At 67, He Is Trying to Leave Advantage. The Medigap Insurer Said Yes, at $385 a Month. His Neighbor Pays $165 for the Same Plan G From the Same Company

Insurers are reshuffling Medicare Advantage options for 2027. Every Advantage plan had to send an Annual Notice of Change by September 30 explaining changes to 2027 coverage, costs, and other plan terms. Advantage premiums are falling in 2027, but not in every state: 19 are exceptions. That gives members reason to rethink their coverage.

A 67-year-old who joined Medicare Advantage at 65 wants to switch to Original Medicare plus Plan G. The Medigap company quotes $385 a month. His neighbor pays $165 for Plan G from the same insurer. Federal law sets Plan G benefits. Premiums and buying rights vary by person. Our retiree’s situation applies most directly to someone who joined Advantage at 65 and stayed past the one-year trial-right window.

His Six-Month Medigap Window Does Not Come Back Every Fall

His federal Medigap Open Enrollment Period started when he turned 65 with Part B and lasted 6 months. During that window, an insurer had to sell him any policy it offered and could not charge him more for pre-existing health problems. It is “a one-time enrollment period” that “doesn’t repeat every year, like the Medicare Open Enrollment Period,” per Medicare. Once it closes, insurers can charge more, offer fewer options, or deny the application.

Same Plan G, Same Insurer, $2,640 Apart

Several factors set a Medigap premium: the insurer’s pricing method (community, issue-age, or attained-age), age, ZIP code, tobacco use, and household discounts. Outside a protected window, health counts too. The neighbor may have bought during his Medigap open enrollment period, when medical underwriting could not raise the premium because of his health.

Both men still pay the $202.90 standard Part B premium, plus the $283 Part B deductible, which Plan G leaves to the members. If they want prescription-drug coverage, each generally needs a separate Part D plan because Original Medicare does not cover most outpatient prescription drugs. Those line items are only the posted price (IRMAA surcharges and coverage gaps can add thousands more a year, and we mapped the full list in a free guide here).

The Costly Assumption Started Two Years Earlier

He likely assumed that if Advantage disappointed him, he could switch back and pick up Plan G later. The federal trial right covers only part of that. If he joined Advantage at 65 and switches back within 12 months, he can buy Medigap without insure. After two years, that federal trial protection has expired. The annual enrollment calendar makes Advantage feel reversible, but Medigap rules can make reversing it much more expensive.

A 2027 Plan Exit Can Hand Him a Federal Right

The rules split on one question: did he leave his plan, or did his plan leave him? If his Advantage plan exits Medicare, stops serving his area, or he moves out of its service area, he gets a guaranteed-issue right to certain Medigap policies. The insurer must sell him the policy, cover pre-existing conditions, and charge nothing extra for his health. He can apply as early as 60 calendar days before his Advantage coverage ends and no later than 63 calendar days after.

In this scenario, the guaranteed-issue right comes from the plan termination or service-area change, and his plan’s non-renewal letter is the proof. A higher copay or smaller network alone generally does not create that federal protection, so he may still face underwriting. Two 67-year-olds can leave Advantage on the same day. One faces underwriting. The other may have a federal right to skip it.

Price to Pay

Underwriting can approve him at a standard or preferred rate, approve him at a higher premium, or turn him down. He got the middle outcome: a policy priced high enough to make leaving Advantage far more expensive than planned. Each insurer underwrites differently, so a second application could come back lower.

Federal law sets the minimum. New York and Connecticut give broader year-round guaranteed issue. The birthday rules in Idaho, Illinois, Nevada, and Oregon generally help only people who already hold a Medigap policy. Medicare.gov tells beneficiaries to check with their State Insurance Department, because state law can grant extra rights.

Before He Disenrolls From Advantage

1. Quote first, drop second. Get written Plan G quotes from at least three insurers. Ask whether insure applies and whether he holds a federal or state guaranteed-issue right. Secure approval before leaving Advantage.
2. Keep every notice. If his plan is exiting for 2027, the non-renewal letter shows his guaranteed-issue right. Apply inside the 60-day/63-day window.
3. Price the gap over time. The underwriting markup costs $2,640 a year, or $13,200 over five years at today’s rates, before any future rate increases.

Leaving Medicare Advantage can take a single enrollment request. Whether he gets the Medigap price he expected may depend on a window that closed two years ago.

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