Switch from Medicare Advantage if Medigap stays?

[+ tassojunior]

It's open season and Kaiser Mid-Atlantic has given us the opportunity to leave and still get immediate MediGap by closing our plan and starting 3 new ones. (the new plans are almost identical so kudos to Kaiser for doing this). I've liked Kaiser a lot but have noticed how hard it is to get referrals to specialists even though they are Kaiser specialists.. Everything says "get out now" but then i also hear no doctors are taking new Medicare patients.

I only have until Jan 1 to make a move. After this yea Medigap will be harder to fully get. FOMO. What to do? 

[spidir]

10 hours ago, tassojunior said:

It's open season and Kaiser Mid-Atlantic has given us the opportunity to leave and still get immediate MediGap by closing our plan and starting 3 new ones. (the new plans are almost identical so kudos to Kaiser for doing this). I've liked Kaiser a lot but have noticed how hard it is to get referrals to specialists even though they are Kaiser specialists.. Everything says "get out now" but then i also hear no doctors are taking new Medicare patients.

I only have until Jan 1 to make a move. After this yea Medigap will be harder to fully get. FOMO. What to do? 

I would opt for Medicare + Medigap (e.g.,  supplemental insurance) + Medicare Part D (e.g., drug coverage) to optimize patient choice and predict cost.

[+ tassojunior]

On 10/20/2025 at 9:35 PM, spidir said:

I would opt for Medicare + Medigap (e.g.,  supplemental insurance) + Medicare Part D (e.g., drug coverage) to optimize patient choice and predict cost.

I agree, even though i like my Kaiser advantage (so far.) But it's hard to find a doctor willing to take new Medicare patients.

[+ Gar1eth]

I'm glad you have the choice. I'm about to go on Medicare in a few months. And can't afford a Medigap plan. I'm going to have to hope whatever   Advantage Plan I pick doesn't screw me over. 

[jeezifonly]

My husband and I used an insurance broker to help navigate meeting our needs when we went on Medicare, and the results of coverage we chose have been great. I got PPO, husband opted for Advantage. Do what you can to avoid the "Advantage" plans that operate like HMO - primary referrals are required for everything. Once you get into the Advantage Plan, you can upgrade only within a year, then you're stuck. He switched just in time, much better care. 

Options: Raise your deductibles and co-pays on PPO type, and if you have no reason to think Rx will play a major role, also higher deductibles on Part D.  We're all in good health until we're not. 

Seek guidance from a pro. A decent broker will know how to best distribute the type of coverage combo that suits your medical needs and budget, and know the laws and rules that apply. They get paid by the companies that sign you up, not by you. 

[+ Gar1eth]

2 hours ago, jeezifonly said:

Do what you can to avoid the "Advantage" plans that operate like HMO - primary referrals are required for everything

I thought that pretty much all Advantage Plans worked like that. Am I wrong?

[chitownguy]

5 hours ago, jeezifonly said:

My husband and I used an insurance broker to help navigate meeting our needs when we went on Medicare, and the results of coverage we chose have been great. I got PPO, husband opted for Advantage. Do what you can to avoid the "Advantage" plans that operate like HMO - primary referrals are required for everything. Once you get into the Advantage Plan, you can upgrade only within a year, then you're stuck. He switched just in time, much better care. 

Options: Raise your deductibles and co-pays on PPO type, and if you have no reason to think Rx will play a major role, also higher deductibles on Part D.  We're all in good health until we're not. 

Seek guidance from a pro. A decent broker will know how to best distribute the type of coverage combo that suits your medical needs and budget, and know the laws and rules that apply. They get paid by the companies that sign you up, not by you. 

You can switch to another Medicare advantage plan or go back to original Medicare every year during the open enrollment period.

[chitownguy]

3 hours ago, Gar1eth said:

I thought that pretty much all Advantage Plans worked like that. Am I wrong?

Just like the private insurance market there are different types of Medicare Advantage plans.  HMO's, PPO, PFFS (private fee for service) and special needs plans.  

[jeezifonly]

8 hours ago, Gar1eth said:

I thought that pretty much all Advantage Plans worked like that. Am I wrong?

No, not wrong. Advantage = HMO in most cases. But each carrier tweaks it to the advantage of their bottom line.

[+ tassojunior]

5 hours ago, chitownguy said:

You can switch to another Medicare advantage plan or go back to original Medicare every year during the open enrollment period.

But if you do it voluntarily there's a big disadvantage in getting Medigap of some sort for years.

[spidir]

On 10/22/2025 at 2:55 PM, Gar1eth said:

I'm glad you have the choice. I'm about to go on Medicare in a few months. And can't afford a Medigap plan. I'm going to have to hope whatever   Advantage Plan I pick doesn't screw me over. 

Good point! It's good that we have Medicare Advantage options if it's necessary to avoid a monthly premium. Check out the Best Medicare Advantage Plans in 2025-2026.

[craigville beach]

20 hours ago, spidir said:

Good point! It's good that we have Medicare Advantage options if it's necessary to avoid a monthly premium. Check out the Best Medicare Advantage Plans in 2025-2026.

I believe all of the plans rated as being the "Best" are from for profit organizations.  

[+ FrankR]

John Oliver did a show on Medicare Advantage last night - worth the watch for some basic facts.

https://youtu.be/Ejoi9yfLVCc

[Danny-Darko]

4 hours ago, FrankR said:

John Oliver did a show on Medicare Advantage last night - worth the watch for some basic facts.

https://youtu.be/Ejoi9yfLVCc

THANK YOU SOOOOO MUCH for sharing that link!!! WOW, what an eyeopener for those of us who are turning 65 and trying to navigate this and trying make the right choice! 😲

[JayCeeKy]

5 hours ago, FrankR said:

John Oliver did a show on Medicare Advantage last night - worth the watch for some basic facts.

I also suggest that you ask ChatGPT what it would advise - try to be as specific as possible - it's amazing the amount of detail it will provide - it will list all the pro's and con's of your options - and it will walk you through your decision process. I ran the OP's original question through ChatGPT and its answer was very thorough. I used ChatGPT recently to help me to determine which Part D (drugs) plan I should choose in my state - it showed me ALL the options (and included specifics like premiums, deductibles, and co-pays - and, most importantly, asked WHAT MEDS DO YOU CURRENTLY TAKE? - you absolutely need to find out which TIER in a plan's "Formulary" your meds are on). And, as a side note, thank God the govt set a cap of $2,100 on out-of-pocket costs for Medicare Part D prescription drugs in 2026 when Congress passed the Inflation Reduction Act of 2022 - otherwise, Eliquis would bankrupt me!

I would ALSO recommend using the various calculators & educational tools on Medicare.gov (specifically: 

Find a Medicare plan

WWW.MEDICARE.GOV

 I personally would NEVER put a huge FOR-PROFIT company in between myself and my medical providers/services. But that's just me. I live in a town where HUMANA rules, so I hear a lot from both sides  - but I like the freedom of choice more than any financial advantages of Advantage. Also, there was a recent Senate report showing that Medicare Advantage plans use prior authorization to intentionally deny post-acute care to vulnerable seniors at exceptionally high rates to boost profit (Google "Senate Permanent Subcommittee on Investigations Releases Majority Staff Report Exposing Medicare Advantage Insurers' Refusal of Care for Vulnerable Seniors"). 

[+ FrankR]

2 hours ago, Danny-Darko said:

THANK YOU SOOOOO MUCH for sharing that link!!! WOW, what an eyeopener for those of us who are turning 65 and trying to navigate this and trying make the right choice! 😲

Calm yourself, young man. Let’s not get overly excited about…Medicare! 🤭

[+ robear]

This is a tangled topic, but just jumping in to say I've been very pleased with my medigap type G+ plan.  Two surgeries and a hospitalization, among other things this year and I never needed pre-approval or other nonsense from a for-profit insurer.  Gap plans ARE more expensive upfront (premiums, deductibles, etc.) and so may be unrealistic for some, but there's peace of mind knowing your needed procedure isn't at the whim of a CEO shopping for his second yacht.  I strongly urge any American over 60 to register with medicare.gov.  Don't wait until you're 65+.  For a government resource it's remarkably useful and gives a clear picture of your options, insurers and providers in your location, and comparative costs.

[+ tassojunior]

After two weeks of inquiries and talking to terrible Medicare agents i got a good one. I've had HMO's my whole adult life and Advantage since getting Medicare 10 years ago. The letter from Kaiser closing my plan is to get a "guaranteed" Plan F Medigap that anyone can get who is terminated. Unfortunately those cost about $500/month. Plan N Medigap plans are the ones with $150 to $250 a month premiums  that you can apply for yearly but the company must accept you and age, weight, medical conditions etc matter in acceptance. 50/50 at best. Medicare bills your medigap company for reimbursement so they seem to be somewhat equal. 

Of course even if accepted then there's a matter of finding good doctors who take new Medicare patients. But Medigap Plan N seems to be the route if accepted. afaik

[Lotus-eater]

 Chapter is another a Medicare plan advisor. 

Personally, I'm not a fan of witless government bureaucrats determining whether something is covered and cost-shifting to the for-profit insurers that people like to demonize.

Edited yesterday at 03:19 AM by Lotus-eater

[+ FrankR]

7 hours ago, Lotus-eater said:

 Chapter is another a Medicare plan advisor. 

Personally, I'm not a fan of witless government bureaucrats determining whether something is covered and cost-shifting to the for-profit insurers that people like to demonize.

Your use of language speaks for itself.