Medicare Advantage members whose plans are canceled may have an opportunity to obtain Medigap coverage without medical underwriting, according to Jae Oh, author of “Maximize Your Medicare.”
That protection is a central point in his conversation with me about disappearing plans and the decisions members face.
Oh explains why he recommends supplementing original Medicare, how Extra Help may assist with prescription coverage, and why members should read their plan notices carefully.
Below is a transcript of the interview with Oh, edited for brevity and clarity.
Medicare Advantage Plans disappearing: the Medigap question
Robert Powell: Medicare Advantage choices are shrinking sharply in some rural counties, according to a recent KFF analysis of CMS plan filings, and it’s not good news.
According to KFF, residents of 193 counties will have no Medicare Advantage plan with drug coverage open to general enrollment in 2027, up from 123 counties this year. The affected counties contain roughly 638,000 Medicare beneficiaries.
Oh: Very tough, especially depending on where you live. KFF has reported that the number of counties with no Medicare Advantage plans at all has increased sharply: 70 additional counties, almost a 40% increase in the number of counties.
I feel terrible for those affected because that’s very unsettling. The number of actual beneficiaries affected by that particular issue is relatively contained. Nevertheless, we have well over a million Medicare Advantage members who will be ejected from their plan because it is no longer available where they live.
Powell: Some folks who apply for Medigap will have to undergo medical underwriting. They may get denied. In other cases, medical underwriting may not affect them.
Oh: No, actually, when this happens, you have automatic acceptance into Medigap.
If you’ve been a member of Medicare Advantage and that plan is canceled, you will be accepted by a Medigap carrier. That is undeniable, unrestricted.
That is a federal rule that protects the consumer. The issue then is locating which plan.
There are also financial resources where there can be additional assistance, especially when it comes to Part D, the stand-alone prescription plan.
Original Medicare and prescription coverage
Powell: For them, is the likely route to go back to original Medicare with a Part D plan?
Oh: It is, and it is a central finding. There are relatively few actual must-dos in “Maximize Your Medicare.” But there is a reason I suggest people do not have just original Medicare alone: Part A and Part B alone have no out-of-pocket maximum.
With uncapped medical expenses, if you have Part A and Part B alone, some type of Medigap plan, a Medicare supplement, plus a standalone Part D plan is very much in order. That will take some extra work.
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Powell: Tell us more about that assistance.
Oh: It’s called Extra Help. In past years, it was called LIS, Limited Income Subsidy. I want to make a couple of things clear. The first, most important one: This is not Medicaid itself.
Too often, we think about the Extra Help program with the implication that the person is on Medicaid. That is not true. You can have people who qualify for Extra Help but are not anywhere close to the Medicaid eligibility line.
This program is probably the most underutilized one. A couple of years ago, more than 10 million people did not take advantage of this.
Perhaps they didn’t because they had a $0 Medicare Advantage plan. But if they were ejected and have to purchase a stand-alone prescription plan, now is a very good time to revisit that.
Notices and enrollment timing
Powell: For folks in Medicare Advantage plans where the insurer is pulling out of the county, I assume many were notified in their annual notice of change. Is that fair to say?
Oh: Yes, to the degree that people have read them. Every year, people have been used to the idea that the annual notice of change has come, and straight into the garbage bin it went.
You and I have spent a considerable amount of time saying, “Please don’t do that. Please never do that.” But the practical reality is that many people have. This is yet another wake-up call.
One thing I’ve not mentioned: Normally, the annual election period runs through Dec. 7, when you can change your Part D plan or your Medicare Advantage plan without restriction.
In this instance, because your Part D plan is coming to an end, meaning it’s no longer being offered in this specific combination, you actually have through Dec. 31, not only Dec. 7. I don’t suggest people wait until New Year’s Eve, but the deadline is extended for those people. For the rest, Dec. 7 still applies.
Powell: For the person who goes onto Medicare’s Plan Finder starting Oct. 15, when they search for a new plan, they may not be told they can purchase a Medigap policy. Is that fair to say? There’s no flashing light saying, “You may be eligible to do this”?
Oh: No, because Plan Finder, especially if you’re not signed in under your own account, would not know. Whether Medicare.gov is actually sending out notices, I do not know. We don’t know that yet.
A consumer can now survey 2027. They cannot actually enroll or file an application until Oct. 15.
Related: The 2027 Medicare rate shock: Why Part D and Medigap premiums are soaring by up to 50%
