Switching from Medicare Advantage to Plan G in California: What You Need to Know

Switching from Medicare Advantage to Plan G in California: What You Need to Know

At our Farmers Insurance agency in Ontario, California, we understand how complex and urgent Medicare decisions can feel—especially when dealing with serious health issues like a loved one's stage 4 cancer diagnosis. We've been hearing a lot of questions from clients recently about switching from a Medicare Advantage HMO (like Kaiser) to a Medicare Supplement Plan G, particularly here in California.

Here’s what you should know:

Yes, the "Guaranteed Issue" Window Is Real

If you're unhappy with your current Medicare Advantage plan, such as Kaiser’s HMO, and you want to switch to a Medicare Supplement (like Blue Shield’s Plan G Extra), there are circumstances where underwriting may be bypassed.

In California, if your Medicare Advantage plan:

  • Does not offer a supplemental plan, and
  • Increases costs in the Annual Notice of Change (such as higher copays for DME or medical services),

...you may be eligible for Guaranteed Issue rights. This means Blue Shield (or another carrier) can’t deny coverage or raise rates due to preexisting conditions.

One user mentioned using "Situation 17" on the Blue Shield application for this exact reason. And yes, we’ve seen this work.

Here’s the Blue Shield Guaranteed Issue Reference Guide (PDF)

Kaiser Members Wanting to Switch

If your current plan is with Kaiser SoCal, and you’re facing:

  • Delays in diagnosis or treatment
  • Restricted provider networks (wanting access to UCLA, City of Hope, etc.)

...then a PPO Medicare Advantage or Supplement Plan G may give you broader access and flexibility. Just know that the timeline is tight—the Annual Election Period ends December 7.

What If You're Denied Plan G?

If underwriting applies and your mom is denied Plan G due to health conditions, the next best move is to look at PPO Medicare Advantage plans like those from Humana or Aetna. These tend to:

  • Offer nationwide provider access
  • Let you see almost any Medicare-accepting doctor
  • Have a higher out-of-pocket max, but more freedom

Other Options Beyond Kaiser

If you're looking to move from Kaiser to another Medicare Advantage (MA) plan, you’re not limited. Some families have had strong experiences with plans like Anthem—and UCLA now offers a UCLA Health Medicare Advantage Plan that employees and insiders are speaking highly of.

If switching to a Medicare Supplement isn’t possible due to underwriting, a high-quality MA PPO plan could still give your mom more provider options without the limitations of an HMO structure.

What’s New in the News?

The 2025 Medicare Advantage Annual Notices from several providers are showing increases in copays and DME costs. This could open the door to more Guaranteed Issue opportunities for Californians looking to move into a Supplement.

We recommend calling the insurance carrier directly—Blue Shield’s Medicare team is helpful and can confirm your eligibility before submitting an application.

Medicare decisions aren’t one-size-fits-all. At Farmers Insurance in Ontario, CA, we help families across California make smart, fast decisions—especially when time is critical. Whether you're switching to a supplement or trying to find a PPO that gives you real access, we’ll help you understand your rights and fight for the coverage your loved one deserves.

Need guidance? Give us a call today. Farmers Insurance – Young Douglas Agency
Ontario, CA

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