Medicare Open Enrollment runs from October 15 to December 7, 2026, and any plan change a beneficiary makes takes effect on January 1, 2027. For practices running Remote Patient Monitoring (RPM) or Chronic Care Management (CCM) programs, the window matters for a reason that is easy to misread.
Open Enrollment does not enroll or disenroll anyone from these services. What it does is reshuffle coverage underneath an existing patient panel.
Patients move between Original Medicare and Medicare Advantage, plans terminate, networks shift, and some patients gain or lose Qualified Medicare Beneficiary status. Those changes all converge on January 1, which makes the weeks before then the time to audit program rosters and documentation.
|
● October 15 The window opens. Nothing changes for your program on this date. |
● December 7 Patient decisions are locked. Your January reverification list is now knowable. |
● January 1 New payers, networks, and cost sharing take effect for everyone who switched. |
● March 31 Advantage members may make one more switch. |
A Misunderstanding Worth Correcting
Before the operational work, settle the question your front desk will field most. Open Enrollment lets a beneficiary join, switch, or drop a Medicare Advantage plan, move between Original Medicare and Medicare Advantage, and join or change a Part D drug plan. That is the full scope.
What patients often assume “I need to sign up for my monitoring program again during Open Enrollment, or I’ll lose it in January.” | What is actually true RPM and CCM are billed under Part B, not selected from a plan menu. Consent is obtained once and holds until the patient withdraws it. Nothing in this window adds or removes anyone. |
What does change is the coverage context underneath the panel. A patient who moves from Original Medicare to a Medicare Advantage plan is still your patient, but the payer, prior authorization requirements, network rules, and cost sharing may all differ. A patient whose plan is discontinued lands somewhere new.
For practices billing Advanced Primary Care Management, a change in Qualified Medicare Beneficiary status changes which level applies.
None of this generates a notification; you discover it in January, either by checking or by getting denied coverage.
Two Programs, Two Separate Reviews
RPM and CCM are distinct Medicare programs with different eligibility criteria, documentation, and billing rules. Reviewing them together invites the error of treating one program’s requirements as the other’s.
The worksheets below are deliberately separate. Print them, or work through them in your EHR reporting.
What to Say at the Front Desk
Care management patients talk to staff constantly, so they ask plan questions more than most. Practices are not licensed insurance agents, and steering a patient toward a plan creates risk unrelated to the quality of the advice.
These three exchanges cover most of what comes in.
“Which plan should I pick?” We are not able to recommend a plan, but there are free counselors who can walk through it with you. Call 1-800-MEDICARE, use the Medicare Plan Finder, or contact your State Health Insurance Assistance Program. |
“If I switch plans, do I lose my monitoring?” No. Your program continues either way. We will verify your new coverage in January so billing goes through correctly, and we will reach out if anything needs your attention. |
“Do you take this plan?” That one staff can answer directly from the practice’s participation list. Confirming participation is factual. Comparing it favorably to another plan is not. |
Also Off Limits
Distributing plan marketing materials in clinical areas, and offering anything of value tied to a patient’s enrollment decision. Both are separate compliance problems from giving plan advice.
Three 2027 Changes Behind the Questions You Will Get
Staff do not need to become plan experts. Recognizing these three helps them route a question instead of guessing at it.
| $2,400 | The Part D annual out of pocket cap for 2027, up from $2,100 in 2026. Patients on many medications will notice this one. |
| Ends | The temporary Part D premium stabilization demonstration concludes after 2026, which affects standalone drug plan premiums. |
| Sept 30 | The deadline for plans to mail Annual Notice of Change letters, so most patients already hold their plan’s 2027 details. |
Patients managing multiple chronic conditions usually have high prescription volume, which is why drug plan changes generate most of the front desk traffic. A short, consistent referral answer is worth more than detailed plan knowledge.
How DrKumo Supports Program Review
DrKumo provides secure, HIPAA compliant digital health technology that supports remote patient monitoring programs operated by healthcare providers. The platform moves health data from patients’ homes to care teams over cellular connectivity, using medical devices as defined by the FDA.
For a fourth quarter review, the practical value is visibility. Knowing which enrolled patients are actively transmitting and which have gone quiet is what turns Worksheet A from a wish into a work list. Practices structuring a program can review DrKumo’s comprehensive guide to RPM.
DrKumo also supports provider led Disease Management Protocols for conditions common among Medicare beneficiaries, including hypertension, diabetes, heart failure, and COPD, and applies healthcare cybersecurity practices to patient data.
For FQHCs and RHCs and community providers adapting to the 2026 shift toward individual code billing, consistent documentation is what determines whether a program holds up under review.
DrKumo is a technology provider and is not a clinical entity. Providers retain full clinical responsibility for patient care decisions, and RPM supports monitoring between visits rather than replacing emergency care.
Key Takeaways
Open Enrollment runs October 15 to December 7, 2026, with changes effective January 1, 2027, and it governs Medicare Advantage and Part D selections only. It does not enroll, disenroll, or require new consent for RPM or CCM.
What it creates is a predictable January reset in payers, networks, prior authorization rules, and in some cases Qualified Medicare Beneficiary status. None of that arrives as a notification, so the reverification list has to be built on purpose.
RPM and CCM are separate programs and are reviewed separately. For plan questions, route patients to 1-800-MEDICARE, the Medicare Plan Finder, or their State Health Insurance Assistance Program rather than advising on a selection.
Data Driven Care Starts Here
Start the new plan year with a program you can actually see into.
To learn how DrKumo can help your organization deliver secure, HIPAA compliant remote patient monitoring, contact us today. Our team is ready to support your journey toward better patient care.
Frequently Asked Questions
Do patients need to enroll again in RPM or CCM during Medicare Open Enrollment
No. RPM and CCM are services billed under Part B, not plan benefits selected during Open Enrollment. Consent is obtained once and remains in effect until the patient withdraws it. Open Enrollment covers Medicare Advantage and Part D plan choices only.
What happens to a care management patient who switches to Medicare Advantage
The patient remains your patient, but the payer changes effective January 1. Coverage rules, prior authorization requirements, network participation, and cost sharing may differ from Original Medicare, so verify benefits before billing in the new plan year.
When do Open Enrollment changes take effect
January 1, 2027, regardless of when during the window the change was made, as long as the plan received the request by December 7, 2026. A separate Medicare Advantage Open Enrollment Period runs January 1 to March 31 and allows one additional switch for people already in an Advantage plan.
Can a practice help patients compare Medicare plans
Practices can point patients to neutral resources: 1-800-MEDICARE, the Medicare Plan Finder, and State Health Insurance Assistance Program counselors, who provide free and unbiased help. Recommending a specific plan or distributing plan marketing materials is a different activity and carries compliance risk.
Does a change in Qualified Medicare Beneficiary status affect care management billing
For practices billing Advanced Primary Care Management, yes. HCPCS G0558 applies to Qualified Medicare Beneficiaries with two or more chronic conditions, so a change in that status changes which level applies. Confirm status as part of January eligibility verification.
References
Centers for Medicare and Medicaid Services. (2026). 2027 Medicare Advantage and Part D Landscape State by State Fact Sheets. CMS.gov.
Centers for Medicare and Medicaid Services. Care Management. CMS.gov.
Centers for Medicare and Medicaid Services. Chronic Care Management Services (MLN booklet). CMS.gov.
Centers for Medicare and Medicaid Services. (2026). Advanced Primary Care Management Services. CMS.gov.
Centers for Medicare and Medicaid Services. Qualified Medicare Beneficiary Program. CMS.gov.
Centers for Medicare and Medicaid Services. (2026). CY 2027 Medicare Physician Fee Schedule Proposed Rule (CMS-1848-P). CMS.gov.
U.S. Department of Health and Human Services, Office of Inspector General. (2024). Additional Oversight of Remote Patient Monitoring in Medicare Is Needed (OEI-02-23-00260). OIG.HHS.gov.
Disclaimer: This article is intended for informational purposes only and does not constitute medical advice, legal advice, billing advice, insurance advice, or financial guidance. The suggested staff responses are illustrative and should be reviewed against your organization’s own compliance policies. Medicare enrollment periods, plan offerings, coding, and payment requirements are subject to change; always consult official sources including Medicare.gov, CMS.gov, and your Medicare Administrative Contractor for current information. DrKumo is a technology provider and is not a clinical entity. Always consult with a licensed healthcare provider for guidance on diagnosis, treatment, or medical decisions. References to the Centers for Medicare and Medicaid Services and the Office of Inspector General do not constitute or imply an endorsement by those agencies or the U.S. Government.
