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Jerry I have not seen data suggesting gouging happens - but it may. As for reasons to switch there are a few:

You might select an HMO and decide you want to get back to traditional Medicare with a supplement - the insurance companies can say "No" to issuing a supplement and/or charge any premium they wish. We actually had this happen to a friend who had a stroke. Our friend was a resident of Tennessee. Eventually the HMO went out of business and we were able to get our friend into the United Healthcare system, but only one supplement plan was offered.

Similarly a person's health changes over time. We have plan "N" which has a co-pay and a deductible. Somewhere between 15 and 25 offices visits a year the total annual cost would be less with the no copay or deductible plan.

Also people might want to add coverage outside the USA - say for reasons of travel or a different residence.
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