What I Learned Trying to Leave an Employer-Sponsored Medicare Advantage Plan

A Cautionary Tale: What I Learned Trying to Leave an Employer-Sponsored Medicare Advantage Plan

This is the story of a friend I helped when she tried to move from her employer’s Group Medicare Advantage plan to Original Medicare and a Supplement. Her experience is a cautionary tale.

I want to share this story because I don’t want others to go through the stress, confusion, and sleepless nights that we did.

When I retired, the company I worked for offered my husband and I a Medicare Advantage plan ,along with a $50,000 Future Health Account credit.  This credit could only be used for this specific Group Medicare Advantage plan.   It sounded like a great deal. For almost three years, that account covered all our premiums and most out-of-pocket expenses. The plan had a $750 maximum for each of us and worked fine—at first.

But then, almost by accident, I learned that the premiums for 2026 were going to nearly double. No letter. No notification. Nothing. I only found out because I called to ask.

That was the moment I realized how vulnerable we really were.

Trying to Switch: Where the Stress Began

We decided to look into moving to Original Medicare + a Supplemental Plan (Medigap). We wanted to be able to go to the top hospitals and see the best specialists if we needed care. 

We started working with an agent who walked us through the Medicare landscape. It was helpful—I knew I would need to pass the medical underwriting requirement, and initially I thought I would be able to do so.

To switch to a Medigap plan outside your initial window, you must “pass” medical underwriting in most states:

• The questionnaire was one page.  It seemed pretty simple at first. Since I had chronic asthma, my Medicare insurance agent thought only one plan – United American would take me.

• They look at your medical records.

• Even one note or referral buried in your chart can change everything.

I decided to double check my medical records myself and it is a good thing I did.

My doctor had pre-authorized knee surgery if injections didn’t work. Even though I’m doing great with injections and feeling fine, that note alone could have meant future claims could be denied under a medically underwritten plan.  The insurance companies will go back through your records to try to deny your large claims.

That realization stopped me in my tracks.

The Confusion and the Fear

The agent believed that if I dropped my corporate Group Medicare Advantage plan, my husband would be automatically dropped as well and would receive Guaranteed Issue for a Medigap plan (meaning no underwriting required). He said this confidently.

But I needed it in writing. The corporation I had worked for outsourced all of the retiree benefits to a third party.   I could not call my previous employee for any information.  I had to talk to the third party  and my Medicare Advantage provider. 

I made:

• Five phone calls

• Spoke to five different representatives

• Received five conflicting answers

No one would put anything in writing.

Every call left me more anxious. I didn’t want to gamble with our healthcare. I didn’t want one wrong move to leave us at risk or uninsured.

That is when the panic started to set in.

 

I was luckier than most.

This is where learning my state’s Medigap protections changed everything.  By poor dumb luck, I found out that Illinois had a small loophole with one insurance company.

Because of a special  Illinois rule, people 65 and older can get Medigap coverage each year without medical underwriting, but only through the specific higher-cost Blue Cross Blue Shield of Illinois plan.

This meant:

• We didn’t have to pass the medical underwriting.

• We could get Blue Cross Blue Shield of Illinois directly.

• We could stop depending on my previous employer, the third party and my Medicare provider for answers they wouldn’t give us.

And something else we didn’t know:
I can reapply anytime during the year.  If my knee improves, or even if I go through surgery, after surgery and PT, I can pass the medical questions and qualify for a lower premium. That flexibility does not exist with Medicare Advantage.

The Emotional Reality

This process wasn’t just confusing—it was scary.

We felt:

• powerless against large insurance companies

• unsure who to trust

• afraid of making one wrong move that could cost us access to care later

I had to make all of my decisions and get through this process by December 7th- the end of Medicare Open Enrollment.   If I made the wrong decision, we could lose our healthcare.

It should not be this hard.

Where We Landed

We are approved for the BCBS of Illinois Medigap plan beginning January 1, 2026.

Yes, we are paying a slightly higher premium today.

And it is still about $700/year less than staying in the Employers  Medicare Advantage plan once the new premiums hit.

More importantly:

• We can go to any  hospital and see any specialist without prior approval.  This is better than the insurance I had while employed.

• We are no longer at the mercy of yearly plan changes. Nearly 1 in 5 health systems—about 20%—stopped accepting one or more Medicare Advantage plans just in the past year. 

 

• We can relax, knowing we won’t face a surprise denial when we need care most.

 

What I Want Others to Know

1. Employer subsidized  Medicare Advantage plans feel generous—but they can become golden handcuffs.
   Once health changes, switching may be impossible.
2. Check your medical records before answering underwriting questions.
   What’s written there can change everything.   Insurance companies may go through your records to deny claims and increase profits.
3. Only you can decide whether the extra cost is worth having the freedom to go to the top hospitals and the best specialists without needing prior approval.

The Lesson

We were lucky—truly lucky—to get out when we did.

Many people don’t realize that Medicare Advantage is easy to get into but can be very hard to get out of once real health issues begin.

If I could give just one message to anyone approaching Medicare:

Do not choose based on today’s health.
Choose based on what you will need when you are sick.

Because that is when the differences matter most

If you’d like to make the best Medicare decision for you or your parents watch Medicare:What the insurance companies won’t tell you.