What Happens If You Do Nothing When Your Medicare Plan Leaves

If a Medicare Advantage plan is ending

With no action from you, you generally revert to Original Medicare on January 1. Doctors and hospitals that accept Medicare will see you, and in some ways your access widens rather than narrows, because you are no longer limited to a network.

Two things you had are gone, though. Any extra benefits the plan bundled in end with the plan. And unless the plan included drug coverage that gets replaced, you may have no prescription coverage at all — which leads to the section below.

There is also no out-of-pocket maximum in Original Medicare. Medicare Advantage plans are required to cap your annual spending; Original Medicare on its own is not. That cap is a large part of what a Medigap policy is bought to replace, and it is why the guaranteed-issue window matters so much here.

If a Part D drug plan is ending

This is the version that costs money quietly. With no action, most people simply end up with no drug coverage on January 1 — no reassignment, no replacement, nothing.

Going without creditable prescription coverage for 63 days or more starts the Part D late enrollment penalty accruing. It is calculated per month you went uncovered, it attaches to your premium once you do enroll, and for most people it is permanent — it does not stop when you finally sign up. Our guide to how the Part D penalty is calculated covers the arithmetic.

One exception: people receiving Extra Help — the low-income subsidy — are generally reassigned by CMS to another drug plan rather than left without coverage. If you get Extra Help, watch for a reassignment letter, and check that the plan you were moved into actually covers your medications. Being placed somewhere is not the same as being placed somewhere suitable.

The trap that is not really 'doing nothing'

Sometimes a non-renewal is not a clean exit. The insurer discontinues one plan and moves its members into a different plan it still offers — a consolidation, sometimes called a crosswalk. If that happens to you, doing nothing means you wake up in January enrolled in a plan you never chose.

It is not necessarily a bad plan. But it was selected because it was the insurer's nearest equivalent, not because anyone checked it against your cardiologist and your medication list. A different network and a different formulary are entirely possible.

Read your letter carefully for which of the two situations you are in. Language about being 'automatically enrolled' or 'moved to' another plan means a crosswalk. If you are being moved, you still have every option described in the three paths — you simply have to exercise one rather than accept the default.

The door that closes permanently

Everything above is recoverable. You can enroll in a drug plan later and pay the penalty. You can join a Medicare Advantage plan at the next Annual Enrollment.

One thing is not recoverable. The guaranteed-issue right to buy a Medigap policy that a plan termination can open runs for a fixed number of days and does not come back. Let it lapse and, in Utah as in most states, a Medigap insurer can review your health history and decline you — this year and every year after.

So of everything on the list, that is the one to decide about first, even if you decide against it. Doing nothing about the drug plan costs money. Doing nothing about the Medigap window can close an option for good. The guaranteed-issue guide has the exact timing, and the deadline order shows how it sits against the enrollment windows.

The smallest useful action

If you take one step, take this one: open medicare.gov/plan-compare, enter your ZIP code and your actual prescriptions, and look at what is available. It costs nothing, requires no appointment, and turns an anxious letter into a short list.

If it raises a question rather than answering one, 1-800-MEDICARE (1-800-633-4227) is staffed around the clock, and your state's Health Insurance Assistance Program gives free one-on-one counseling and sells nothing at all.