Can a Medicare Advantage Plan Drop You? What Utahns Should Know

Sources: 42 CFR § 422.74 – Disenrollment by the MA organization · Medicare.gov – Special Enrollment Periods

This guide is for Utahns with Medicare who are in a Medicare Advantage plan, or thinking about one, and want to know whether a Medicare Advantage plan can drop you. It covers when coverage can and can’t end, the Special Enrollment Periods that follow, the notices you’ll get, how Medigap timing works if you choose Original Medicare, and what to do here in Utah.

Did the question “can a Medicare Advantage plan drop you?” come up because you got a letter saying your plan is ending for 2027? Go straight to Medicare Advantage plan ending in Utah for 2027.

Can a Medicare Advantage plan drop you for health reasons? No

Can a Medicare Advantage plan drop you after a diagnosis? The rule

Federal rules list the only reasons a Medicare Advantage plan may end your enrollment, and your health isn’t one of them. Outside those reasons, a plan may not disenroll you, and it can’t ask or encourage you to leave, in writing, out loud, or “by any action or inaction.” Plans also can’t deny, limit or condition coverage based on health status. (42 CFR § 422.74(a) · 42 CFR § 422.110)

What that means for you

So can a Medicare Advantage plan drop you for getting sick? No. A cancer diagnosis, a surgery, a hospital stay or expensive drugs can’t get you dropped. Your plan’s costs and benefits can change from one year to the next (you’ll see those changes in your Annual Notice of Change), but changes apply to everyone in the plan, not just to you.

If you think a plan is pressuring you to leave, call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) or Utah’s SHIP at 1-800-541-7735.

When can a Medicare Advantage plan drop you? 5 situations

1. The plan leaves your county, your service area or Medicare

A plan can stop serving part of its area, such as your Utah county, or not renew its Medicare contract at all. Everyone affected is disenrolled, not just you. (42 CFR § 422.74(b)(3))

2. Non-renewal or a contract that ends

A plan that won’t renew must tell each member by mail at least 90 calendar days before the non-renewal takes effect. For coverage ending December 31, that means the notice comes in early October. The notice must also explain your other options. (42 CFR § 422.506)

3. You move out of the plan's service area

Medicare Advantage plans are tied to where you live. A plan must disenroll you if you no longer live in its service area. That includes being away more than 6 months in a row, unless the plan offers a visitor or travel option. Moving from Salt Lake County to another state, or between Utah counties with different plans, can trigger this. (42 CFR § 422.74(b)(2), (d)(4))

4. You lose eligibility, for example for a D-SNP

A Dual Eligible Special Needs Plan (D-SNP) is for people with both Medicare and Medicaid. If your Medicaid ends, the plan must disenroll you, but not right away. It must send an advance notice at least 30 days ahead, give you a chance to prove you’re still eligible, and tell you about any period of deemed continued eligibility it offers while you try to get Medicaid back. You’ll also be disenrolled if you lose Part A or Part B. (42 CFR § 422.74(b)(2), (d)(8)) Utahns can check Medicaid income rules on Medicaid income limits in Utah.

5. You don't pay a plan premium

If your plan has a monthly premium and you don’t pay it, the plan may disenroll you, but only after a grace period of at least 2 full calendar months and a written notice. (42 CFR § 422.74(d)(1)) Remember, you still need to pay your Part B premium to stay in any Medicare Advantage plan.

Rarer reasons in the same rule include fraud on the enrollment form and seriously disruptive behavior, which needs CMS approval first.

If a Medicare Advantage plan drops you: your Special Enrollment Periods

Losing a Medicare Advantage plan doesn’t take away your Medicare. Each situation comes with its own window to choose new coverage. If you don’t join another Medicare Advantage plan in time, you’re enrolled in Original Medicare, and if your plan included drug coverage, you may lose it unless you join a Part D plan. (Medicare.gov – Special Enrollment Periods)

These dates come from Medicare.gov. Your notice will say which one applies to you. Compare your choices on the Medicare Open Enrollment Utah page. For other life events, see Medicare Special Enrollment Period.

If a Medicare Advantage plan drops you and you choose Original Medicare

When you can apply for a Medigap policy

If your Medicare Advantage plan is leaving Medicare or stops serving your area, and you choose Original Medicare instead of another Medicare Advantage plan, you may have a guaranteed issue right to buy certain Medigap plans. In that case, a company can’t turn you down, charge more because of your health or make you wait to cover a pre-existing condition. You can generally apply as early as 60 days before your Medicare Advantage coverage ends and no later than 63 days after it ends, and your plan’s notice may list your dates. A Medigap policy can’t start until your Medicare Advantage coverage ends, so keep your plan’s letters in case you need to show why your coverage ended (Medicare.gov – Medigap guaranteed issue rights).

If your coverage ended for another reason, such as not paying premiums, you can still apply for a Medigap policy at any time, but timing matters. Outside your Medigap Open Enrollment Period, a Medigap company may ask health questions, charge more or turn you down. (Medicare.gov – When can I buy Medigap?)

Plans C and F aren’t available to people who became eligible for Medicare on or after January 1, 2020. If you were eligible for Medicare before January 1, 2020, you may still be able to buy Plan C or Plan F.

Lining up your coverage dates

• A Medigap policy can’t start until your Medicare Advantage coverage ends. Ask for the policy to start the day after so you don’t have a gap.
• Add drug coverage too. Original Medicare alone doesn’t cover most outpatient drugs, so you’ll want a Part D plan or other creditable drug coverage. A gap of 63 days or more without creditable drug coverage can mean a Part D late enrollment penalty, which usually lasts as long as you have Part D. (Medicare.gov – Part D costs)

Not sure which route fits? See Medicare Advantage vs Medicare Supplement, Medigap Open Enrollment Period and Medicare Supplement plans in Utah.

The notices you'll get before a Medicare Advantage plan can drop you

• Annual Notice of Change (ANOC): every fall, usually in September. Your plan continues, but costs or benefits may change in January. (Medicare.gov – Plan Annual Notice of Change)
• Plan Non-Renewal Notice: usually in October. Your plan is leaving Medicare or your area, so you need new coverage for next year. It must be sent at least 90 days before coverage ends and explain your options. (Medicare.gov – Plan Non-Renewal Notice · 42 CFR § 422.506)
• Premium past-due notice: if a plan premium goes unpaid, you get a written notice that starts at least a 2-month grace period, then a disenrollment notice if it’s still unpaid. (42 CFR § 422.74(d)(1))
• Loss of special needs status (D-SNP or other SNP): an advance notice at least 30 days before disenrollment, sent within 10 days of the plan learning about the change, then a final notice. (42 CFR § 422.74(d)(8))
• Out-of-area notice: if the plan learns you’ve moved or been away too long, it notifies you before disenrolling you.

Keep every letter. The dates on the notice tell you how long you have to choose new coverage, and the notice can help show that you have a guaranteed issue right if you apply for a Medigap policy.

What happened to your plan? Find your window

Pick what happened to your plan to see the window from the table above and the notice you can expect, using Medicare.gov’s dates and the federal rules.

What to do in Utah if a Medicare Advantage plan drops you

1. Read the notice and find the end date. It will tell you why and when the plan can drop you. Write down the last day of coverage and the deadline for your Special Enrollment Period.
2. Check what’s available in your county. Options differ across Utah’s counties. Use the Medicare.gov Plan Finder or call 1-800-MEDICARE. Learn the basics in What is Medicare Part C? and on our Medicare Advantage plans page.
3. Decide on a route: another Medicare Advantage plan, or Original Medicare with a Part D plan and an optional Medigap policy.
4. If you want Medigap, check the timing. If your plan is leaving Medicare or your area, or you moved out of its service area, you may have a guaranteed issue right to buy certain Medigap plans; you can generally apply no later than 63 days after your Medicare Advantage coverage ends. Otherwise, a Medigap company may ask health questions, charge more or turn you down outside your Medigap Open Enrollment Period. Ask for the policy to start when your Medicare Advantage coverage ends.
5. Don’t skip drug coverage. Original Medicare alone doesn’t cover most outpatient drugs.
6. Moving? Tell your plan before you move so your window starts a month early.
7. Lost Medicaid? Contact Utah Medicaid about getting coverage back, and watch the 3-month window.
8. Get neutral help. Utah’s Senior Health Insurance Information Program (SHIP) offers counseling, and SHIP counselors don’t charge for their help: 1-800-541-7735 (Utah DHHS Aging & Adult Services).

I’m Fores Boo, a licensed independent Medicare agent (NPN 17255694) with Boo Insurance Services in Draper, licensed since 2014. We’ve helped 1,000+ Utahns with Medicare and have 170+ 5-Star Google Reviews. We can read your notice with you and map out your dates by phone or video, with no obligation.

Talk through your notice with a local agent

Frequently asked questions

Find more Medicare questions answered.

Can a Medicare Advantage plan drop you because you're sick?

No. Federal rules don’t allow a Medicare Advantage plan to end your coverage because of your health, how much care you use, or a pre-existing condition. A plan can only disenroll you for specific reasons, like leaving your area, your move, losing eligibility, or unpaid plan premiums after a grace period.

What happens if my Medicare Advantage plan leaves my county?

You’ll get a non-renewal notice at least 90 days before coverage ends. You can join another plan during Open Enrollment or a Special Enrollment Period that runs December 8 through the end of February. If you don’t choose one, you’re enrolled in Original Medicare, and if your plan included drug coverage, you may lose it unless you join a Part D plan. Because your plan is leaving your area, you may also have a guaranteed issue right to buy certain Medigap plans; you can generally apply as early as 60 days before your coverage ends and no later than 63 days after it ends.

When can I buy a Medigap policy after my plan ends?

If your plan is leaving Medicare or stops serving your area and you choose Original Medicare, you may have a guaranteed issue right to buy certain Medigap plans. You can generally apply as early as 60 days before your coverage ends and no later than 63 days after it ends. In other situations, you can apply at any time, but outside your Medigap Open Enrollment Period a Medigap company may ask health questions, charge more or turn you down. A Medigap policy can’t start until your Medicare Advantage coverage ends.

Can a Medicare Advantage plan drop you for not paying the premium?

Yes, but only after a grace period of at least 2 full calendar months and a written notice. Your Part B premium also has to stay paid for you to remain in any Medicare Advantage plan.

What if I lose Medicaid while I'm in a D-SNP?

The plan must give you at least 30 days’ notice and a chance to show you’re still eligible. It may keep you during a period of deemed continued eligibility. After that, you have 3 full months to choose other coverage.

Do I lose Medicare if my plan drops me?

No. Losing your plan doesn’t take away your Part A and Part B. If you don’t join another Medicare Advantage plan in time, you’re enrolled in Original Medicare. You’ll still want drug coverage to avoid a gap.

Serving Utah residents. We do not offer every plan available in your area. Currently we represent 9 organizations which offer 58 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Sources

• 42 CFR § 422.74, Disenrollment by the MA organization
• 42 CFR § 422.110, Discrimination against beneficiaries prohibited
• 42 CFR § 422.506, Nonrenewal of contract
• Medicare.gov, Special Enrollment Periods
• Medicare.gov, When can I buy Medigap?
• Medicare.gov, Medigap guaranteed issue rights
• Medicare.gov, Choosing a Medigap Policy (guide)
• Medicare.gov, Plan Non-Renewal Notice
• Medicare.gov, Plan Annual Notice of Change
• Medicare.gov, How much does Medicare drug coverage cost?
• CMS, CY 2027 MA and Part D Enrollment and Disenrollment Guidance
• Utah DHHS Aging & Adult Services, SHIP

Last updated: October 21, 2026