If you or someone you know has a Medicare Advantage (MA) plan and has developed health issues, there may be an important opportunity to explore this fall. Every fall, MA plans send their members an important document called an Annual Notice of Change (ANOC). This document explains how the plan’s premiums, costs, benefits, and other coverage details will change for the following year.

For many people, the ANOC is something they receive in the mail and put away without giving it much thought. But if you or someone you know has an MA plan and has been thinking about returning to Original Medicare (Part A and Part B), it is worth taking a closer look.

Thinking About Leaving Medicare Advantage?

Some people who have been enrolled in MA plans eventually decide they would prefer Original Medicare along with a Medicare Supplement, also known as a Medigap policy.

One reason people hesitate to make that change is medical underwriting. Outside of certain guaranteed issue situations, someone applying for a Medicare Supplement may have to answer health questions and could be declined because of their health history. In some circumstances, a Medicare Supplement policy may also cost more when medical underwriting applies. That can be especially concerning for someone who developed significant health problems after enrolling in Medicare Advantage. However, California has specific protections for certain MA members whose plans make significant changes.

What Is an Annual Notice of Change?

MA plans generally send their ANOCs in September. The document explains changes that will take effect the following year, including changes to premiums, cost sharing, benefits, and other aspects of the plan.

For 2027 (and every year) the Medicare Annual Election Period (AEP) runs from October 15th through December 7th. During this period, Medicare beneficiaries can make certain changes to their Medicare coverage, including returning to Original Medicare.

During the AEP, Medicare beneficiaries can also review and change their Medicare Part D prescription drug coverage for the following year. If you are returning to Original Medicare from a Medicare Advantage plan, it is especially important to make sure you have appropriate prescription drug coverage in place, since Original Medicare generally does not include Part D prescription drug coverage.

A California Protection You Should Know About

California Insurance Code Section 10192.12 provides guaranteed issue protections in certain situations for people enrolled in MA plans. For example, if an MA plan does any of the following:

• Increases its premium by 15% or more
• Increases physician, hospital, or drug copayments by 15% or more
• Reduces benefits
• Or discontinues its relationship with a provider who is currently treating the individual, other than for certain quality of care reasons

The individual may qualify for a Medicare Supplement without being medically underwritten, subject to the requirements of California law. This can be especially important for someone who has developed health conditions since enrolling in Medicare Advantage and might otherwise have difficulty qualifying for a Medicare Supplement.

It is important to understand that not every cost increase qualifies. The California law specifically refers to a 15% or greater increase in the MA plan’s premium or in physician, hospital, or drug copayments. Simply seeing a 15% increase in any cost listed in your ANOC does not necessarily mean you qualify for guaranteed issue. That is why it is important to review the actual changes carefully and determine whether the specific circumstances meet the requirements.

Which Medicare Supplement Company Can You Choose?

There is another important detail to understand about California’s guaranteed issue protections. If your MA plan makes a qualifying change, California law generally gives you the right to obtain a Medicare Supplement from the same insurance company that provides your MA plan, if that company offers Medicare Supplement policies. The law also provides for certain related companies, including a subsidiary of the parent company or a network that contracts with the parent company.

If a Medicare Supplement is not available through those related companies, you may be eligible to obtain a Medicare Supplement from another insurance company if your MA plan has made one of the qualifying changes described above, such as increasing the premium by 15% or more, increasing physician, hospital, or drug copayments by 15% or more, or reducing benefits.

For an unaffiliated Medicare Supplement company, the enrollment normally takes place during the AEP. That is one reason it is important to review your ANOC early and understand exactly what your options may be.

Don’t Just File Away Your Annual Notice of Change

When your ANOC arrives, don’t simply put it in a drawer. Take a few minutes to compare your current year’s costs and benefits with what your plan will offer in the coming year.

Pay particular attention to the following:

Premium Changes

• Will your monthly premium increase by 15% or more?

Copayments

• Are your physician, hospital, or prescription drug copayments increasing by 15% or more?

Benefits

• Are any benefits being reduced or eliminated?

Your Providers

• Will your doctors, hospitals, or other providers continue to participate in your plan?

If you notice significant changes, don’t assume that you have to remain in your MA plan simply because you have developed health problems. You may have options worth exploring.

Need Help Reviewing Your ANOC?

If you have an MA plan and receive your Annual Notice of Change, you are welcome to send me a copy of your ANOC. I can review the changes with you and help determine whether they may qualify you for guaranteed issue rights to a Medicare Supplement under California law.

If you are considering returning to Original Medicare, I can also help you understand your Medicare Supplement options. If you would like me to review your ANOC, simply email it to me at Ron@RonLewisInsurance.com. I’m happy to help you understand your options.

Why This Can Be Especially Important If Your Health Has Changed

Imagine someone who enrolled in an MA plan several years ago when they were relatively healthy. Since then, they may have developed heart disease, cancer, kidney disease, diabetes, or another significant medical condition. Today, they would like to return to Original Medicare and purchase a Medicare Supplement, but they are concerned that their health history could make it difficult to qualify. That is exactly why California’s protections can be important.

A qualifying change to the MA plan may create a guaranteed issue opportunity that could otherwise be unavailable. However, eligibility is based on the specific circumstances, the plan changes, the timing of the disenrollment and the applicable Medicare Supplement rules. A qualifying change does not automatically mean that every Medicare Supplement plan from every carrier is available.

Don’t Wait Until December 7th

If you are considering a change, don’t wait until the last minute. The Medicare Annual Election Period (AEP) runs from October 15th through December 7th each year. If you believe your ANOC shows a change that may give you guaranteed issue rights under California law, it is a good idea to have your situation reviewed early in the AEP.

That gives you time to review your current Medicare Advantage coverage, examine the changes in your ANOC, determine whether you may qualify for guaranteed issue, compare available Medicare Supplement options, complete an application if appropriate, and allow time for the application and enrollment process.

Know Your Options

If you or someone you know has Medicare Advantage and has developed significant health problems, don’t automatically assume that returning to Original Medicare and obtaining a Medicare Supplement is impossible. The ANOC may reveal changes that are important to your Medicare options for the coming year.

And this information isn’t just for you. If you have a parent, spouse, friend, relative, or someone else you care about who has Medicare Advantage, particularly someone with significant health issues, consider forwarding this article to them. Encourage them to review their ANOC when it arrives. A few minutes spent reviewing that document could be very important.

If you see a qualifying increase in premiums or specified copayments, a reduction in benefits, or another situation described under California law, reach out to me or another licensed Medicare insurance professional to find out whether you may qualify for guaranteed issue Medicare Supplement coverage.

I’m always happy to help you understand your options and determine whether these protections may apply to your situation.

This article is for educational purposes only and is not intended to provide legal, tax, or insurance advice. Medicare and California Medicare Supplement rules are subject to change. Guaranteed issue rights depend on the individual’s specific circumstances, the Medicare Advantage plan’s changes, timing, and applicable federal and California rules. Eligibility for a particular Medicare Supplement policy is not guaranteed by this article.

About the Author

I’m an independent Medicare Supplement insurance specialist working with most of the major insurance carriers throughout California, Nevada, Arizona, and several other states.

I help people turning 65 coordinate their Medicare enrollment so their Medicare Supplement and prescription drug coverage begin at the same time as Medicare.

I also work with many people who already have Medicare Supplement plans and would like to review their options. In California, there is a law called the California Birthday Rule, which allows Medicare Supplement policyholders to change their plans each year during the 60 days following their birthday without answering health questions or going through medical underwriting. During this annual 60-day enrollment period, you cannot be turned down for coverage when changing to a Medicare Supplement plan with the same or fewer benefits.

I regularly help clients lower their Medicare Supplement premiums while keeping the same benefits and coverage.

Over the years, I have helped many clients save hundreds and sometimes even thousands of dollars on their annual premiums.

There is never a fee for my services because I am compensated by the insurance companies, not my clients. My goal is to help you find competitive premiums while providing dependable, personal service year after year.

If you’re turning 65 or already have a Medicare Supplement plan and would like to review your options, I’m happy to help.

Read what my clients have to say about working with me.

Contact Information

Ron Lewis
Independent Medicare Supplement Insurance Specialist

Cell: (760) 525-5769

Toll-Free: (866) 718-1600

Email: Ron@RonlewisInsurance.com

Website: www.MedigapShopper.com

Insurance Licenses

• California: #0B33674
• Nevada: #3822123
• Arizona: #681166

This website is operated by a licensed insurance agent and is intended for educational purposes only. I am not affiliated with or endorsed by Medicare or any government agency.