At 71, She Wanted Out of Medicare Advantage. These 3 Health Questions Stopped Her.

Medicare Advantage exits are less straightforward in 2026

More than half of eligible beneficiaries now get Medicare through private plans, and the Medicare Advantage penetration rate remains at 55%. That makes 2026's shake-up feel larger than it might otherwise: CMS expects nearly one million beneficiaries to leave MA as insurers cut back, and the average beneficiary now sees only 32 MA-PD plans, down from 36 at the 2024 peak. In other words, more people are being pushed to reconsider coverage just as choice has tightened slightly.

The bigger risk is not picking a new MA plan. It is leaving MA for Original Medicare after your health has changed. If you buy a Medigap policy outside your initial open enrollment window, insurers may require medical underwriting, meaning they can review your health status and charge you more or decline your application. That is why timing matters. If you are unhappy with your MA plan, waiting can turn a seemingly simple switch into a coverage problem.

Medigap underwriting is the real gatekeeper

Her six-month open enrollment window is the only time insurers must accept her without question. Once that window closes, guaranteed issue protection is gone, and outside it insurers can review medical history and decide whether to issue a policy and at what price. That is the key mechanism to understand: the health questions are not formalities. They can affect both availability and cost.

What the underwriting questions are testing

The application breaks into a few main areas:

• Current care needs: The form asks whether she is hospitalized, confined to a nursing facility, bedridden, or needs a wheelchair or motorized mobility aid, and whether she is receiving hospice, home health care, or physical therapy.
• Diabetes and major medical history: It then asks about diabetes treatment, as well as history of heart attack, stroke, or kidney disease.
• Serious conditions: The application also widens to a longer list that can include transplants, amputations, dementia, oxygen-dependent lung disease, and other major conditions.

These questions are how insurers screen for higher expected healthcare use when Medicare Supplement coverage is not being issued on a guaranteed-issue basis.

Why state rules and health status both matter

Take the Wisconsin retiree whose cardiologist's office said the local hospital system will no longer be in-network for her Humana MA plan starting next January. Her first thought may be to switch to Original Medicare and buy Medigap, but that backup option is not automatically open. As Federal law doesn't require companies to sell Medigap policies to people under 65, younger enrollees can face a thinner safety net, and state rules also vary for people with disabilities or ESRD.

That is why timing matters before network changes or health changes make the decision more complicated.

If you want out, protect the backup coverage first

The practical mistake is not leaving Medicare Advantage. It is leaving it without secured backup coverage. Before canceling MA, it makes sense to explore Medigap first. A Medigap denial would not remove her from her current MA plan, but canceling MA before securing supplement coverage could leave her exposed if underwriting becomes a barrier.

There are two main switch windows to know. The fall window runs Oct. 15 to Dec. 7, and changes made then generally take effect January 1 of the following year. The spring window runs Jan. 1 to March 31, and coverage usually starts the first of the month after the plan receives the request. If she moves to Original Medicare and wants prescription drug coverage, she also needs a stand-alone Part D plan to avoid a possible late-enrollment penalty.

The real stress test is not the premium alone. In 2026, MA out-of-pocket caps are $9,250 in-network and $13,900 for PPOs; those limits exclude Part D drugs. So even a plan with a capped cost share can still become expensive when medications are accounted for.

Before making a switch, compare three things together: network access, total expected costs, and whether Medigap is likely to be available on acceptable terms.