At 69, She Tried to Leave Medicare Advantage. Her Cancer Had Been Gone Four Years. One Medigap Insurer Required Five
Four years in remission sounds like a clean slate, but one Medigap insurer's underwriting clock told a different story, and leaving Medicare Advantage before getting that answer could have cost her everything Original Medicare does not cover.
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A 69-year-old woman finished cancer treatment four years ago and is in remission. She spent four years in a Medicare Advantage plan, fighting prior authorization requests and network limits. Now she plans to use Annual Enrollment, which runs October 15 through December 7, to switch to Original Medicare and add Medigap Plan G.
In this example, her first Medigap application asks whether she has been diagnosed with or treated for cancer within the past five years.
She has company. On Reddit’s r/retirement forum, one poster described “a close call with almost being unable to get a Medicare supplement (Medigap).” People leaving Advantage with a serious diagnosis can face the same risk unless federal or state protections give them the right to buy Medigap. A healthier applicant may have an easier time getting approved.
Medicare Takes Her Back, but Medigap Gets to Decide
Original Medicare will re-enroll her without asking a single question about cancer. Medigap is sold by private insurers, and in most states they can ask whatever health questions state law allows. That supplement is what limits Original Medicare’s open-ended cost sharing.
Annual Enrollment gives her the right to leave Advantage. Her right to buy Medigap without health questions comes from a separate, narrower set of rules. Her federal guarantee was a one-time six-month Medigap Open Enrollment Period that started when she first enrolled in Part B. That window closed years ago. Outside it, insurers in most states can review her medical history and deny coverage.
Federal trial rights generally protect people who joined Advantage when first eligible for Medicare at 65, or dropped Medigap to try Advantage for the first time, then leave within 12 months. Four years in, she is past that trial window
The five-year lookback is one carrier’s rule. Medicare does not set it. Another provider might look back two years, ask only about active treatment, accept certain cancer histories, or charge a higher premium for the risk where state law permits.
The exact wording of the question changes when the clock starts. A carrier may count from her last treatment, not her diagnosis. If she still takes a daily cancer-prevention drug or sees her oncologist yearly, she should ask how the insurer treats those details. A routine follow-up visit does not necessarily restart the clock.
Leaving Advantage First Leaves Her With No Cap
Original Medicare has no annual out-of-pocket maximum. If she drops Advantage before her Medigap coverage is approved for January, she starts the year with Original Medicare and nothing to cover the gaps. On top of her monthly Part B premium, she would pay these costs herself:
| Cost-Sharing Item | How Often It Applies | 2026 Amount Per Person |
|---|---|---|
| Part B deductible | Once per year | $283 |
| Part B coinsurance | Every covered outpatient service | 20% of the approved amount, with no cap |
| Part A hospital deductible | Each benefit period | $1,736 |
| Hospital days 61 to 90 | Per day, each benefit period | $434 |
| Skilled nursing days 21 to 100 | Per day, each benefit period | $217 |
The 20% coinsurance is the risky exposure. If her cancer returns, chemotherapy in a doctor’s office generally leaves her paying 20% of the Medicare-approved amount after the Part B deductible, with no annual ceiling. Advantage’s in-network cap protected her. Standard Plan G would cover that coinsurance. Original Medicare alone does neither.
She also loses the drug coverage built into her Advantage plan. She needs a standalone Part D plan starting the same day. Premium surcharges, coverage gaps, and other traps like this one are the whole subject of our free Medicare guide.
Get Approved Before You Leave Advantage
- Compare health questions before filing. Get current Medigap applications from at least three carriers. Check each question’s exact wording against your dates: diagnosis, last treatment, last medicine, last follow-up visit. Apply first to the carrier whose lookback your records clear.
- Apply with a future effective date and wait for written approval. Request Medigap coverage starting January 1. Once approval gets, complete your Advantage disenrollment and enroll in a separate Part D plan before December 7. If approval never comes, your current plan stays active.
- Call your state insurance department or State Health Insurance Assistance Program (SHIP). Some states give broader Medigap switching or guaranteed-issue rights that override carrier health questions. If your state does, the five-year question may not apply.
If every carrier turns her down, she should stay in Advantage and use Annual Enrollment to find a plan whose network includes her oncologist. Its in-network out-of-pocket cap protects her far better than Original Medicare with no supplement.
Her oncologist’s remission clock had reached four years. The insurer’s underwriting clock required five, and leaving Advantage would have left her exposed to the difference.
Contact [email protected] for any questions or corrections.
Gerelyn Terzo is the author of dividend investing handbook "Dividend Investing Strategies: How to Have Your Cake & Eat It Too." A veteran financial journalist, she covers agri-finance for outlets like Global AgInvesting and the broader stock market and personal finance for 24/7 Wall Street. She began at CNBC and later helped launch Fox Business in New York. Gerelyn currently resides in Woodland Park, Colorado and dabbles in nature photography as a hobby.
