The Great Medicare U-Turn: How to Switch Back to Original Medicare
If you’ve spent the last year realizing that “Advantage” doesn’t always feel like an advantage, you aren’t alone. Maybe your favorite specialist left the network, or you’re tired of asking for “prior authorization” just to get an MRI.
The good news? If you’re reading this in January, the door is wide open for a change. But before you jump ship, there’s a specific sequence you need to follow to avoid getting stranded without coverage.
1. The “Right Now” Window: The 2026 MA OEP
Since today is January 26, 2026, you are currently in the Medicare Advantage Open Enrollment Period (MA OEP). This runs from January 1 to March 31. The Fall Window: Annual Enrollment Period (AEP) Dates: October 15 – December 7.
During this time, you can:
Switch from Medicare Advantage back to Original Medicare.
Sign up for a standalone Part D prescription drug plan.
Note: If you make the switch this month, your new coverage will typically begin on the 1st of the following month.
2. The Medigap “Trap”: Don’t Drop Your Plan Yet!
This is the most critical part of the U-turn. Unlike Medicare Advantage, which must take you regardless of health, Medigap (Medicare Supplement) providers in most states can use medical underwriting.
The Risk: If you have a pre-existing condition, a Medigap insurer can charge you more or deny you a policy entirely unless you have a “Guaranteed Issue Right.”
Do you have a “Guaranteed Issue Right”?
You generally don’t need a health screening if:
The Trial Right: This was your very first time joining a Medicare Advantage plan and you’ve been in it for less than 12 months.
The Move: You moved out of your Advantage plan’s service area.
Special State Rules: You live in a state like New York, Connecticut, or Massachusetts, which have year-round or annual protections for Medigap enrollment.
The Golden Rule: Secure your Medigap policy and get an acceptance letter before you officially disenroll from your Medicare Advantage plan.
3. Your 2026 Transition Checklist
Switching back involves a three-step dance. If you miss a step, you could face lifetime penalties or massive bills.
Step
Action
Why it matters
Step 1
Apply for Medigap
Ensures your “gap” coverage is locked in before you leave your current plan.
Step 2
Join a Part D Plan
Medicare Advantage usually includes drugs; Original Medicare does not. Missing this causes a late-enrollment penalty.
Step 3
Confirm Disenrollment
Joining a standalone Part D plan usually automatically triggers your exit from Medicare Advantage, but always call your plan to confirm.
4. What Original Medicare Costs in 2026
Since you’re moving back to the “Original” way of doing things, here is a quick look at the 2026 rates:
Part B Monthly Premium:$202.90 (standard).
Part B Annual Deductible:$283.
Part A Inpatient Deductible:$1,736 per benefit period.
Part D Out-of-Pocket Cap:$2,100. (Once you spend this on meds, you pay $0 for the rest of the year!)
Why People are Making the Switch
In 2026, the maximum out-of-pocket (MOOP) for Medicare Advantage plans can be as high as $9,250. For someone facing a major surgery or chronic illness, that “low premium” plan can suddenly become very expensive. Medigap Plan G, by contrast, covers nearly everything after you pay the small Part B deductible, giving you total “cost predictability.”
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If you’ve been scouring the internet for “Medicare Part G,” I have some good news and a tiny “well, actually” for you. First, the correction: there is no Medicare Part G. Medicare has “Parts” (A, B, C, and D) that come from the government. What you’re looking for is Medicare Supplement Plan G (also known as Medigap).
Now, the good news: you’ve accidentally stumbled upon what most experts consider the “Gold Standard” of Medicare coverage in 2026. If you value predictability, flexibility, and never having to wonder if your doctor is “in-network,” Plan G is your new best friend.
What is Medicare Supplement Plan G?
Think of Original Medicare (Parts A and B) as a solid foundation for a house, but one that’s missing a few windows and maybe a front door. You’re responsible for deductibles, 20% coinsurance, and “excess charges” that can turn a simple procedure into a financial headache.
Plan G is the high-end renovation that fills almost every one of those gaps. It is the most comprehensive plan available to anyone new to Medicare since 2020.
The Big Benefits: What’s Covered?
In 2026, Plan G remains the heavyweight champion of coverage. Here’s the breakdown:
Part A Deductible ($1,736 in 2026): If you’re admitted to the hospital, Plan G pays this entire amount for you.
Part B Coinsurance (20%): Medicare usually pays 80% of doctor visits and outpatient care. Plan G picks up the remaining 20%.
Part B Excess Charges: Some doctors don’t accept “Medicare Assignment,” meaning they can charge up to 15% more than the Medicare-approved amount. Plan G is one of the few plans that covers this fully.
Skilled Nursing Facility Coinsurance: Covers your costs for days 21–100 of a Medicare-approved stay.
Foreign Travel Emergency: Provides 80% coverage (after a $250 deductible) for emergency care outside the U.S., up to a $50,000 lifetime limit.
Why Choose Plan G Over the Competition?
1. The “No Surprises” Budget
With Plan G, your only major out-of-pocket medical expense for the year is the Medicare Part B deductible ($283 in 2026). Once you pay that first $283, the plan covers 100% of your Medicare-approved expenses for the rest of the year. No $20 copays, no “facility fees,” just peace of mind.
2. Freedom of Movement
Unlike Medicare Advantage (Part C), Medigap Plan G has no networks. If a doctor, specialist, or hospital anywhere in the U.S. accepts Medicare, they accept your Plan G. You don’t need a referral to see a cardiologist in another state or a surgeon across town.
Summary: Why Buy Plan G?
Comprehensive: Covers almost everything except the $283 Part B deductible.
Predictable: One small annual deductible, then you’re done.
Flexible: No networks, no referrals, nationwide coverage.
Safe: Protects you from “excess charges” that other plans ignore.
Looking for a Medigap plan in Sun City, Arizona? I can help!
Medigap offers the type of flexibility that some seniors may find is worth the higher price tag.
As Medicare open enrollment kicks into high gear, millions of older adults are taking a fresh look at their health insurance options. For many, that means deciding between sticking with or switching to either a Medicare Advantage plan or a Medicare supplemental insurance policy, also known as Medigap. It’s a choice that can shape not just monthly budgets but also how easily seniors can access the care they need.
At first glance, Medicare Advantage plans may seem like the obvious choice. Many offer low or $0 monthly premiums and bundle extra perks like dental, vision and hearing coverage. For retirees living on fixed incomes, those features can be appealing. But despite the popularity of Medicare Advantage — 54% of all Medicare beneficiaries are enrolled in these plans — a significant share of seniors continue to rely on Medigap coverage instead.
So what drives some seniors to choose Medigap coverage over Medicare Advantage plans? That answer typically comes down to what people value in their healthcare coverage. Below, we’ll break down what to consider.
Why do some seniors choose Medigap over Medicare Advantage?
Medigap plans work alongside Original Medicare, covering many of the out-of-pocket costs that traditional Medicare doesn’t, like deductibles, coinsurance and copayments. Medicare Advantage plans, on the other hand, replace Original Medicare with a private insurance plan that often comes with its own rules, networks and cost structures. Here’s more on why many older adults opt for Medicare supplemental coverage over Medicare Advantage plans:
Access to a wider network of doctors and hospitals
One of the main reasons seniors opt for Medicare supplemental coverage is the flexibility to see any doctor or specialist who accepts Medicare, anywhere in the nation. There are no restrictive provider networks or referral requirements. For retirees who travel frequently, live in multiple states or simply want to keep their existing doctors, this nationwide access can be a major advantage.
While Medigap plans typically have higher monthly premiums than Medicare Advantage plans, they tend to offer more stable and predictable out-of-pocket expenses. Depending on the plan type, like Plan G or Plan N, Medigap may cover nearly all of the costs left over after Medicare pays its share. For seniors managing chronic conditions or anticipating regular medical visits, that type of coverage predictability can be invaluable.
Fewer administrative hurdles
Medicare Advantage plans often require beneficiaries to obtain prior authorizations before they can be approved for certain treatments or services, and these hurdles can sometimes lead to delays or denials for otherwise necessary medical care. Medigap paired with Original Medicare typically doesn’t have these barriers, though, which makes it easier to access care when you need it.
Stable benefits year after year
While Medicare Advantage plans can change their provider networks, cost-sharing rules and benefits annually, Medicare supplemental plans are standardized and don’t change once you enroll. That type of stability can make long-term financial planning simpler and reduce the risk of unexpected coverage shifts.
How to decide between Medicare supplemental coverage and Medicare Advantage
Both Medicare Advantage and Medigap have clear benefits and tradeoffs and the right choice often depends on your health needs, financial situation and lifestyle. Here’s what to weigh as you’re deciding which coverage option makes the most sense for your needs:
Consider your healthcare usage
If you visit doctors frequently, need specialist care or expect ongoing medical costs, Medigap’s more comprehensive coverage may make sense. On the other hand, if you’re relatively healthy and want to minimize monthly premiums, a Medicare Advantage plan could be more cost-effective.
Think about where you receive care
Seniors who split time between states or travel often may benefit more from Medigap’s nationwide coverage. But if your care is primarily local and your providers are in-network, Medicare Advantage could work well.
Weigh long-term costs carefully
While Medigap premiums can rise with age, Medicare Advantage plans can also change cost structures each year. Some seniors start with Advantage plans for the lower premiums and switch to Medigap later. However, in many states, switching to Medigap after your initial enrollment period may require medical underwriting, and you could be denied coverage or face higher premiums if your health has changed.
Factor in extra benefits
Medicare Advantage plans often offer extras like dental, vision, fitness memberships or transportation services. If these are important to you, they might tilt the balance toward Medicare Advantage. Medigap focuses primarily on covering medical costs rather than additional perks.
The bottom line
When choosing between Medicare Advantage and Medigap, there’s no universal answer for retirees. Medigap appeals to many seniors because of its flexibility, predictable costs and stable coverage, while Medicare Advantage can be more affordable for those with limited healthcare needs or who value additional benefits.
When weighing your options during open enrollment, be sure to assess your health, budget and lifestyle carefully. By understanding the potential benefits and downsides of each option, you can select the coverage that best fits your unique situation and ensures you have the care you need at a cost you can manage.
Would you like more information on a Medigap plan?
Medicare coverage doesn’t just mean signing up for government insurance. In fact, more than half of Medicare recipients now get their coverage through a Medicare Advantage plan, or Medicare Part C plan, which is offered by a private insurer.
Advantage plans are an alternative to original Medicare, replacing Part A (hospital coverage), Part B (outpatient care coverage), and sometimes Part D (prescription drug coverage).
Yet, while Advantage Plans seem like a good alternative, a substantial number of older Americans who sign up for them don’t stick with them. In fact, among those who signed up between 2011 and 2022, around half left their plans within five years.
Recent research published in the journal Health Affairs helps demonstrate why so many are opting out of their Advantage Plan during open enrollment, either by switching to a different Part C plan or by returning to traditional Medicare instead. Since these Advantage plans are less likely to attract beneficiaries over the long term, the study warns that such plans will likely have less incentive to cater to participants with chronic conditions.
Should you ditch your Medicare Advantage plan? Why others are
Researchers sought to gain insight into why Medicare Advantage participants were disenrolling by using information from the Medicare Current Beneficiary Survey, linked with data on Medicare Advantage enrollment. The survey measures patient satisfaction with access to medical care, as well as the cost and quality of the care they receive.
Researchers found two primary factors drove departures from Medicare Advantage plans, and neither was related to cost. Instead, most people who disenrolled did so because of difficulty accessing care as well as concerns about the quality of their care.
Access issues, in particular, were especially likely to prompt Advantage customers not just to switch to a different Medicare Part C plan but instead to return to traditional Medicare. This makes sense, given that traditional Medicare doesn’t impose the same limits as Advantage Plans on which doctors or care providers patients can visit.
Hospitals have also been ending their affiliations with Medicare Advantage Plans, creating huge problems when break-ups happen outside of the open enrollment period, and Advantage Plan customers suddenly find themselves without coverage at the hospital where they’d been treated.
Researchers also revealed that individuals with health issues were more likely to switch out of their Medicare Advantage plan. Those who described themselves as being in poor health were:
More than twice as likely as other Advantage members to express difficulty with getting care;
More than three times as likely to be dissatisfied with the quality of care they are getting
More than twice as likely to be unhappy with the cost of their care
More than twice as likely to be dissatisfied with their specialty care.
“People who stay in [Medicare Advantage} are shopping for better service, but … those who switch to traditional Medicare are the ones potentially with high health care needs, who are much more strongly driven by dissatisfaction with access to care issues ” said Geoffrey Hoffman, Ph.D., Associate Professor, U-M School of Nursing and one of the study’s authors.
This tendency to switch between Advantage plans or back to original Medicare could undermine the long-term effectiveness of these plans while also driving up the nation’s cost to provide original Medicare. The study warns that Advantage plans will likely focus on the short-term healthcare needs of beneficiaries due to plan hopping.
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How you can find the right Medicare plan
Since concerns about care quality and accessibility were the most likely reasons for retirees to switch out of their Medicare Advantage Plan — often back to traditional Medicare — it’s clear that these are issues that older Americans should pay attention to when shopping for an Advantage Plan.
Don’t put yourself in this position. The best way to protect yourself is with original Medicare A & B and the a true medicare supplement such as plan G. Turning 65 is also the only time you are eligible for a supplement without answering any health questions.
Let us help answer your questions and provide you with a quote, ensuring you receive all available discounts.
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.
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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.
