Patients want Medicare guidance from their providers. Health systems are allowed to give it.

When Medicare beneficiaries choose 2027 coverage this fall, most will look to their own provider for help. In a BPD Health survey of 600 Medicare-eligible adults, 57% said they trust their provider most for confidence in a coverage choice, ahead of insurance agents and every advertising channel.

Yet many health systems stay out of the conversation during annual enrollment, Oct. 15 through Dec. 7, out of worry that any discussion of plans will look like steering.

That worry reaches further than federal rules do. A clinician talking with an established patient is the most trusted setting in the decision and among the least restricted under CMS marketing rules. Communications and marketing teams have room to help as well, which can take much of the burden off physicians.

What patients told us

Two-thirds of respondents said they understand Medicare at a basic level, yet only 29% felt confident heading into enrollment and 35% felt overwhelmed. The industry has answered Medicare complexity with more explanatory material. What patients struggle with is applying it to their own care. Their biggest questions are about access to their own providers, and only the provider can answer them with confidence.

The most common worry was continuity, with 43% citing loss of access to their current doctors as their biggest concern in selecting a Medicare plan. Three in four trust their personal doctor a lot or completely as a source of Medicare information. Meanwhile, only 4% distrust hospitals and health systems entirely, compared with 16% for insurers and 59% for social media. That gives health systems a credibility advantage few other resources in this decision have.

Patients were also clear about their preferred format of the Medicare information they receive: 37% prefer a one-to-one conversation and 30% a printed guide, while webinars and social content ranked low.

What’s holding systems back

Federal rules treat a provider answering an established patient’s coverage questions very differently from marketing done on a plan’s behalf, and the full report details what that allows.

The real constraint is scale. One-to-one conversations are what patients prefer, but they’re not efficient. Communications and marketing teams can carry much of the load, from explaining network participation and contract changes to pointing patients toward unbiased counseling. Schedulers, financial counselors and call centers can all be scripted to help educate patients, too.

Brokers will move faster this year

Systems that stay quiet leave the field to the people who sell plans, and CMS just gave them more room. The contract year 2027 final rule, effective Oct. 1, eliminated the 48-hour wait between a scope of appointment and a sales conversation, among other safeguards. A JAMA Internal Medicine study this year found 44% of first-time Medicare Advantage enrollees used a broker in 2022.

Brokers compare premiums and benefits well, but they cannot tell a client what happens to her cardiologist or infusion schedule under each plan. Only the treating organization can. Broker pay also differs by product: for 2026, CMS caps commission at $694 for a new Medicare Advantage enrollment, while traditional Medicare pays none. With 60% of people approaching eligibility unsure they understand the difference between the two, their own provider carries more weight.

What to do before Dec. 7

Most of the capability already exists. What’s missing is the connection between teams.

1. Name one owner across managed care, marketing, access and revenue cycle.
2. Give communications, marketing and patient-facing teams clear guidance on which coverage conversations they can have.
3. Offer the printed guides and one-to-one time patients asked for.
4. Put payer strategy and patient communications on one calendar, so a contract termination never reaches patients without a plan.

Coverage determines which hospitals a patient can use, and trust shapes which one they choose. Systems that treat enrollment as an enterprise capability will keep more patients with the care teams they already trust.

The cost of staying out of the conversation lands in denials, observation status and lost patient relationships. BPD Health’s report, “The Medicare Confidence Gap,” details the findings, the regulatory framework and a model for sizing that exposure.

Kate Caverno is senior vice president and practice lead for Payer, Policy & Market Advisory at BPD Health, where she helps health systems anticipate reimbursement pressure, payer disputes, policy changes and market dynamics early enough to shape their response.