, your hospital stays.

We do not accept insurance, and some Medicare setups fit alongside a membership here better than others. The ones that work well are Original Medicare (Parts A and B) paired with a Medicare Supplement plan such as Plan G, and Medicare Advantage PPO plans.

We are not able to accept patients on Medicare Advantage HMO plans right now. An HMO expects your primary care to come from a provider inside its network, and it routes your referrals, labs, and specialist visits through that provider.

If you are on an HMO today and want to join us in 2027, this enrollment window is the time to change. You can move to a PPO plan or to Original Medicare by December 7, and your new coverage starts January 1. Original Medicare with a Supplement plan is easiest to set up now, because Rhode Island’s guaranteed Supplement enrollment period (described above) runs on the same dates. If December 7 passes, you still get one switch between January 1 and March 31 (covered below), though a Supplement insurer may be allowed to review your health at that point.

If December 7 passes and the plan turns out wrong

You are not stuck for all of 2027. Three narrower doors stay open, and each one has limits.

If you are in a Medicare Advantage plan, you get one switch between January 1 and March 31. You can move to another Advantage plan or return to Original Medicare, and that is the whole menu.

If a plan in your area holds an overall five-star quality rating, you can move into it once between December 8 and November 30. Medicare's page on special enrollment periods lists the conditions.

The third one is the least known and the most relevant. If your plan notifies you that its provider network has changed significantly, you may qualify for a special enrollment period. Medicare reviews those case by case, so call and ask rather than assuming the answer is no.

Free help, from people who do this all day

Rhode Island's State Health Insurance Assistance Program gives one-on-one Medicare counseling at no charge through the Office of Healthy Aging. Their counselors compare plans with you and have no product to sell. You can reach them at 1-888-884-8721 or through the Office of Healthy Aging's Medicare page. Your local senior center can also connect you with free Medicare counseling close to home.

For any question about which plan to choose, start with one of them.

Schedule a Meet and Greet once your 2027 coverage is in place, and we will explain what membership here includes.

This article covers Medicare enrollment periods, plan types, and Rhode Island insurance rules in general terms. It is not insurance advice. Confirm the details with Medicare, a SHIP counselor, or a licensed agent before you change anything.