8 Questions to Ask Before Switching from Medicare Advantage to Original Medicare
You opened the letter. Your Medicare Advantage plan is ending or your benefits have been slashed so much it barely resembles the plan you chose. You’re not alone. According to the Kaiser Family Foundation, 2.6 million people had their Medicare Advantage coverage terminated at the end of 2025, roughly 13% of all individual MA-PD enrollees, a share more than double what it was just a year before.
For many people, this is the first time they’ve seriously considered Original Medicare. And it turns out, the question isn’t as simple as “which one is cheaper?” There are network rules, income surcharges, Medigap underwriting windows, and drug cost caps that all interact in ways that can either protect you or cost you significantly, depending on when and how you make the move.
This piece walks through eight questions worth asking before you decide. Some of these are time-sensitive. One of them, the guaranteed issue window, is something almost nobody knows about, and it may be the most important thing you read this year.
Switching from Medicare Advantage to Original Medicare can make sense if your plan was terminated, your benefits were cut, or your doctors left your network, but the move requires careful sequencing. If your plan was terminated through no fault of your own, you have a federally-protected window to buy a Medigap policy without medical underwriting, meaning you can’t be denied or charged more due to pre-existing conditions. That window is 63 days from when your coverage ends and it does not wait. Before switching, also confirm whether your income triggers IRMAA surcharges, whether your doctors accept Original Medicare, and whether you need a standalone Part D drug plan.
1
Did Your Plan Get Terminated and Do You Know What That Means for Medigap?
Here’s what most people don’t realize: if your Medicare Advantage plan was terminated, not because you chose to leave, but because the insurer pulled out of your area, you have a federally-protected guaranteed issue right to purchase a Medigap (Medicare Supplement) policy. No medical underwriting. No denial based on pre-existing conditions. No higher premiums because of your health history.
That matters enormously. Under normal circumstances, if you’ve been in Medicare Advantage for several years and want to switch to Original Medicare, insurers in most states are allowed to check your health and charge you more or turn you down entirely for conditions like diabetes, heart disease, or cancer. A plan termination bypasses all of that.
The catch: the window is 63 days from the date your coverage ends. Not from when you received the notice. Not from when you started shopping. From when coverage actually ended. Miss it by a day and you likely lose the protection.
If you received a plan termination notice for coverage ending December 31, 2025, that 63-day window may already be closing. If you haven’t acted yet, call a licensed Medicare counselor or your State Health Insurance Assistance Program (SHIP) today. Don’t default into a replacement plan before you understand your Medigap options.
Source: Medicare.gov — Medigap Guaranteed Issue Rights
2
Have You Used Your 12-Month “Trial Right”, and Do You Still Have It?
There’s a lesser-known protection called a Medicare Advantage trial right. If you enrolled in Medicare Advantage for the first time when you turned 65, you have 12 months to change your mind and return to Original Medicare, with guaranteed issue rights to buy a Medigap policy, regardless of your health.
Similarly, if you had Original Medicare with a Medigap plan and switched to Medicare Advantage for the first time, you have a 12-month window to go back and reclaim your previous Medigap plan (or purchase a comparable one without underwriting).
These trial rights are a one-time opportunity. You can’t use them twice. If you’ve already switched to Medicare Advantage once, gone back to Original Medicare, and then returned to Advantage again, you likely don’t have another trial right. Timing and sequence matter.
Before assuming you can’t get Medigap coverage without medical underwriting, check when you first enrolled in Medicare Advantage and whether you’ve ever used a trial right. A Medicare counselor can review your enrollment history at no cost.
Source: Medicare.gov — When Can You Buy a Medigap Policy
3
Will Your Doctors Accept Original Medicare?
Medicare Advantage plans use networks. Original Medicare doesn’t, but that doesn’t mean every doctor accepts it. Most do, but “most” isn’t the same as “yours.”
Before switching, confirm that your primary care physician, any specialists you see regularly, and any hospitals you rely on accept Original Medicare (also called Medicare fee-for-service). This is especially important if you’re receiving ongoing cancer treatment, have a regular cardiologist, or use a specific hospital system.
Medicare.gov includes a Care Compare tool where you can search whether specific providers accept Medicare assignment. Providers who accept assignment have agreed to Medicare’s approved payment rates.
One more thing: if you add a Medigap policy, your coverage is genuinely nationwide, any provider who accepts Original Medicare, anywhere in the country. That’s a meaningful difference from Advantage plans, which can restrict you to a regional network and may require referrals.
Make a list of every provider you’ve seen in the past two years and check them individually at Medicare.gov/care-compare. This takes 20 minutes and could prevent a costly surprise.
4
What Will You Pay Under Original Medicare, and Have You Factored In IRMAA?
Original Medicare isn’t free. Part B carries a standard premium of $202.90 per month in 2026. But if your income exceeds certain thresholds, you’ll pay more, sometimes a lot more, through a surcharge called IRMAA (Income-Related Monthly Adjustment Amount).
In 2026, the IRMAA surcharge kicks in for single filers whose 2024 Modified Adjusted Gross Income exceeded $109,000, or married couples filing jointly above $218,000. At those levels, monthly Part B premiums start at $284.10 and can reach as high as $689.90. Part D drug coverage carries its own IRMAA surcharge, ranging from $14.50 to $91.00 per month in 2026.
Here’s what trips people up: IRMAA is based on your income from two years ago. Your 2026 premiums are calculated from your 2024 tax return. A large Roth conversion, a business sale, or a high-income final year of work in 2024 could mean elevated Medicare costs in 2026, even if your income has since dropped significantly.
And IRMAA is a cliff system. Just one dollar over a threshold triggers the full surcharge for that tier. Staying below a bracket by managing income thoughtfully can save a couple thousands of dollars per year in Medicare premiums.
A Roth conversion or IRA withdrawal in 2024 can push your 2026 premiums into a higher IRMAA tier. If your income dropped in 2025 due to retirement, you can appeal using Form SSA-44, a step many people don’t know exists.
If you’re in Medicare Advantage today and haven’t thought about IRMAA, now is the time. Income planning in the years around Medicare eligibility, managing Roth conversions, capital gains timing, and IRA withdrawals, can make a meaningful difference in what you pay. This is where a financial advisor earns their keep.
Source: Kiplinger — IRMAA Brackets and Surcharges 2026
“The guaranteed issue window is one of the most powerful protections in Medicare and one of the least-known. For someone with pre-existing conditions, it can mean the difference between full Medigap coverage and being turned down entirely.”
5
What Happens to Your Drug Coverage, and Does the New $2,100 Cap Change the Math?
One of the biggest arguments against Original Medicare in years past was drug coverage: you had to buy a standalone Part D plan, and costs could spiral into thousands before catastrophic coverage kicked in. That math has changed.
Thanks to the Inflation Reduction Act, the out-of-pocket cap on covered Part D drug costs dropped to $2,000 in 2025, and is $2,100 in 2026, adjusted for inflation going forward. Once you hit that cap, covered drugs cost you nothing for the rest of the year. The “donut hole” coverage gap is gone.
This cap applies equally whether your drug coverage comes through a standalone Part D plan (the Original Medicare route) or through a Medicare Advantage plan with built-in drug coverage. So the playing field is more level than it used to be.
If you switch to Original Medicare, you’ll need a standalone Part D plan. You’ll have a Special Enrollment Period to pick one when you leave Medicare Advantage, so you won’t face a late enrollment penalty. The average standalone Part D premium is around $34.50 per month in 2026.
Run your current medications through the Medicare Plan Finder at Medicare.gov. It estimates your annual drug costs across specific plans based on your exact prescriptions and preferred pharmacy. Premium alone is a poor guide, a plan with a low premium may charge more for your specific drugs.
Source: CMS — Final CY 2026 Part D Redesign Program Instructions | Medicare.gov — Part D Costs
6
Will You Lose Benefits That Original Medicare Doesn’t Cover?
Medicare Advantage plans often bundle dental, vision, hearing, and over-the-counter allowances. Original Medicare doesn’t cover any of those. If you rely on those benefits, switching means either going without or paying for separate coverage.
This is where the math gets personal. A generous dental benefit that you actually use, annual cleanings, X-rays, maybe a crown, has real dollar value. An OTC allowance you’ve been spending on hearing aid batteries and pain relievers adds up too. Before switching, tally what you’ve actually received and used from your Advantage plan’s extra benefits, not just what was advertised.
That said, in 2026 a smaller share of Medicare Advantage plans are offering over-the-counter allowances and post-hospital meal benefits than in previous years. Plans have been cutting extras as their margins tighten. If your plan already stripped those benefits, this trade-off may be less significant than it once was.
Source: KFF — Medicare Beneficiaries Affected by Plan Terminations, March 2026
7
Do You Live in a Rural Area Where the Calculus Is Different?
KFF’s March 2026 analysis found that Medicare Advantage plan terminations hit rural counties disproportionately hard. While rural beneficiaries made up just 14% of MA-PD enrollment in 2025, they accounted for nearly 23% of those in plans that were terminated. In some rural states, the share of Medicare Advantage enrollees affected exceeded 60%.
If you live in a rural county and your plan was terminated, you may find that your replacement Advantage plan options are thin or that the remaining plans have narrow networks that don’t include the providers nearest you. Original Medicare, paired with a Medigap policy, offers nationwide acceptance and no network restrictions. For rural beneficiaries who travel for specialty care or who see providers across county lines, that flexibility can be worth more than bundled extras.
On the flip side: Original Medicare’s cost-sharing model means you pay 20% of approved costs after the Part B deductible, with no out-of-pocket maximum unless you add Medigap. A serious illness without a supplement could expose you to significant costs.
Source: KFF — Medicare Beneficiaries Affected by Plan Terminations, March 2026
8
What’s the Right Sequence, and What Happens If You Get It Wrong?
This is where it gets tricky. The order in which you take action determines what rights you have. Get it wrong and you could accidentally waive the guaranteed issue protections that would let you buy Medigap without medical underwriting.
Don’t disenroll from your Medicare Advantage plan before receiving the official termination notice if your plan is being discontinued. Your guaranteed issue rights are tied to the plan’s formal termination date. Leaving early on your own could change what protections apply.
A few things worth knowing about the sequence:
Don’t default into a CMS-assigned replacement plan without understanding your Medigap options first. When a plan terminates, Medicare may auto-enroll you in another Advantage plan. You have the right to decline that and pursue Original Medicare + Medigap instead, but you need to act within the enrollment windows.
You can apply for Medigap before your coverage ends. Under federal rules, you can apply as early as 60 days before your coverage ends. You don’t have to wait until you’re officially on Original Medicare to start the process.
Enroll in a Part D plan at the same time you transition. Returning to Original Medicare without drug coverage, even briefly, can trigger a late enrollment penalty that adds permanently to your monthly premium, 1% of the national base beneficiary premium ($38.99 in 2026) for every month you were without creditable coverage.
Source: Medicare.gov — Medigap Ready to Buy | California Health Advocates — Guaranteed Issue Rights
Common Questions
What is guaranteed issue and why does it matter for Medicare Advantage enrollees?
Guaranteed issue is a legal protection that prevents insurance companies from denying you a Medigap policy or charging you more based on your health history. Normally, outside of your initial 6-month Medigap enrollment period, insurers in most states can use medical underwriting, turning you down or charging higher premiums if you have conditions like diabetes, heart disease, or cancer. If your Medicare Advantage plan was terminated through no fault of your own, federal law gives you a guaranteed issue right within 63 days of your coverage ending, allowing you to buy a Medigap policy without any health screening.
How long do I have to switch from Medicare Advantage to Original Medicare if my plan was terminated?
You have 63 days from the date your coverage ends to exercise your guaranteed issue rights and apply for a Medigap policy. This window starts when coverage actually stops, not from when you received the termination notice. For most people whose coverage ended December 31, 2025, that window expires in early March 2026. You also have a Special Enrollment Period to choose a new Medicare plan and a standalone Part D drug plan. Contact your State Health Insurance Assistance Program (SHIP) at no cost if you’re unsure where you stand.
If I switch to Original Medicare, do I have to buy a Medigap plan?
No, Medigap is optional, but without it, Original Medicare leaves meaningful gaps. You’re responsible for the Part A deductible ($1,736 per benefit period in 2026), 20% coinsurance on Part B services with no annual out-of-pocket cap, and other cost-sharing. Without a supplement, a serious illness or extended hospital stay could expose you to significant costs. Most people who switch to Original Medicare from Advantage add a Medigap plan for this reason.
Does the new $2,100 Part D cap apply if I’m on Original Medicare with a standalone Part D plan?
Yes. The $2,100 annual out-of-pocket cap on covered prescription drugs in 2026 applies to all Part D plans, whether that’s a standalone Part D plan (which you’d use with Original Medicare) or the drug coverage built into a Medicare Advantage plan. Once your covered drug costs reach $2,100 for the year, your plan pays 100% of covered drug costs for the rest of the calendar year. This cap was introduced in 2025 under the Inflation Reduction Act and replaced the old “donut hole” structure.
Source: Medicare.gov — Part D Costs
What is IRMAA and could it make Original Medicare more expensive than it looks?
IRMAA (Income-Related Monthly Adjustment Amount) is a surcharge added to your Medicare Part B and Part D premiums if your income exceeds certain thresholds. In 2026, the surcharge applies to single filers with 2024 income above $109,000 (or married couples above $218,000). IRMAA uses a cliff system: crossing a threshold by just one dollar triggers the full surcharge for that tier. Because IRMAA is based on income from two years prior, thoughtful planning around Roth conversions, capital gains, and IRA withdrawals can help manage exposure. If your income dropped significantly due to retirement or another life event, you may be able to appeal using Form SSA-44.
Source: Kiplinger — Medicare Premiums 2026: IRMAA Brackets and Surcharges
Rules of thumb only get you so far with Medicare. The right answer depends on your doctors, your medications, your income, and your health history, and it also depends on timing that can close on you quickly. If you’d like to talk through how any of this applies to your specific situation, the team at Madison Partners is happy to have that conversation. No pressure, no agenda, just a clear look at your options.
This content is for educational purposes only and should not be considered financial, tax, legal, or investment advice. Individual circumstances vary, and readers should consult with a qualified financial advisor, tax professional, or attorney before making decisions based on this information. Madison Partners does not guarantee the accuracy of third-party data cited herein.
