Switching Between Medicare Advantage and Original Medicare for 2027: What Fresno Seniors Should Know
By Dr. Harman Virk, DO — Board‑Certified Internal Medicine, The Modern Medicine Group (Fresno, CA)
Medical disclaimer: This article is educational and not medical advice. If symptoms are severe, worsening, or you’re worried—seek urgent care or call 911.
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Quick Take
With many Medicare Advantage plans cutting benefits or leaving areas for 2027, more Fresno seniors are asking whether to switch to Original Medicare, or the other way around.
You can switch either direction during Open Enrollment, October 15 – December 7, 2026. Medicare Advantage members get one more chance January 1 – March 31, 2027.
The biggest catch: in California, a Medigap plan may require health questions if you leave Medicare Advantage, unless you have a guaranteed-issue right.
If you leave Medicare Advantage, you'll usually need a separate Part D drug plan, too.
Plan the switch in the right order so you're never without coverage.
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Table of Contents
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1) Why More Fresno Seniors Are Rethinking Their Choice for 2027
For 2027, many patients are asking us: "Should I stay in Medicare Advantage?" Here's why:
Plans are pulling back. Many insurers are raising out-of-pocket maximums, adding drug deductibles, trimming extra benefits, or leaving some counties. California has 394 Medicare Advantage plans for 2027, down from 402.
California premiums are rising. The average Medicare Advantage premium in California is going up, from $13.77 to $14.12.
Flex cards are more restricted. Benefit cards must now be limited to eligible items. Other purchases will be declined at the register.
Networks have changed locally. In 2026, contract disputes between Community Health System and some health plans temporarily left Fresno patients out of network.
No mid-year exit if your doctor leaves. A proposed rule to allow switching plans when a doctor leaves the network was not approved.
None of this means Medicare Advantage is wrong for you. But 2027 is a good year to look before you renew.
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2) Quick Recap: The Two Paths
Original Medicare (Parts A & B):
See any doctor or hospital in the U.S. that accepts Medicare, usually with no referrals.
There's no yearly out-of-pocket limit unless you add a Medigap plan.
Drug coverage comes from a separate Part D plan.
Medicare Advantage (Part C):
A private plan with a network, an out-of-pocket maximum, and usually built-in drug coverage and extra benefits.
Often uses referrals and prior authorization.
For a doctor's view of how each option affects your care, read our guide: Medicare Advantage vs. Original Medicare: What Matters Clinically
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3) Switching From Medicare Advantage to Original Medicare
If you're considering leaving Medicare Advantage for 2027, think about these three
pieces:
1. Original Medicare (Parts A & B): You return to it automatically when you leave Medicare Advantage.
2. A Part D drug plan: Choose one when you switch. If you go without drug coverage for 63 days or more, you may face a late enrollment penalty.
3. A Medigap (Medicare Supplement) plan: Optional, but it covers most of the deductibles and 20% coinsurance that Original Medicare leaves to you.
Do it in this order:
1. Apply for Medigap first and get approved, if you want one.
2. Enroll in a Part D plan during Open Enrollment. Enrolling in a standalone Part D plan automatically ends your Medicare Advantage plan on January 1.
3. Confirm your doctors accept Original Medicare, and keep your plan's ID card until January 1.
Projected 2027 costs on Original Medicare (final figures are expected from Medicare in the fall):
Part B premium: about $209.50/month
Part B deductible: about $292
Part D: the out-of-pocket cap is $2,400 for 2027, and the deductible can be up to $700
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4) The Medigap Question in California
This is the part most people don't know about until it's too late.
Outside of special situations, Medigap insurers can ask health questions. They may deny coverage or charge more if you have health conditions.
You have a guaranteed right to buy certain Medigap plans, with no health questions, in situations like these:
Your Medicare Advantage plan is leaving your area or ending.
You joined Medicare Advantage when you first got Medicare at 65, and you're still within your first 12 months.
You dropped a Medigap plan to try Medicare Advantage for the first time, and you're within 12 months.
California's Birthday Rule: If you already have a Medigap plan, you can switch to another Medigap plan with equal or lesser benefits within 60 days starting on your birthday, every year, with no health questions.
Before you leave Medicare Advantage, talk with HICAP, Fresno's free, unbiased Medicare counseling program: (559) 224-9117 or 1-800-434-0222.
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5) Switching From Original Medicare to Medicare Advantage
Some people go the other way, from Original Medicare to Medicare Advantage, usually for lower monthly costs or extra benefits. Before you switch:
Check the network: your primary care doctor, medical group, specialists, and hospital.
Check your drugs on the plan's 2027 drug list.
Compare worst-case costs. Look at the plan's out-of-pocket maximum, not just the $0 premium.
Think hard before dropping Medigap. If Medicare Advantage doesn't work out after your first-time trial year, getting Medigap back may require health questions.
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6) Your Switching Deadlines for 2027
October 15 – December 7, 2026: Switch in either direction. Changes start January 1, 2027.
January 1 – March 31, 2027: Medicare Advantage members only. You can switch to another Medicare Advantage plan or to Original Medicare (and add Part D), one time.
If your plan is ending: You have a special window through the end of February 2027.
Medigap Birthday Rule: 60 days starting on your birthday, every year.
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7) Frequently Asked Questions
If I leave Medicare Advantage, do I have to get a new drug plan?
Usually, yes. Most Medicare Advantage plans include drug coverage. Without a Part D plan, you'd have no drug coverage and could face a late penalty later.
Can I be turned down for Medigap in California?
Yes, if you apply outside a guaranteed-issue situation. Check your rights with HICAP before you switch.
Will Original Medicare cost more than my $0 Medicare Advantage plan?
Often, yes, each month. But it may cost less in a year with heavy medical use. Compare total yearly cost and worst-case cost.
I switched last year and regret it. Can I switch back?
Yes, during Open Enrollment. If you're in your first year of Medicare Advantage, you may also have a guaranteed right to Medigap.
Will I have to change doctors?
Not if your doctors accept Original Medicare, or are in your new Medicare Advantage plan's network. Always confirm with the office.
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Fresno CTA — The Modern Medicine Group
Switching between Medicare Advantage and Original Medicare is one of the biggest decisions you can make during Open Enrollment. The right choice depends on the doctors, medications, and care you actually use.
Before December 7, make sure your 2027 coverage includes your primary care doctor, specialists, hospital, and prescriptions.
The Modern Medicine Group sees patients with Original Medicare and most major Medicare Advantage plans. We help Fresno seniors with medication lists, chronic-condition care, and Annual Wellness Visits. Call us to confirm whether a specific plan and medical group are accepted by our office.
Visit: 7053 N. Cedar Ave., Fresno, CA 93720
Phone: 559-369-7787
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