Plan Sunset
Your Medicare Advantage plan won't be back in 2027. Here are your deadlines, the replacements that keep your doctors, and what each one costs in a normal year and a bad one.
Plan Sunset
Your Medicare Advantage plan won't be back in 2027. Here are your deadlines, the replacements that keep your doctors, and what each one costs in a normal year and a bad one.
Date: 2026-10-08 Form factor: web app Status: Prototype
What it is
Plan Sunset starts from the non-renewal letter. You enter the plan's end date, your doctors, and your prescriptions, and it gives you a dated list of every deadline that letter sets off. Then it lines up each 2027 replacement in your county: which doctors it keeps, whether your drugs are covered, and the yearly cost in a typical year and in a year with a hospital stay. Pick one and you get a short checklist plus a plain-text summary to send to family.
Who it serves
The main user is the adult child who handles a parent's paperwork. Usually that's someone in their 40s or 50s, often in another city, who opens a forwarded letter in early October and has about two months to sort it out.
The letter is easy to misread. If the household does nothing, the parent ends up in Original Medicare on January 1 with no drug plan and no Medigap. Going 63 days without drug coverage starts a Part D late-enrollment penalty that never goes away. The useful exit, Medigap without health underwriting, runs on its own 63-day clock, and you lose it if you join another Advantage plan instead. Medicare's Plan Finder will compare plans, but it won't tell you that one choice shuts off another.
The second user is the beneficiary who does their own paperwork and wants the same answer without a sales call.
Why it could be profitable
The timing is the case for it. Insurers are cutting Advantage plans hard for 2027. Becker's lists twelve payers that sold MA plans in 2026 and are dropping out completely for 2027. Centene is leaving 344 counties, UnitedHealthcare 140, and Aetna 123. Humana has said its 2027 exits affect about 600,000 members. Non-renewal letters had to go out by October 2, 2026, which leaves 66 days until Open Enrollment closes on December 7.
Monetization:
- Consumer, one-time: a free deadline timeline and letter reader, then $79 per household for the full comparison, checklist, and reminders through the end of February. CareRoute charges $99 for decision support on this same problem, so somebody already thinks people will pay. I haven't seen numbers on how many do.
- B2B license: a white-label version for State Health Insurance Assistance Program (SHIP) offices, Area Agencies on Aging, and employer retiree-benefit teams. Their counselors are swamped every fall. A tool that turns the letter into a timeline before the appointment should make each session shorter, though I haven't tested that with a SHIP office.
- No commissions. Selling plans would make this a broker, with CMS marketing rules and a conflict of interest. If the household pays, the ranking has no reason to favor one insurer, and that's the main thing setting this apart from a broker's call center.
The weak spots, plainly. Demand comes in a burst each fall, so revenue will be lumpy. 2027 is an unusually bad year for exits, and a calmer year could shrink the market a lot. Medicare's Plan Finder and SHIP counselors cost nothing. Realistic plan data (networks, formularies, Medigap rates by county) is the hard and expensive part, and this prototype fakes all of it.
Form factor & scope
This is a responsive web app built for an adult child on a laptop, and it works on a phone too. The prototype covers one complete pass through the core flow: deadlines, the must-keep doctor list, the cost comparison under two health scenarios, and the action plan. Plans, prices, and networks are fictional sample data for three households.
How to run it
- Open
index.htmlin any modern browser. The sample data is also inlined in the page, so it runs fromfile://without a server. If you serve the folder over HTTP, it loadssample-data.jsonwithfetchinstead. - Switch households from the top-right menu. Ray (Arizona HMO), June (North Dakota PPO, where most of her market left), and Marcus (Texas, full Medicaid) each run into a different trap.
- Change "Pretend today is" to a date after March 4, 2027 to watch the Medigap guaranteed-issue window close on the cards.
- Untick or tick "must keep" on a doctor, flip between Typical year and Hospital year, then press "Plan around this one" on a card.
What's in this prototype
- Household header with the ending plan and a countdown to its end date.
- Deadline timeline built from the plan end date: Open Enrollment, the guaranteed-issue window (60 days before through 63 days after), the December 31 pick-by date for January 1 coverage, the February 28 special enrollment cutoff, and the Part D penalty clock. Past items fade, and the next one is highlighted.
- Doctor and prescription list with "must keep" toggles.
- Replacement cards with annual cost (premiums + medical + drugs, with drug costs capped at the out-of-pocket limit), a coverage check for each doctor and drug, and red flags: drops a must-keep doctor, no drug coverage, Medigap blocked by full Medicaid, guaranteed-issue window expired.
- A "lowest cost that keeps your must-haves" badge that moves as you change toggles.
- Typical-year vs hospital-year switch. This is where a $0-premium HMO and a Medigap G plan swap places.
- Action checklist specific to the plan type, and a family summary you can copy to the clipboard.
sample-data.json: three households, 12 fictional 2027 options, season dates, and 2026 Part B figures.
Roadmap
- Photo or PDF upload of the non-renewal letter, with the plan name and end date pulled out automatically.
- Real plan data from CMS's public landscape and formulary files, plus Medigap rate tables by state.
- State Medigap rules: birthday-rule states, year-round guaranteed issue in New York and Connecticut, and community-rated pricing.
- Shared household workspace so two siblings can see the same plan and checklist, with email or SMS deadline reminders.
- Counselor mode for SHIP offices: a caseload view and a printable one-page handout per client.
Sources
- https://247wallst.com/personal-finance/2026/09/05/insurers-have-already-told-wall-street-which-advantage-plans-die-on-december-31-members-are-the-last-to-know-and-the-letter-isnt-due-until-october-2/ — letters due October 2, 2026; the December 8 to February 28 special enrollment period; the Medigap guaranteed-issue window; Humana's roughly 600,000 affected members.
- https://247wallst.com/personal-finance/2026/09/03/if-your-advantage-plan-ends-december-31-and-you-do-nothing-you-wake-up-january-1-in-original-medicare-with-no-drug-coverage-and-no-medigap/ — what happens by default, the 63-day Part D penalty rule, and 2026 Part B premium and deductible.
- https://www.beckerspayer.com/?p=29059 — the twelve payers dropping out of Medicare Advantage entirely for 2027.
- https://www.beckerspayer.com/?p=29040 — county exits by insurer for 2027 (Centene, UnitedHealthcare, Aetna, Humana).
- https://www.careroute.ai/medicare-advantage-plan-ending — an existing $99 commission-free decision-support service for this same situation.
- https://www.phlp.org/en/news/missed-medicare-open-enrollment-you-may-still-have-options — Medigap guaranteed issue after a plan ends, and the full-Medicaid exclusion.
Requirements
Plan Sunset — Requirements
Goals
- A household that got a non-renewal letter can see every deadline it sets off, with dates, in under a minute.
- Before choosing, the user knows which replacement keeps their must-keep doctors and covers their drugs.
- The user sees cost under a bad health year as well as a normal one, so a $0-premium plan isn't picked on premium alone.
- Choices that close off other options (losing Medigap guaranteed issue, going without Part D) are flagged before the user commits.
- The user leaves with a checklist and a summary they can forward to family.
Primary user
An adult child managing a parent's Medicare, usually remotely and squeezed in around work. They have the letter, a rough list of the parent's doctors and medications, and roughly October 2 to December 31 to act. The job: "Get Mom into a 2027 plan that keeps her doctors, without a coverage gap or a penalty, and without having to trust a broker."
Secondary: a beneficiary doing this for themselves.
Functional requirements
- FR1: The user can select a household (in production: create one) with name, county, ending plan, letter date, and plan end date.
- FR2: The system generates a deadline timeline from the plan end date: Open Enrollment start and end, Medigap guaranteed-issue open (end − 60 days) and close (end + 63 days), pick-by date for January 1 coverage, special enrollment end (last day of February), and the Part D 63-day penalty threshold.
- FR3: Each timeline item shows days remaining relative to "today"; past items are de-emphasized and the next upcoming item is highlighted.
- FR4: The user can override "today" to preview how deadlines and flags change over the season.
- FR5: The user can mark each doctor or facility as must-keep; changes re-rank the options immediately.
- FR6: For each replacement option, the system shows per-doctor network status and whether every listed drug is covered.
- FR7: The system computes annual cost = 12 × monthly premium + medical cost for the selected scenario + drug cost, with drug cost capped at the Part D out-of-pocket limit.
- FR8: The user can switch between Typical year and Hospital year; Hospital year uses the plan's MOOP, or a supplied estimate where there is no cap.
- FR9: The system flags options that drop a must-keep provider, lack drug coverage, are Medigap while the user has full Medicaid, or are Medigap after the guaranteed-issue window has closed.
- FR10: Medigap options are disabled for households with full Medicaid.
- FR11: The system badges the lowest-cost option that has no blocking flags.
- FR12: The user can pick an option and receive a checklist specific to its type (Advantage, D-SNP, Medigap + Part D, Original + Part D).
- FR13: The system produces a plain-text family summary (ending plan, choice, estimated cost, out-of-network providers, numbered to-dos) and copies it to the clipboard.
- FR14: The page runs from
file://using inline seed data, and preferssample-data.jsonwhen served over HTTP.
User stories
- As an adult child, I want the letter turned into dated deadlines, so that I know how long I actually have.
- As an adult child, I want to mark my dad's cardiologist as must-keep, so that plans that drop him stop looking like the best deal.
- As a beneficiary with a chronic condition, I want to see cost in a hospital year, so that a $0-premium plan's $5,900 maximum doesn't catch me off guard.
- As a caregiver for someone on Medicaid, I want options I can't legally use to be blocked, so that I don't waste a phone call on them.
- As a sibling who isn't doing the paperwork, I want a short summary of the decision, so that I can check it without opening the app.
- As a beneficiary, I want to know that joining a new Advantage plan forfeits my Medigap guaranteed-issue route, so that I'm making that trade on purpose.
- As a SHIP counselor (future), I want a client to arrive with a filled-in timeline, so that the appointment can go straight to the decision.
Non-functional requirements
- No account, no server, and no network calls beyond static assets for the prototype; household data stays in the browser.
- In production, health and prescription data is sensitive. Store it encrypted, never sell or share it with insurers, and support deleting a household.
- Readable at 200% zoom; all controls reachable by keyboard; the scenario toggle exposes radio semantics.
- Large type and high contrast for older users who may share the screen with a helper.
- Every figure that depends on a plan year (Part B deductible, drug cap) lives in data, not code, and carries the year it belongs to.
- Cost estimates are labeled as estimates, and the tool never presents itself as enrolling the user in a plan.
Out of scope (for the prototype)
- Real plan, network, formulary, or Medigap rate data.
- Letter upload and parsing.
- State-specific Medigap rules (birthday rule, year-round guaranteed issue, community rating).
- Accounts, sharing, reminders, and payments.
- Enrollment itself; the tool points to Medicare Plan Finder or 1-800-MEDICARE.
Open questions
- Can provider networks be trusted enough to show a green check? Directories are known to lag, so production may need a "verified by phone" state.
- Should the paid tier be one-time per season or a small subscription that covers next year's Annual Notice of Change too?
- Would a SHIP office license a tool from a private company, or does it need to be grant-funded and free to the public?
- How to handle households who are also eligible for Plan C or F (Medicare before 2020) without cluttering the comparison for everyone else?
- What's the right hospital-year estimate for Original Medicare with no Medigap, where there's no cap to point to?
