Newsroom · San Diego County, California

Can I Get Medigap Without Health Questions in California?

Yes, if your Medicare Advantage plan is being discontinued, and Sharp Direct Advantage is. A Sharp member has a guaranteed-issue right to a Medicare Supplement policy with no health questions, no higher price for health, and no waiting period, from the October 2 letter through March 4, 2027. Here is the federal rule, the California rule that sits on top of it, the plan letters each one covers, and the drug plan you will need alongside.

Medicare On Main Data Desk

Published October 6, 2026 · 10 min read · Reviewed by Brian Penner

Of the three doors the October 2 letter opens, this is the one with a clock most people misread. We covered the exit itself (Is Sharp Direct Advantage ending in 2027?), the county's full list of departing plans (22 plans ending in San Diego County), and how to keep your Sharp doctors (the two medical groups and the UnitedHealthcare plans). This post is the Medigap door on its own: what the rule actually guarantees, what California adds, and what it does not do. Everything below comes from Medicare.gov, the California Insurance Code and the California Department of Insurance, with the drug plans from the CMS 2027 file. Carrier names are factual reporting, not endorsement; we do not offer every plan available in your area.

Why a Sharp member can skip the health questions

Outside a few protected windows, a Medigap company in California may ask about your health and decline you or charge more. Medicare.gov's own Medigap tool puts it plainly for anyone outside those windows: "there's no federal guarantee that an insurance company will sell you a Medigap policy. If you're able to buy one, it may cost more due to past or present health problems." The protected windows are your six-month open enrollment when you first take Part B, and a short list of guaranteed-issue events. A Medicare Advantage plan that leaves Medicare or stops serving your county is on that list, and Sharp Health Plan's four Sharp Direct Advantage HMOs have no row anywhere in the CMS 2027 file. Sharp Health Plan's contract carried 19,868 members in September 2026, so a lot of San Diego County is in this window at once.

Two rulebooks apply, and they are not identical. The federal rule is what Medicare.gov describes and what every state must honor at minimum. California's Insurance Code § 10192.12 is the state's version, and it is broader in three places.

Sources: Medicare.gov guaranteed-issue tool; Cal. Ins. Code § 10192.12 subdivisions (a)(2), (b)(2)(B), (c)(2), (e)(1) and (f)(1); California Department of Insurance. The statute's published text lists Plans C and F; federal law since 2020 bars selling C or F to anyone first eligible for Medicare on or after January 1, 2020, which is why Medicare.gov names D and G for them. Confirm the exact letters a company will issue on a guaranteed-issue basis with the company or HICAP, California's free counseling program, before you apply.

Read the second row twice. Medicare.gov says you may apply from 60 days before the plan ends, which is November 1. California's statute says the period "begins on the date that the individual receives a notice of termination," and that letter is dated October 2. In practice the policy cannot take effect until January 1 either way, because Medicare.gov is explicit that "Medigap coverage can't start until your Medicare Advantage Plan coverage ends." The early start matters for one reason: it lets you have a signed, approved Medigap application in hand before December 7, when you also have to pick your drug plan, instead of juggling both in the last weeks of the year.

Which plan letter: G, N, high-deductible G, K or L

The guaranteed-issue right tells you which letters a company must sell you. It does not pick one. The table is the practical shape of each letter on the list, using Medicare.gov's 2026 figures because the 2027 Medigap figures are not yet posted; the Part B deductible and the K, L and high-deductible amounts change each January.

Source: Medicare.gov, Compare Medigap plan benefits: Plan K limit "$8,000 in 2026," Plan L "$4,000 in 2026," high-deductible F and G "You must pay up to $2,950 in 2026," Part B deductible "$283 in 2026," and "Not everyone can buy Medigap Plan C & Plan F." Plans A and B are also on both lists; they cover less and are rarely the answer for someone leaving a $2,900-cap plan. Plan M is on California's list only. Benefits are standardized by letter; premiums are not, so get quotes for the same letter from more than one company.

The honest framing for a Sharp Direct Advantage member: you had a $2,900 ceiling on in-network medical costs for a $0 or $62 premium. Plan G replaces the ceiling with a $283 deductible and then no medical bills, at a monthly premium that depends on your age and company. High-deductible G sits closest to the old plan's shape, a $2,950 ceiling for a much smaller premium. Plan N trades a lower premium for small copays and the excess-charge gap, and is the one letter where the two rulebooks differ: Medicare.gov's federal list does not include it, California's statute does, so ask the company whether it will issue N on guaranteed-issue terms before you count on it. The Medicare.gov Medigap finder shows which companies sell each letter in your ZIP code.

The birthday rule is not this

California is one of a handful of states with a Medigap birthday rule, and it gets mixed up with the discontinuation right every October. The California Department of Insurance describes it this way: "If you already have Medigap insurance, you have 60 days of 'open enrollment' following your birthday each year when you can buy a new Medigap policy without a medical screening or a new waiting period. The new policy must have the same or lesser benefits as your old policy." Three words carry the whole rule: already have Medigap. It is a Medigap-to-Medigap right. It does not open a door from an Advantage plan. For a Sharp member the order is: use the discontinuation right to get into Medigap by March 4, then use the birthday rule each year after that to shop the same or a lesser letter without health questions. We wrote up the equivalent Utah rule for members there (does the birthday rule apply if I'm on Medicare Advantage?); the answer is the same shape in California.

The drug plan you will need

Sharp Direct Advantage was a Medicare Advantage plan with Part D built in. Medigap has no drug coverage at all, so the Medigap door is really two enrollments: the Medigap policy, and a stand-alone Part D plan. The CMS 2027 file lists ten of them sold in every California county.

Source: CMS CY2027 landscape file, Part D rows for California, all counties, data last updated September 22, 2026. "Total premium" is the file's Part D Total Premium column; the standard 2027 Part D deductible is $700 and the 2027 out-of-pocket threshold is $2,400 on every row. The file does not carry formularies, tiers or pharmacy networks; check your own prescriptions in Medicare.gov Plan Compare before choosing. Listing a plan is not a recommendation.

Two timing points. First, the drug plan, unlike Medigap, is tied to the enrollment calendar: pick it between October 15 and December 7 and it starts January 1 (Medicare.gov). Second, Medicare.gov's rule is "Don't go 63 days or more without creditable drug coverage"; the penalty is permanent and grows with every month you wait. The December 8 to February 28 Special Enrollment Period for a discontinued plan lets you add a drug plan late, starting the first of the following month, but a January pick means a January without drug coverage. Treat it as the net.

What Original Medicare costs underneath all this

Whichever letter you choose sits on top of Original Medicare, and the numbers underneath are federal and the same for everyone. For 2026, Medicare.gov lists the Part B premium at $202.90 a month (more at higher incomes) and the Part B deductible at $283; the 2027 figures are announced in the fall. Without a Medigap policy or an Advantage plan, "There's no yearly limit on what you pay out-of-pocket," which is the whole reason the guaranteed-issue window exists: it is the only time most people over 65 can buy that limit without a health review. Medigap premiums are not federal and are not in any CMS file; quote them by letter, by company, at your age.

The calendar from the letter to March 4

The letter is required by 42 CFR § 422.506 at least 90 days before the plan ends, and California's § 10192.12(f)(1) requires that the same mailing tell you about your Medigap rights. If yours did not, call the California Department of Insurance consumer line or HICAP; the right exists whether or not the page was in the envelope. Keep the letter: Medicare.gov says you may need to send a copy with the Medigap application as proof the plan ended.

What I would do this week

1. Decide whether you want a cap or first-dollar coverage. That one choice sorts you into high-deductible G, K or L on one side, and G or N on the other.
2. Get two or three quotes for the same letter. The right guarantees issue, not price; companies rate the same Plan G differently by age and ZIP.
3. Ask each company two questions. "Are you issuing this on a guaranteed-issue basis under the plan termination?" and "Will you issue Plan N that way?" Get the answer in writing.
4. Run your prescriptions through the ten drug plans in Medicare.gov Plan Compare, and enroll in the winner between October 15 and December 7.
5. Apply for Medigap before December 7 anyway, with a January 1 effective date. California's statute lets you apply from the day the letter arrives; there is no reason to leave it for February.

How we know all this: the Medicare On Main Data Desk frames every article with public data — here, Medicare.gov's Medigap guaranteed-issue tool, benefit chart and costs pages as read on October 6, 2026, the text of California Insurance Code § 10192.12, the California Department of Insurance's Medigap senior alert, the CMS CY2027 landscape file for the California drug plans, and the federal rules on non-renewal notices and enrollment periods. Mentioning a carrier or a health system is factual reporting, not endorsement or criticism. This is education, not advice; Medigap premiums, underwriting practices and plan availability vary by company, so confirm them with the company, a licensed agent, HICAP or Medicare.gov. We take no payment from any carrier to feature a plan.