Newsroom · San Diego County, California
What If I Do Nothing When Sharp Direct Advantage Ends?
It is the most common plan people make without meaning to. The October 2 letter goes in a drawer, December fills up, and on January 1 Medicare does exactly what the rules say it will do. Here is what that morning looks like for a San Diego Sharp Direct Advantage member, priced from Medicare.gov's own numbers, and the three windows that are still open behind you if the drawer has already closed.
The bottom line
- January 1, 2027 you are in Original Medicare. Medicare.gov: "You'll be enrolled in Original Medicare if you don't join another Medicare Advantage Plan before your current plan ends." You keep Medicare. You are not moved to any other plan, including the UnitedHealthcare plans with Sharp in the name.
- The $2,900 ceiling is gone. Original Medicare has "no yearly limit on what you pay out-of-pocket." In 2026 terms that is a $1,736 hospital deductible per benefit period, a $283 Part B deductible, then 20% of everything Part B covers, with no stopping point. CMS posts the 2027 amounts this fall.
- Your drug coverage ends with the plan. Original Medicare has none. The 63-day clock starts January 1; a drug plan that starts March 1 keeps you under it, and anything later does not.
- Three windows stay open: the Annual Enrollment Period to December 7 (starts January 1), the non-renewal Special Enrollment Period December 8 – February 28 (a December pick still starts January 1; January and February picks start a month later), and Medigap with no health questions November 1 – March 4. The January–March open enrollment period is not one of them.
- Doing nothing is a real choice for a few people, mainly those with VA, TRICARE For Life or retiree drug coverage who want Original Medicare without a supplement. For everyone else it is the most expensive door, and it is the default.
This is the sixth post in our series on Sharp Direct Advantage ending. We covered the exit itself (is Sharp Direct Advantage ending in 2027?), the 22 plans leaving San Diego County, keeping your Sharp doctors, Medigap without health questions in California and the side-by-side with UHC Sharp Medicare Advantage. This one is for the member who has not decided, because not deciding is itself a decision with a date on it. Nothing here is a recommendation; the plan is being discontinued, and carrier names are factual reporting; we do not offer every plan available in your area.
What actually happens on January 1
The rule is short. Medicare.gov's Special Enrollment Period page, under the row for a plan whose "contract with Medicare isn't renewed," says: "You'll be enrolled in Original Medicare if you don't join another Medicare Advantage Plan before your current plan ends." The Plan Non-Renewal Notice page says what the October letter is for: "You must look for a new plan for coverage next year." Must look. Nobody looks for you.
Two things do not happen. You are not dropped from Medicare; Parts A and B were always yours and the plan was a way of receiving them. And you are not moved into another company's plan. 42 CFR § 422.530 allows a crosswalk only between plans "under a contract between the MA organization and CMS," which means inside one insurer. Sharp Health Plan's contract (H5386) has no 2027 row in the CMS landscape file, and UnitedHealthcare of California's (H0543) is a different contract. The 17,247 San Diego County members on the four Sharp Direct Advantage plans in September either enroll in something or wake up in Original Medicare. There is no third outcome.
December 31 versus January 1, line by line
| December 31, 2026: Sharp Direct Advantage | January 1, 2027: did nothing | |
|---|---|---|
| Hospital and medical coverage | Sharp Direct Advantage HMO (Parts A and B through the plan) | Original Medicare Parts A and B, automatically. You do not lose Medicare. |
| Monthly premium | $0 (Platinum: $62) plus Part B | Part B only ($202.90 in 2026, more at higher incomes). The plan premium disappears. |
| Yearly out-of-pocket ceiling | $2,900 in network | None. Medicare.gov: "There's no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage." |
| Hospital stay | Plan copays, counted toward the cap | $1,736 deductible per benefit period in 2026, before Part A pays |
| Doctor visits, tests, outpatient care | Plan copays, counted toward the cap | $283 yearly deductible (2026), then usually 20% of the Medicare-approved amount, with no ceiling |
| Prescription drugs | Part D built in (deductible $350, a no-deductible tier) | No drug coverage at all. Original Medicare has none, and the 63-day clock starts January 1. |
| Network and referrals | Sharp HMO network, referrals required | Any doctor or hospital in the country that takes Medicare; no referrals |
| Dental, vision, hearing, fitness extras | Whatever the plan included | None |
Sources: Medicare.gov, Medicare costs (2026 amounts, read October 7, 2026); CMS CY2026 landscape file, San Diego County rows for H5386-003 to -006; CMS September 2026 county enrollment. CMS had not published 2027 Part A and Part B amounts as of this writing; it normally does so in the fall, and the 2027 numbers will be higher than the 2026 ones shown. The Part B premium is higher at higher incomes.
Read the ceiling row twice. Every Sharp Direct Advantage plan carried a $2,900 in-network cap in 2026; it is the single thing the plan did that Original Medicare does not do. Medicare.gov: "There's no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage, like a Medicare Supplement Insurance (Medigap) policy or join a Medicare Advantage Plan (Part C)." Twenty percent of a cardiac stent, a joint replacement's outpatient work, a course of chemotherapy or a year of dialysis has no stopping point in Original Medicare alone. That is not an argument against Original Medicare, which with a Medigap plan has a known worst case and no network at all. It is an argument against Original Medicare by accident.
The drug side: a gap, then a clock
Your Part D coverage was a feature of the Sharp Direct Advantage plan, and it ends when the plan does. Original Medicare does not include drug coverage. So on January 1 you pay the pharmacy's full price for everything, and a second clock starts. Medicare.gov: "Don't go 63 days or more without creditable drug coverage." From January 1, day 63 is March 4.
The penalty, if the gap gets that long, is set by formula. Medicare.gov: it is "calculated by multiplying 1% times the 'national base beneficiary premium' ... times the number of full, uncovered months you were eligible to join Medicare drug coverage but didn't," rounded to the nearest ten cents and added to your premium, and "You'll generally have to pay the penalty for as long as you have Medicare drug coverage." CMS set the 2027 base at $41.33 (2026: $38.99), so each uncovered month is worth about $0.41. Two uncovered months, January and February with a drug plan starting March 1, is a 59-day gap and no penalty. Twelve uncovered months, which is what happens if you miss February 28 and wait for the fall 2027 enrollment period and a January 1, 2028 start, is about $5.00 a month, for life, refigured upward each year as the base premium rises. The dollar figure is small. The twelve months paying cash at the pharmacy are not.
If you choose Original Medicare on purpose, the drug plan is a separate enrollment. California has 10 stand-alone Part D plans for 2027 in the CMS file:
| Stand-alone drug plan (PDP) | Plan ID | Insurer | 2027 monthly premium |
|---|---|---|---|
| Wellcare Value Script (PDP) | S4802-163 | Wellcare | $5.30 |
| Wellcare Classic (PDP) | S4802-094 | Wellcare | $7.30 |
| HealthSpring Assurance Rx (PDP) | S5715-049 | Blue Cross and Blue Shield of IL, NM, OK, TX | $9.30 |
| Humana Basic Rx Plan (PDP) | S5884-114 | Humana | $118.30 |
| Humana Value Rx Plan (PDP) | S5884-211 | Humana | $130.30 |
| AARP Medicare Rx Saver from UHC (PDP) | S5921-376 | UnitedHealthcare | $170.80 |
| Humana Premier Rx Plan (PDP) | S5884-178 | Humana | $191.20 |
| Blue Shield Rx Plus (PDP) | S2468-003 | Blue Shield of California | $210.00 |
| AARP Medicare Rx Preferred from UHC (PDP) | S5921-413 | UnitedHealthcare | $242.60 |
| Blue Shield Rx Enhanced (PDP) | S2468-004 | Blue Shield of California | $252.60 |
Source: CMS CY2027 landscape file, California PDP rows, read October 7, 2026. Premium is the only cost in the file; deductibles, formularies, tiers and pharmacy networks are in each plan's documents and on Medicare Plan Compare. Listing a plan is not a recommendation. A low premium with your drugs on a high tier can cost more than a high premium with them on a low one; run your own list.
The windows still open after the letter
| Window | Dates | Coverage starts | Who can use it | What to know |
|---|---|---|---|---|
| Annual Enrollment Period | October 15 – December 7, 2026 | January 1, 2027 | Everyone with Medicare | The calm door. Any plan on the county shelf, or Original Medicare plus a drug plan. |
| Non-renewal Special Enrollment Period | December 8, 2026 – February 28, 2027 | December request: January 1. January request: February 1. February request: March 1. | Members of a plan that is not renewing (42 CFR § 422.62(b)(1)) | A December 8 – 31 enrollment still starts January 1. After that, every month you wait is a month in Original Medicare with no drug plan and no cap. |
| Medigap guaranteed issue | November 1, 2026 – March 4, 2027 (60 days before to 63 days after) | The day after the plan ends, if you apply before December 31 | Members who switch to Original Medicare | Plans A, B, D, G, K, L (C or F if eligible before 2020), no health questions. California's § 10192.12 window runs alongside it. |
| January – March Medicare Advantage open enrollment | January 1 – March 31, 2027 | First of the following month | People "enrolled in an MA plan" (§ 422.62(a)(3)) | Not you, if you defaulted. A person in Original Medicare on January 1 is not enrolled in an MA plan and cannot use it. |
Sources: Medicare.gov, Joining a plan; Medicare.gov, Special Enrollment Periods; CMS CY 2027 Enrollment and Disenrollment Guidance § 30.6.10.A for the effective dates; 42 CFR § 422.62 (a)(3) and (b)(1); Medicare.gov, When can I buy a Medigap policy?; California Insurance Code § 10192.12 as covered in the Medigap post.
The row most people get wrong is the last one. The January–March Medicare Advantage open enrollment period exists, and it sounds like a safety net. § 422.62(a)(3) gives it to "an individual who is enrolled in an MA plan." On January 1 a Sharp Direct Advantage member who did nothing is enrolled in Original Medicare, not an MA plan, so that period is closed to them. The net that does exist is the non-renewal Special Enrollment Period, and CMS's 2027 guidance prices it by the month: a request received December 8 through 31 takes effect January 1; a January request takes effect February 1; a February request takes effect March 1. Each month of delay after December is a month with no cap and no drug coverage, and after February 28 the ordinary doors are the fall 2027 enrollment period, or a Medicare Advantage plan with a 5-star rating if one is offered in the county, which the 2027 ratings will tell us in October.
The Medigap window is the generous one and the one with the hardest stop. From November 1 to March 4 a California company must sell you Plan A, B, D, G, K or L with no health questions, if you are going to Original Medicare. On March 5 that right is gone, and California's birthday rule does not restore it: the birthday rule lets someone who already has a Medigap policy change to one of equal or lesser value each year, and a Sharp Direct Advantage member has no Medigap policy to change from. So the member who does nothing through March is not only in Original Medicare without a cap; they may have lost the ability to add the cap back without underwriting.
Letter still in the drawer? Bring it, and we will put the three dates on a calendar together.
Brian Penner has worked with Medicare clients for more than 22 years, is licensed in California and works by phone. We will confirm what your plan's end date means for each window, run your prescriptions against the plans we offer in San Diego County and the stand-alone drug plans, and price the Medigap door beside them. No cost, no pressure. We do not offer every plan available in your area.
Book a phone appointment →When doing nothing is the right answer
Honesty requires this section. A small group of Sharp Direct Advantage members genuinely want Original Medicare with nothing added, and January 1 gives it to them. The usual reasons: TRICARE For Life, which pays after Medicare with no network and includes its own pharmacy benefit; VA health care, whose drug coverage Medicare counts as creditable; or an employer or union retiree plan that coordinates with Original Medicare and carries creditable drugs. For those members the 63-day clock never starts, because their other coverage is creditable, and the missing cap is handled by the other payer. Even then, two checks: ask the other plan in writing whether its drug coverage is creditable and keep the letter, and confirm it pays secondary to Original Medicare rather than requiring a Medicare Advantage plan. If neither of those describes you, the default is not a plan. It is the absence of one.
What I would do with the letter this week
- Confirm the plan number on your card is H5386-003, -004, -005 or -006 and that the letter is a non-renewal notice, not an Annual Notice of Change. If it is, every window above is yours.
- Decide the door by October 31: another Medicare Advantage plan on the county shelf (the San Diego County reference page lists what left and what arrived), or Original Medicare with Medigap and a stand-alone drug plan. The doctor and drug checks differ by door, and each takes an evening.
- If Medigap, apply November 1 with a January 1 effective date, and enroll in the drug plan before December 7. Keep the October letter; the Medigap company may ask for a copy.
- If another plan, enroll between October 15 and December 7, and if life intervenes, before December 31. January is not a deadline. It is a month without coverage.
- If you truly want Original Medicare alone, get the creditable-coverage letter from your other plan now, so the question is answered before the clock starts.
How we know all this: the Medicare On Main Data Desk frames every article with public data — here, Medicare.gov's pages on Special Enrollment Periods, the Plan Non-Renewal Notice, Medicare costs, the Part D late enrollment penalty, joining a plan and Medigap guaranteed-issue rights as read on October 7, 2026; CMS's July 28, 2026 release of the 2027 Part D base beneficiary premium; the CMS CY 2027 Enrollment and Disenrollment Guidance; the text of 42 CFR §§ 422.62, 422.506 and 422.530; the CMS CY2026 and CY2027 landscape files for San Diego County and California; and the CMS September 2026 county enrollment file. Carrier and health-system names are factual reporting, not endorsement or criticism; "the plan is being discontinued" describes the file, not a judgment; nothing here is a recommendation. 2026 Part A and Part B amounts are shown because CMS had not yet published 2027's. This is education, not advice; confirm plans, costs and eligibility with the plan, a licensed agent, HICAP or Medicare.gov. We take no payment from any carrier to feature a plan.
Frequently asked questions
What happens if I don't choose a new Medicare plan when my plan ends?
Medicare.gov's Special Enrollment Period page says it in one sentence: "You'll be enrolled in Original Medicare if you don't join another Medicare Advantage Plan before your current plan ends." For a Sharp Direct Advantage member that means January 1, 2027 in Original Medicare Parts A and B, with no drug coverage, no yearly out-of-pocket limit and none of the plan's extras. You keep Medicare itself; what you lose is everything the plan added on top of it.
Will I automatically be enrolled in Original Medicare if my Medicare Advantage plan ends?
Yes. That is the default, and it requires nothing from you. It is also the only automatic thing that happens. You are not moved into another Medicare Advantage plan, not enrolled in a stand-alone drug plan, and not issued a Medigap policy. Each of those is an enrollment you make, inside a window that closes.
Will Sharp Direct Advantage members be moved to UHC Sharp Medicare Advantage automatically?
No. 42 CFR § 422.530 defines a plan crosswalk as moving enrollees between plans "under a contract between the MA organization and CMS." Sharp Health Plan (contract H5386) and UnitedHealthcare of California (contract H0543) are different organizations with different contracts, so no rule moves you from one to the other. The October 2 letter may describe other plans; describing is not enrolling.
Do I lose my prescription drug coverage if my Medicare Advantage plan ends?
Yes, unless you enroll in something that has it. Your Part D coverage was part of the Sharp Direct Advantage plan and ends with it on December 31. Original Medicare has no drug coverage. To have drugs covered on January 1 you need either a new Medicare Advantage drug plan or one of California's ten stand-alone Part D plans for 2027 ($5.30 to $252.60 a month), enrolled by December 7, or by December 31 under the non-renewal Special Enrollment Period.
Is there a Part D late enrollment penalty if my plan ends and I wait?
Only if the gap reaches 63 days. Medicare.gov: "Don't go 63 days or more without creditable drug coverage." If you use the non-renewal Special Enrollment Period by February 28 and the drug plan starts March 1, the gap is January and February, 59 days, and no penalty applies. Miss February 28 and the next ordinary door is the fall 2027 enrollment period for a January 1, 2028 start: twelve uncovered months, and a penalty of 1% of the national base beneficiary premium per month, about $5.00 a month at the 2027 base of $41.33, for as long as you have drug coverage.
Can I still get Medigap after January 1 in California?
Yes, until March 4, 2027 with no health questions. Medicare.gov's guaranteed-issue right runs from 60 days before to 63 days after your Medicare Advantage coverage ends, for Plans A, B, D, G, K or L (C or F if you were eligible for Medicare before 2020), and only if you switch to Original Medicare. California Insurance Code § 10192.12 gives a parallel state right. After March 4, a California Medigap company can ask health questions and decline you, and the state birthday rule does not help, because it only applies to someone who already holds a Medigap policy.
Sources
- Medicare.gov — Special Enrollment Periods ("You'll be enrolled in Original Medicare if you don't join another Medicare Advantage Plan before your current plan ends").
- Medicare.gov — Plan Non-Renewal Notice ("You must look for a new plan for coverage next year").
- Medicare.gov — Medicare costs (2026 Part A deductible, Part B premium and deductible, 20% coinsurance, no yearly limit, the 63-day rule).
- Medicare.gov — Part D late enrollment penalty (1% × national base beneficiary premium × uncovered months).
- CMS — Medicare Part D 2027 National Average Monthly Bid Amount and Base Beneficiary Premium (July 28, 2026) — "For 2027, the base beneficiary premium will be $41.33."
- CMS — CY 2027 Medicare Advantage and Part D Enrollment and Disenrollment Guidance (PDF; § 30.6.10.A non-renewal SEP effective dates).
- 42 CFR § 422.62 — Election periods: (a)(3) the January–March open enrollment is for individuals enrolled in an MA plan; (b)(1) SEP when a plan is discontinued (Cornell LII).
- 42 CFR § 422.530 — Plan crosswalks (within one MA organization's contract).
- 42 CFR § 422.506 — nonrenewal notice to each enrollee at least 90 days before.
- Medicare.gov — When can I buy a Medigap policy? (guaranteed-issue rights).
- Medicare.gov — Joining a plan (October 15 – December 7 changes start January 1).
- CMS — CY2027 Medicare Advantage / Part D Landscape file (zip) — California PDP rows; no H5386 row.
- CMS — CY2026 Medicare Advantage / Part D Landscape file (zip) — H5386-003 to -006, San Diego County.
- CMS — Monthly Enrollment by Contract/Plan/State/County, September 2026 (zip) — September 2026 members by plan.
- Medicare Plan Compare (Medicare.gov) — drug costs by plan and every plan available in your county.
