If you’re tempted to ditch Medicare Advantage, you’re not alone. Millions of Americans switch away from Medicare Advantage plans every year — and the numbers are growing. Here’s when it makes sense to leave, how to do it, and the critical timing issue most people miss.
Why More People Are Choosing to Ditch Medicare Advantage
The most common reasons people decide to ditch Medicare Advantage:
Their doctor left the plan’s network
Prior authorization denied necessary care
Out-of-pocket costs were higher than expected after a serious illness
Benefits were cut at the annual renewal
Moving to a different part of Arizona or another state
Wanting access to Mayo Clinic, which doesn’t accept most Advantage plans
According to CMS data, Medicare Advantage enrollment has seen increasing churn as plan benefits change annually and major insurers pull back from markets.
The Critical Warning Before You Ditch Medicare Advantage
Here’s what stops many people from leaving: the one-way door problem. If you ditch Medicare Advantage and want to switch to a Medicare Supplement (Medigap) plan, you may need to pass medical underwriting — especially if you’ve been on Advantage for more than a year.
That means insurance companies can review your health history and potentially deny you Medigap coverage or charge more based on pre-existing conditions. The longer you stay on Medicare Advantage, the more health conditions you may accumulate — and the harder it becomes to qualify for Medigap.
This is why timing matters: if you’re thinking about leaving, do it sooner rather than later.
When You Can Ditch Medicare Advantage Without Penalty
There are two main windows to leave Medicare Advantage:
Medicare Advantage Open Enrollment Period (MA OEP): January 1 – March 31. You can switch to Original Medicare, with coverage starting the first of the following month.
Annual Enrollment Period (AEP): October 15 – December 7. Changes take effect January 1.
What to Do After You Ditch Medicare Advantage
Once you return to Original Medicare, you’ll want a Medicare Supplement Plan G to cover your out-of-pocket costs. With Plan G, after the Part B deductible ($283 in 2026), you pay nothing for covered services for the rest of the year — no networks, no prior authorization, no surprises.
Ready to Make the Switch?
I’m Andy Orlikoff, an independent Medicare broker in Surprise, AZ. I help Arizona seniors who want to ditch Medicare Advantage navigate the process and enroll in the right Medigap plan — even when medical underwriting is required.
UnitedHealth Group’s collapse in 2025 has become the most visible example of a structural problem with Medicare Advantage flaws that independent brokers have warned about for years. The nation’s largest Medicare Advantage insurer is facing federal investigations, allegations of fraud, and a dramatic stock collapse — all while its Medicare Advantage business model is under scrutiny. Here’s what happened and what it means for Arizona seniors.
UnitedHealth’s Collapse: What Happened
In early April 2025, market analysts were calling UnitedHealth Group a tariff safe haven. Two months later, the company is in free fall. UnitedHealth faces three federal investigations covering:
Civil and criminal fraud allegations related to Medicare Advantage billing practices
DOJ antitrust investigation into its healthcare operations
Allegations that clinicians were pressured to record questionable diagnoses to trigger additional Medicare payments — a practice known as “upcoding”
The Wall Street Journal reported the DOJ is investigating whether UnitedHealth made its clinician employees record questionable diagnoses to make Medicare Advantage patients appear sicker than they are, generating extra federal payments.
The Medicare Advantage Flaws at the Core of the Problem
UnitedHealth’s troubles aren’t just a corporate scandal — they reflect fundamental Medicare Advantage flaws built into the program’s payment model.
Medicare Advantage pays private insurers a set amount per enrollee based partly on their health status. Sicker patients generate higher payments. This creates a financial incentive to make patients appear sicker on paper — regardless of whether they actually receive more care. The Guardian alleged UnitedHealth secretly paid nursing homes to prevent or delay transfers of Medicare Advantage patients to hospitals, saving the company money while patients who desperately needed hospital care were delayed.
Prior Authorization and Denial Rates
Medicare Advantage plans — including UnitedHealth’s — have significantly higher prior authorization denial rates than Original Medicare. A Senate investigation found that UnitedHealth denied coverage for medically necessary care at rates that alarmed federal investigators.
Original Medicare does not require prior authorization for most services. Medicare Supplement Plan G works alongside Original Medicare — meaning your doctor decides your care, not an insurance company’s algorithm.
What This Means for Arizona Medicare Advantage Enrollees
If you’re currently enrolled in a UnitedHealth Medicare Advantage plan in Arizona, here’s what to consider:
UnitedHealth has been reducing its Medicare Advantage footprint — your plan may not renew in 2026
Federal investigations could lead to plan disruptions
This is an opportunity to review whether Medicare Advantage is still the right choice for your situation
The Annual Enrollment Period runs October 15 – December 7. That’s your window to switch to Original Medicare with a Medigap supplement plan if you qualify.
Questions About Your Medicare Options?
I’m Andy Orlikoff, an independent Medicare broker in Surprise, AZ. I don’t sell Medicare Advantage. The Medicare Advantage flaws exposed by UnitedHealth’s collapse are exactly why I’ve recommended Medicare Supplement Plan G to Arizona seniors for 20+ years.
The Centers for Medicare and Medicaid Services (CMS) announced it is pursuing further limits on Medicare Advantage plans’ use of prior authorization and artificial intelligence — the latest move in an ongoing effort to address Medicare Advantage guardrails that protect seniors from coverage denials. Here’s what the proposed rules would do and what they mean for Arizona Medicare enrollees.
Why CMS Is Proposing Medicare Advantage Guardrails
Prior authorization — requiring insurer approval before medical care can be delivered — has become one of the most significant complaints from Medicare Advantage enrollees. A Senate Finance Committee investigation found that major Medicare Advantage insurers denied prior authorization requests at rates far higher than originally reported, and that many denials were for care that Original Medicare would have covered without question.
Adding to the concern, many insurers began using artificial intelligence algorithms to make or assist with prior authorization decisions. In some cases, these AI systems were denying care without adequate review by a physician.
What the Proposed Medicare Advantage Guardrails Would Do
CMS’s proposed Medicare Advantage guardrails target several specific practices:
AI-based denials — Plans would be required to have physician oversight of any AI-assisted prior authorization decision. An algorithm alone could not deny a claim.
Criteria alignment — Plans would need to use coverage criteria that align with Original Medicare, reducing the ability to deny care that Medicare would otherwise cover.
Faster decisions — Stricter timelines for prior authorization decisions, particularly for urgent care situations.
Continuity of care — Protections for patients who are mid-treatment when a plan changes its network or coverage.
What This Means — and What It Doesn’t Fix
The proposed rules are a step in the right direction. However, they don’t eliminate the fundamental structure of Medicare Advantage guardrails — they only constrain how plans can implement them.
According to CMS, even with these new rules in place, Medicare Advantage plans will still require prior authorization for many services. Original Medicare does not require prior authorization for most care. That fundamental difference remains.
The Alternative: Original Medicare With Plan G
If you’re concerned about prior authorization, AI-based denials, or narrow networks, the most reliable solution is returning to Original Medicare with a Medicare Supplement Plan G.
With Plan G, you pay the Part B deductible once per year — $283 in 2026 — and after that, Medicare and Plan G cover your costs for the year. No prior authorization. No AI deciding your care. No networks.
Questions About Your Medicare Coverage Options?
I’m Andy Orlikoff, an independent Medicare broker in Surprise, AZ. I help Arizona seniors understand what the latest Medicare Advantage guardrails and policy changes mean for their coverage — and whether Original Medicare with Plan G is a better fit.
When it comes to Medicare vs Medigap, the question isn’t really whether you need Medicare — you do. The real question is whether to stick with Original Medicare alone, add a Medicare Supplement (Medigap) plan, or opt for Medicare Advantage instead. Here’s how to think through that decision clearly.
Medicare vs Medigap: What’s the Difference?
Medicare is the federal health insurance program for people 65 and older. It has two core parts:
Part A — Hospital insurance. Free for most people (if you or a spouse paid Medicare taxes for 10+ years).
Part B — Medical insurance covering doctor visits, outpatient care, and lab tests. The standard premium in 2026 is $202.90/month.
Original Medicare covers about 80% of most approved medical costs. The other 20% — plus deductibles, coinsurance, and hospital stays — comes out of your pocket. There’s no out-of-pocket maximum with Original Medicare alone, which means a serious illness can cost you tens of thousands of dollars.
A Medicare Supplement (Medigap) plan is private insurance you buy to cover most of what Original Medicare leaves behind. Plan G is the most comprehensive option available to new enrollees — after the Part B deductible ($283 in 2026), it covers 100% of Medicare-approved costs for the rest of the year.
Are Consumers Better Off With Medicare Plus a Medigap Plan?
For most people who can qualify medically and afford the premium, yes. Here’s why the Medicare vs Medigap math usually favors adding a supplement:
Predictable costs — You know your maximum out-of-pocket before January 1. Plan G + Part B deductible = your total annual exposure.
No networks — You can see any doctor in the U.S. who accepts Medicare. No referrals, no prior authorization, no in-network restrictions.
Stability — Medigap benefits are standardized by federal law and don’t change annually. Your Plan G in 2026 covers the same things in 2027.
Mayo Clinic access — Most Medicare Advantage plans are not accepted at Mayo Clinic. Plan G is.
When Medicare Advantage Might Make Sense
Medicare Advantage — also called Medicare Part C — bundles Medicare with private insurance. It often has lower or zero premiums but comes with networks, prior authorization requirements, and annual benefit changes.
According to Medicare.gov, Medicare Advantage may make sense if:
You can’t afford a Medigap premium
You qualify for low-income assistance programs that make Advantage more affordable
You’re healthy and unlikely to need significant care
The plan includes extra benefits (dental, vision) you actually need and will use
However, the critical risk is the one-way door: if you enroll in Medicare Advantage and later want to switch to a Medigap plan, you may need to pass medical underwriting. That means pre-existing conditions could prevent you from qualifying.
The Role of an Independent Medicare Broker
An independent broker doesn’t work for any insurance company — they compare plans across multiple carriers to find the best fit for your situation. They’re compensated by the insurer, so their help costs you nothing extra. Your premium is the same whether you use a broker or enroll directly.
The right broker will walk you through the real Medicare vs Medigap tradeoffs for your specific health situation, income, and preferred doctors — without steering you toward higher-commission products.
Talk Through Your Medicare Options in Arizona
I’m Andy Orlikoff, an independent Medicare broker in Surprise, AZ. I don’t sell Medicare Advantage. I help Arizona seniors work through the Medicare vs Medigap decision honestly — comparing costs, coverage, and long-term risk.
As you approach the age of 65, understanding the various Medicare options available to you can feel overwhelming. Two of the most popular choices—Medicare Supplement Part G and Medicare Advantage plans—often cause confusion among beneficiaries. While both plans aim to fill gaps in Original Medicare, they are vastly different in terms of coverage, cost, and flexibility. This comprehensive guide will help you understand Medigap Part G and Medicare Advantage options, making it easier to choose the right plan based on your healthcare needs.
Understanding Medicare Supplement Part G
What is Medicare Supplement Part G?
Medicare Supplement Part G, often referred to as Medigap Part G, is a private insurance plan that works alongside Original Medicare (Parts A and B) to cover “gaps” in Medicare. These gaps include out-of-pocket expenses such as copayments, coinsurance, and deductibles that Medicare doesn’t cover. Essentially, Part G helps reduce the financial burden of medical costs by supplementing Original Medicare’s limitations.
What Does Part G Cover?
Medicare Supplement Part G offers comprehensive coverage, second only to the now-unavailable Medicare Supplement Plan F. It covers:
Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are exhausted)
Medicare Part B coinsurance or copayments
Part A deductible
Skilled nursing facility care coinsurance
Part B excess charges (the difference between what a provider charges and what Medicare will pay)
Foreign travel emergency coverage (up to plan limits)
The only thing Part G doesn’t cover is the Medicare Part B deductible, which as of 2024 is $226 annually. Otherwise, it covers nearly all out-of-pocket costs for Medicare-approved services.
Pros of Medicare Supplement Part G
Comprehensive Coverage: You pay very little out of pocket beyond your monthly premiums, providing peace of mind when facing high medical expenses.
No Network Restrictions: Medigap Part G allows you to see any doctor or specialist nationwide who accepts Medicare, offering greater flexibility.
Predictable Costs: With Part G, you can anticipate your healthcare costs, knowing that you’ll be covered for most of the expenses not included in Original Medicare.
Cons of Medicare Supplement Part G
Higher Premiums: Medigap Part G tends to have higher monthly premiums compared to other Medigap plans and Medicare Advantage options.
Does Not Include Drug Coverage: Part G does not cover prescription drugs, so you’ll need to purchase a Medicare Part D plan separately for drug coverage.
No Extra Perks: Unlike some Medicare Advantage plans, Medigap Part G doesn’t offer additional benefits like vision, dental, or hearing care.
What is Medicare Advantage?
How Does Medicare Advantage Work?
Medicare Advantage plans (also known as Medicare Part C) are an all-in-one alternative to Original Medicare, offered by private insurers. These plans must provide at least the same level of coverage as Original Medicare but often include additional benefits like prescription drug coverage, vision, dental, and hearing care. Medicare Advantage plans bundle Medicare Part A, Part B, and sometimes Part D into a single plan, offering beneficiaries convenience and potentially lower overall costs.
Types of Medicare Advantage Plans
There are several types of Medicare Advantage plans, including:
Health Maintenance Organization (HMO): Requires you to use a network of doctors and hospitals, and you need a referral to see a specialist.
Preferred Provider Organization (PPO): Offers more flexibility by allowing you to see doctors outside of the network at a higher cost, and no referrals are needed for specialists.
Private Fee-for-Service (PFFS): Allows you to see any provider that accepts the plan’s payment terms, but provider acceptance is not guaranteed.
Special Needs Plans (SNPs): Tailored for people with specific diseases or conditions, these plans offer specialized care management.
Pros of Medicare Advantage Plans
Lower Monthly Premiums: Many Medicare Advantage plans have low or even $0 monthly premiums, making them an attractive option for cost-conscious beneficiaries.
All-in-One Coverage: These plans often include prescription drug coverage (Part D) and additional benefits like vision, dental, and hearing care.
Additional Benefits: Medicare Advantage plans may offer extras such as gym memberships, wellness programs, and telehealth services.
Cons of Medicare Advantage Plans
Network Restrictions: Most Medicare Advantage plans have network limitations, requiring you to use specific doctors and hospitals. You may need referrals to see specialists.
Variable Costs: While premiums may be low, out-of-pocket costs can vary greatly, especially if you need care outside of your plan’s network.
Limited Nationwide Coverage: Unlike Medigap Part G, Medicare Advantage plans may not provide the same level of nationwide coverage, making them less suitable for frequent travelers.
Medicare Supplement Part G vs. Medicare Advantage: A Direct Comparison
Now that we’ve reviewed the basics of both Medigap Part G and Medicare Advantage, let’s dive into a side-by-side comparison to highlight their key differences.
1. Coverage Options
Medigap Part G: Covers nearly all out-of-pocket costs that Original Medicare does not, including Part A deductible, Part B coinsurance, and excess charges. However, it does not include prescription drugs or additional perks like dental and vision care.
Medicare Advantage: Offers all-in-one coverage, often bundling Medicare Parts A, B, and D with extra benefits like vision, dental, and hearing care. However, it comes with network restrictions and varying out-of-pocket costs.
2. Cost
Medigap Part G: Higher monthly premiums but predictable and stable out-of-pocket costs for covered services. You’ll need to buy a separate Part D plan for drug coverage.
Medicare Advantage: Generally lower or no monthly premiums, but more unpredictable out-of-pocket expenses, especially if you go outside the plan’s network. Prescription drug coverage is often included.
3. Flexibility
Medigap Part G: Allows you to see any doctor who accepts Medicare, without worrying about network restrictions. This makes it ideal for those who travel frequently or want the freedom to choose any provider.
Medicare Advantage: Often requires you to stay within a specific network of healthcare providers. While some plans, like PPOs, offer more flexibility, you’ll still pay more to see out-of-network doctors.
4. Prescription Drug Coverage
Medigap Part G: Does not include prescription drug coverage. You’ll need to enroll in a separate Medicare Part D plan.
Medicare Advantage: Most plans include prescription drug coverage, offering convenience and potentially saving you the cost of purchasing a separate plan.
5. Additional Benefits
Medigap Part G: Focuses on supplementing Original Medicare, so it doesn’t offer additional benefits like dental, vision, or hearing care.
Medicare Advantage: Often includes these extras, making it a more comprehensive option for those looking for additional non-medical services.
Which Plan is Right for You?
When choosing between Medicare Supplement Part G and Medicare Advantage plans, your decision will largely depend on your personal healthcare needs and lifestyle.
Choose Medigap Part G if:
You want comprehensive coverage for out-of-pocket Medicare expenses and don’t want to deal with network restrictions.
You value predictability in your healthcare costs and don’t mind paying higher monthly premiums for peace of mind.
You travel frequently and need access to doctors and hospitals nationwide.
Choose Medicare Advantage if:
You are looking for an affordable option with lower monthly premiums, especially if you’re on a fixed income.
You prefer an all-in-one plan that includes drug coverage and extra benefits like dental, vision, and hearing care.
You don’t mind using a network of healthcare providers and are comfortable with some unpredictability in out-of-pocket expenses.
Conclusion
Choosing between Medicare Supplement Part G and Medicare Advantage plans is a critical decision that can impact your healthcare and financial well-being. Each plan offers unique benefits, with Medigap Part G providing comprehensive coverage and flexibility, while Medicare Advantage plans are more affordable and offer additional benefits. Understanding the key differences and considering your personal healthcare needs will ensure that you select the right Medicare coverage option that works best for you.
Need Affordable Health Plans in Surprise, AZ?
At American Insurance Benefits, we’re passionate about helping individuals and families in Arizona secure the health insurance coverage they need at a price they can afford. Since 2004, Andy Orlikoff and our team have been dedicated to making the process of finding the right plan as simple and stress-free as possible. If you’re looking for expert guidance tailored to your unique needs and budget, don’t hesitate to reach out to us today. Let’s find the perfect health insurance solution together.
Andy Orlikoff • NPN #7558435 • Licensed in Arizona, North Carolina & South Carolina
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