Author: Armando C Aguilar Jr

The recent announcement from a major insurer about targeted Medicare Advantage exits for 2027—impacting roughly 600,000 members—has understandably left many San Diego seniors with questions about what comes next. Whenever a Medicare Advantage plan isn’t renewed, rest assured that your Medicare eligibility remains intact. If new coverage isn’t selected, you’ll generally transition back to Original Medicare.

Key enrollment windows matter here: the main period to review and change your coverage runs from early to mid-fall, with most plan changes beginning at the start of the following year. If you’re considering a move back to Original Medicare, keep in mind there’s a special protected window for Medigap plans that starts 60 days before your current coverage ends and closes no later than 63 days after. This can be a crucial opportunity for those who want to supplement their coverage.

When weighing your next steps, I always encourage families to look beyond just the monthly premium—check your doctors, hospitals, prescription coverage, copays, deductibles, and what the worst-case yearly costs might look like. Sometimes, a $0 premium comes with bigger tradeoffs elsewhere.

Free, unbiased counseling is available through state programs, and I regularly remind the families I work with to double-check their choices with Medicare or a qualified adviser. My role is to help you navigate these changes calmly and clearly, ensuring your coverage fits your life—not the other way around.

I've noticed a significant trend among Medicare Advantage enrollees from 2016 to 2022: more people are switching plans, especially those with dual eligibility. For fully dual-eligible individuals, the rate of switching within Medicare Advantage plans jumped from about 12% to 22%, and for partial dual-eligible, it went from 17% to 30%. Among other beneficiaries, it rose more modestly—from 10% to 13%. Despite these shifts, very few made the move back to traditional Medicare by 2022: just around 4% of fully dual-eligible and 2% of partial dual-eligible, with less than 1% for others.

I see these numbers reflected in conversations here in San Diego, where every change in coverage can mean a new provider network or different plan features. Age, risk, and background influence these decisions—older adults tend to switch less, while those facing higher health risks are more likely to consider traditional Medicare. Interestingly, those enrolled in dual special needs plans are less likely to change. My social work background has shown me just how personal these choices are. That’s why my approach is always to help you weigh your options thoughtfully, so you can feel confident about your coverage—no pressure, just honest guidance.

One of the most common surprises I hear about from newcomers to Medicare is that first bill—sometimes it's much bigger than people expect. When you enroll (most folks do so during that 7-month window around age 65), you choose among Parts A, B, C, and D. Right now, Part B premiums are about $203, but your first bill might cover several months at once, including any backdated coverage. And for those with higher incomes or who sign up late, surcharges kick in above $109,000 for individuals or $218,000 for couples.

I've seen how these unexpected costs can create stress, especially if you're not having premiums withheld from Social Security. Setting up monthly autopay or using your online account or bank's bill pay can help make things more manageable. Once everything is in place, billing tends to settle into a routine—but planning ahead, enrolling on time, and checking for any surcharges are key steps to avoid that first big surprise. I always aim to bring clarity and confidence to these decisions, so you can focus on what matters most to you and your family.

When a Medicare Advantage Prescription Drug (MA-PD) plan ends, it can feel overwhelming to know what steps to take. If no new plan is chosen, you’ll automatically return to Original Medicare on January 1—but your drug coverage will end. For those with Extra Help, there’s a chance you may be reassigned to another plan, but it’s important not to leave your decision to chance.

Original Medicare doesn’t have an annual out-of-pocket maximum, so your potential costs can add up. For 2026, expect Part B premiums at $202.90 per month, a $283 deductible, and a Part A deductible of $1,700. With nearly 600,000 Medicare Advantage members set to lose their coverage in 2027, those early notification letters are more than just paperwork—they’re your cue to start reviewing your options.

There’s a window for guaranteed-issue Medigap rights that opens 60 days before your plan ends and lasts for 63 days after. Be mindful: if you go more than 63 days without drug coverage, you could face permanent Part D penalties.

To stay protected starting January 1, it’s best to select your new plan by December 31. Take time to review every medication, coverage tier, and pharmacy. Whether you choose a new Advantage plan or stick with Original Medicare plus a Part D plan, making an informed decision ensures you’re not left without the coverage you need.

As someone who’s guided many San Diego families through these same choices, I know how much clarity and peace of mind matter. If you’re sorting through your options, you don’t have to do it alone—sometimes, a careful conversation makes all the difference.

Navigating the financial aftermath of losing a spouse is never easy—especially when it comes to understanding how insurance death benefits interact with Medicare costs. While life insurance payouts are typically tax-free, any interest earned if you leave those proceeds with the insurer can be taxable. For example, if a widow’s regular MAGI is around $105,000, an extra $10,000 in taxable interest could push her just above the $109,000 single filer threshold for standard Medicare Part B premiums. And if MAGI reaches about $115,000, she could see her Part B premium increase by $81.20 per month and Part D by $14.50, amounting to roughly $1,100 more each year.

If your household income has dropped after a spouse’s passing, you have the right to appeal—Medicare may be able to review your newer, lower income instead of relying on an older tax return. My work with seniors across San Diego has shown me how important it is to look ahead: before deciding to leave funds with an insurer, consider the timing of any interest, your total income, and whether taking the proceeds sooner might help you avoid hitting those premium surcharges. If you’re sorting through these decisions, having a clear understanding of the rules can make a real difference.