2027 Medicare Open Enrollment: How a Client’s Plan Change Can Reshape Your Personal Injury Case and Its Liens
***NEWSLETTER***
Medicare’s annual fall open enrollment runs October 15 through December 7, 2026. Coverage elections made during that window generally take effect January 1, 2027. A second enrollment window follows from January 1 through March 31, 2027, during which beneficiaries already enrolled in Medicare Advantage may make another permitted change (42 C.F.R. § 422.62(a)(2)–(3)).
For most beneficiaries, open enrollment is a discussion about premiums, provider networks, deductibles, and prescription drug formularies.
For a Medicare beneficiary with an open personal injury claim, however, there is another question plaintiff counsel cannot afford to overlook:
Who holds the reimbursement claim?
Every fall, we see the same problem. A client was injured while covered by Original Medicare or a particular Medicare Advantage plan. January 1 arrives, the client changes coverage, and nobody tells the attorney.
The file contains a Medicare conditional payment letter from the Benefits Coordination & Recovery Center, or BCRC. The case settles based upon that number. Months later, a Medicare Advantage recovery vendor appears with a separate reimbursement claim for treatment paid after the coverage change.
By then, the settlement funds may already have been distributed.
The principle driving the problem is straightforward:
The payer responsible for a particular date of service generally holds the reimbursement claim associated with that payment.
A change in Medicare coverage during treatment can therefore divide a single personal injury case among multiple reimbursement claimants, each with its own payment history, recovery process, reduction arguments, and resolution requirements.
For plaintiff attorneys, Medicare open enrollment is not simply a benefits issue. It is a lien identification and settlement planning issue.
What Is Changing for 2027?
A few developments are particularly relevant this enrollment cycle.
- Annual Notices of Change have been issued. Medicare Advantage and Part D plans were required to send their 2027 Annual Notices of Change by September 30, 2026. These notices explain changes to premiums, cost sharing, provider networks, formularies, and other plan terms. Those changes frequently prompt beneficiaries to shop for new coverage.
- California beneficiaries have a slightly smaller Medicare Advantage market. CMS reports 394 Medicare Advantage plans available in California for 2027, compared with 402 for 2026 (CMS 2027 state fact sheets, September 28, 2026). When a plan terminates or leaves a service area, affected beneficiaries may receive a Special Enrollment Period and be required to select new coverage.
- The Part D Premium Stabilization Demonstration is ending. CMS has announced that the demonstration will conclude at the end of 2026 (CMS, July 28, 2026 announcement). Changes in standalone Part D premiums may encourage some beneficiaries to select a different prescription drug plan or move into a Medicare Advantage plan that includes prescription drug coverage.
Each of these developments creates another opportunity for the identity of the responsible payer to change during the life of a personal injury case.
Below, we walk through the 2027 calendar, why a plan change matters to the lien picture, and what to ask your Medicare clients now.
The 2027 Medicare Calendar
September 30, 2026
Deadline for Medicare Advantage and Part D plans to send their 2027 Annual Notices of Change.
October 15, 2026
Medicare annual open enrollment begins.
December 7, 2026
Medicare annual open enrollment ends.
December 8, 2026 through November 30, 2027
Five Star Special Enrollment Period. Eligible beneficiaries may switch into a Medicare plan that has received an overall five star quality rating, subject to applicable Medicare rules.
January 1, 2027
Coverage elections made during annual open enrollment generally take effect, and the new Medicare plan year begins.
January 1 through March 31, 2027
Medicare Advantage open enrollment period for beneficiaries already enrolled in Medicare Advantage. During this period, eligible beneficiaries may generally switch to another Medicare Advantage plan or return to Original Medicare.
Two practical points deserve particular attention.
Coverage Can Change Outside the Fall Enrollment Period
Special Enrollment Periods may apply throughout the year when a plan terminates, leaves a service area, a beneficiary moves, or another qualifying circumstance occurs under § 422.62(b).
Beneficiaries who are eligible for both Medicare and Medicaid, including Medi Cal in California, or who receive Extra Help with prescription drug costs may also have additional opportunities to change coverage.
The takeaway for plaintiff counsel is simple:
A payer map created in October may no longer be accurate in April.
Coverage needs to be monitored throughout the case.
The January Through March Window Works Differently
The Medicare Advantage open enrollment period from January 1 through March 31 applies to beneficiaries who are already enrolled in Medicare Advantage.
During that period, they may generally switch to another Medicare Advantage plan or return to Original Medicare.
It does not provide a general opportunity for someone enrolled in Original Medicare to newly enroll in Medicare Advantage.
Accordingly, when a client changes coverage during the first quarter of 2027, counsel should determine exactly what coverage existed on January 1 and what changed afterward.
Why a Medicare Plan Change Matters to the Personal Injury Case
One Injury Can Create Several Reimbursement Claimants
A single personal injury case can involve more than one Medicare related reimbursement claimant when coverage changes during treatment. Rather than looking only at the insurance card currently in the client’s wallet, plaintiff counsel should map coverage according to dates of service.
Date of injury through December 31, 2026
Payer: Original Medicare Parts A and B
Potential Recovery Claimant: CMS through the BCRC or CRC
January 1, 2027 forward
Payer: Medicare Advantage
Potential Recovery Claimant: The Medicare Advantage organization, frequently acting through a recovery vendor
Any applicable treatment period
Payer: Standalone Part D plan
Potential Recovery Claimant: The Part D sponsor, separately from Original Medicare or the Medicare Advantage organization
The BCRC conditional payment letter reflects payments made by Original Medicare.
It does not necessarily include payments made by a Medicare Advantage organization or a Part D sponsor.
Those entities pursue their own reimbursement claims.
If the only Medicare document in the file is a BCRC conditional payment letter, but the client has been enrolled in Medicare Advantage during any portion of the treatment period, counsel should not assume that every Medicare related reimbursement claim has been identified.
Do Not Forget Part D
Prescription drug recovery claims are among the easiest Medicare related claims to overlook.
A client enrolled in Original Medicare may also have a separate Part D prescription drug plan. That can mean two separate recovery claimants arising from the same injury.
Pain medication, muscle relaxants, postoperative prescriptions, and other injury related medications can accumulate substantial charges over the life of a case.
Part D should therefore be part of the payer investigation from the beginning.
Different Payers, Different Rules for Past Medical Payments
Identifying the payer is only the first step.
The identity of the payer can materially affect the recovery process and the strategies available to plaintiff counsel.
Original Medicare
Original Medicare’s recovery process is defined by statute and regulation. There is a conditional payment letter, a final demand, a formal waiver and compromise process, an administrative appeal path, and a required reduction for procurement costs under 42 C.F.R. § 411.37. In most instances, this means a procurement cost reduction and payment of the final demand. Unless the recovery is insufficient to pay the lien and leaves the client some net, or you have a real case of financial hardship, CMS is getting paid.
Medicare Advantage
A Medicare Advantage organization’s recovery right rests on a different footing. The statute allows an MA plan to charge for services when Medicare is a secondary payer (42 U.S.C. § 1395w-22(a)(4)), and the regulation lets the plan bill the liability insurer or the enrollee who has been paid (42 C.F.R. § 422.108). The difference here is significant. If they want to be paid form the enrollee/Plaintiff, they have to provide the same procurement cost reduction as CMS, but if they pursue the liability carrier as a primary payer they do not!
That said, plaintiff counsel has several solid strategies to deploy to counter the MAO lien and get it reduced and resolve. Check out the modules on lienprojectnetwork.com for the beta. Suffice to say you are better off dealing with the MOAs than the BCRC.
Different Payers, Different Considerations for Future Medical Care
The distinction between Original Medicare and Medicare Advantage can also affect future medical planning.
When a plaintiff is Medicare eligible, whether through Original Medicare or Medicare Advantage, counsel should ensure that the client is appropriately informed about how settlement may affect payment for injury related future medical care.
Original Medicare and Liability Medicare Set Asides
For clients enrolled in Original Medicare, settlement planning may require an analysis of whether future Medicare interests should be addressed through a Liability Medicare Set Aside or another appropriate planning mechanism.
The proper analysis depends upon the facts of the case, the settlement structure, anticipated future treatment, Medicare eligibility, and the developing regulatory landscape.
Medicare Advantage and Future Recovery
The future medical analysis can look different when the client is enrolled in Medicare Advantage.
Our experience has been that Medicare Advantage organizations have generally not asserted the same forward looking rights against personal injury settlement proceeds that are associated with concerns surrounding Original Medicare and Liability Medicare Set Asides.
Whether Medicare Advantage organizations could successfully expand those rights without meaningful statutory or regulatory development remains an important legal question.
Plaintiff counsel should nevertheless expect continued evolution in this area.
Practice Pointer
When resolving a Medicare Advantage claim for past medical expenses, consider seeking language confirming that the plan is resolving its recovery rights associated with the settlement and does not claim a future credit or offset against the settlement proceeds.
Recovery vendors are routinely focused on past payments. That does not mean plaintiff counsel should leave the future issue unaddressed.
Settlement planning may also warrant discussion of the consequences of changing Medicare coverage.
A plaintiff considering Medicare Advantage may face a different future medical analysis than a plaintiff remaining in Original Medicare. Conversely, a beneficiary who moves from Medicare Advantage back to Original Medicare may create additional Medicare future interest considerations that were not previously as significant.
These are issues to identify before settlement, not after the proceeds have been distributed.
Medigap, Medi Cal, and Dual Eligible Clients
Medigap
A beneficiary who remains in Original Medicare may also carry Medicare Supplement insurance, commonly referred to as Medigap.
Medigap is private insurance, and policy language matters. Some policies may contain reimbursement or subrogation provisions that need to be evaluated independently.
Ask for the policy.
Counsel should also remember that a beneficiary who drops Medigap coverage to enroll in Medicare Advantage may not always be able to obtain the same Medigap coverage later without medical underwriting, subject to applicable guaranteed issue and trial rights.
For a client with significant ongoing medical needs, that can be an important consideration.
The attorney does not need to become the client’s Medicare insurance advisor. But counsel should recognize when the issue exists and direct the client to an appropriate licensed advisor or, in California, HICAP.
Dual Eligible Clients
Clients eligible for both Medicare and Medi Cal may be enrolled in an integrated plan that presents both programs through a more unified patient experience.
One insurance card, however, does not necessarily mean one reimbursement claimant.
Plaintiff counsel may still face a Medicare side recovery claim through the Medicare Advantage organization and a separate Medi Cal recovery claim through the California Department of Health Care Services.
Each claim has its own authority, procedures, and potential reduction arguments.
Never assume that resolving one resolves the other.
Plan Changes Can Affect Treatment and Damages
The lien implications are only part of the problem.
Changing Medicare plans can also change the client’s treating providers.
Medicare Advantage HMOs may rely upon provider networks, referrals, and prior authorization requirements. A client who changes plans on January 1 may suddenly lose access to the surgeon, pain management provider, physical therapist, or other practitioner who has been documenting the injury.
Interrupted treatment hurts the client first.
It can also hurt the case.
Gaps in care, changes in providers, delays in authorization, and interrupted treatment plans can create both medical and evidentiary complications.
Plaintiff attorneys generally should not advise clients which Medicare plan to select. That decision involves the beneficiary’s complete medical, financial, prescription, and provider needs and often falls outside the scope of the personal injury representation.
Counsel can, however, make one point very clear:
If you are considering changing Medicare coverage while your personal injury case is pending, tell us before you make the change.
In California, clients seeking unbiased Medicare counseling may also be referred to HICAP, the Health Insurance Counseling and Advocacy Program, at 1 800 434 0222.
What to Ask Every Medicare Client This Fall
A short check-in call or letter before October 15 goes a long way. Ask:
- What Medicare coverage do you have right now? Send us a photo of every card: the red, white and blue Medicare card, any Medicare Advantage or drug plan card, any Medigap card and any Medi-Cal card.
- Have you changed plans at any point since the injury? If so, when?
- Did you get an Annual Notice of Change, or a letter saying your plan is ending or leaving your area?
- Are you planning to change plans for 2027? Please call us first.
- Are you on Medicaid/Medi-Cal, or do you receive Extra Help with drug costs?
- Has any plan or recovery company sent you a letter or questionnaire about the accident? Please send it to us.
Points to consider for the 2027 season
- Now through October 14. Identify every open case with a Medicare-eligible client, including clients who will turn 65 or reach 24 months of disability benefits before the case resolves.
- Tell the clients. Send the check-in above, and ask each client to call before changing plans.
- Build the payer map by date of service. Original Medicare, each MA plan, each Part D sponsor, Medigap and Medi-Cal, with enrollment dates for each.
- Put every payer on notice. Open the BCRC case. Notify each MA organization and Part D sponsor. Put DHCS on notice for Medi-Cal. Giving notice is not conceding the claim.
- Audit every ledger. MA and Part D itemizations regularly include unrelated diagnoses, pre-injury care and duplicate lines. Verify before you negotiate.
- Refresh after January 1, and again after March 31. Confirm the client’s 2027 coverage and re-run every payer’s numbers.
- Don’t concede the MA plan’s position on preemption or reductions. Hammer them!
- Hold disputed funds in trust. Don’t disburse over a claim you know about. Rule 1.15 of the California Rules of Professional Conduct governs funds in which a third party claims an interest.
- Close with a release from each payer. Not just a payoff letter. A signed release that resolves the claim and addresses future care.
The Bottom Line
Medicare open enrollment can quietly change the lien landscape of a personal injury case.
A client can move from Original Medicare to Medicare Advantage, switch Medicare Advantage organizations, change Part D coverage, or experience a Special Enrollment Period while treatment is still ongoing.
Each change can create another reimbursement claimant.
That means the Medicare lien analysis cannot be based solely upon the client’s coverage at the time of injury, the card currently in the file, or a single BCRC conditional payment letter.
Map the payer by date of service. Identify every recovery claimant. Audit every ledger. Refresh the investigation when coverage changes. And resolve each claim before the settlement proceeds leave trust.
The earlier plaintiff counsel identifies the coverage changes, the more options counsel has to manage the reimbursement claims strategically and protect the client’s net recovery.
The Lien Project, PC assists personal injury attorneys with Medicare, Medicare Advantage, Part D, Medi Cal, ERISA, and other health care reimbursement claims. If you have a Medicare client whose coverage is changing, or a lien picture that may not be complete, contact us at Intake@TheLienProject.com or (619) 468 5559.
Members of Lien Project Network can access additional Medicare and Medicare Advantage lien resolution resources at www.lienprojectnetwork.com.