Switch Medicare Advantage to Medigap is a decision that requires understanding two separate sets of Medicare rules.
You may be allowed to leave a Medicare Advantage plan and return to Original Medicare, but that does not always mean you are guaranteed the Medicare Supplement policy you want.
The bigger question may be whether a Medigap insurance company can require medical underwriting before accepting your application.
Your rights can depend on when you first joined Medicare Advantage, why you are leaving, your state, and whether you qualify for a guaranteed-issue right.
Understanding those rules before dropping existing coverage is important.
Yes, you can switch from Medicare Advantage back to Original Medicare during certain enrollment periods or when you qualify for a Special Enrollment Period.
But getting a Medicare Supplement policy is a separate issue.
In some situations, federal or state protections give you a guaranteed right to purchase certain Medigap policies without medical underwriting.
Outside those protections, an insurance company may be allowed to review your health history before deciding whether to issue a Medigap policy.
Do not cancel your Medicare Advantage coverage simply because you want Medigap. First determine whether you can obtain the Medigap coverage you want and when the change can take effect.
You generally cannot leave a Medicare Advantage plan whenever you want. Changes usually must occur during a Medicare enrollment period or when you qualify for a Special Enrollment Period.
The Medicare Annual Enrollment Period, from October 15 through December 7, allows people with Medicare Advantage to return to Original Medicare for coverage beginning January 1.
The Medicare Advantage Open Enrollment Period, from January 1 through March 31, also allows someone already enrolled in Medicare Advantage to return to Original Medicare.
Certain life events and changes involving your plan may create additional opportunities to leave Medicare Advantage.
But returning to Original Medicare and qualifying for Medigap are two separate issues.
Medical underwriting is the process an insurance company may use to evaluate your health when you apply for a Medicare Supplement policy outside a protected enrollment period.
Depending on the circumstances and state rules, the insurer may ask health questions and use your medical history when deciding whether to issue the policy.
This is why someone who has been enrolled in Medicare Advantage for several years should not assume they can automatically purchase any Medigap plan later.
Your ability to leave Medicare Advantage may be guaranteed during an enrollment period while your ability to obtain the Medigap policy you want may not be.
A guaranteed-issue right is a protection that allows you to purchase certain Medicare Supplement policies without medical underwriting when specific circumstances apply.
Federal law provides guaranteed-issue protections in situations such as certain losses or changes of coverage. Some states provide additional protections beyond the federal requirements.
When a guaranteed-issue right applies, an insurer generally cannot deny you the protected Medigap coverage because of your health or charge you more because of health problems.
The exact policies available under guaranteed issue can depend on the situation, so it is important to determine which protection applies before changing coverage.
A Medicare Advantage trial right can give certain people an opportunity to return to Original Medicare and purchase specific Medigap coverage without medical underwriting.
One trial-right situation can apply if you joined a Medicare Advantage plan when you first became eligible for Medicare at 65 and decide within the first 12 months that you want to switch to Original Medicare.
Another can apply in certain circumstances if you dropped a Medigap policy to join Medicare Advantage for the first time and decide within 12 months that you want to switch back.
Trial rights have specific requirements, so do not assume the 12-month protection applies to every Medicare Advantage enrollment.
If your Medicare Advantage plan stops participating in Medicare or stops providing coverage in your area, you may receive a Special Enrollment Period and certain Medigap guaranteed-issue protections.
This can allow you to return to Original Medicare and purchase certain Medicare Supplement policies without medical underwriting.
The exact rights and deadlines depend on the circumstances.
Keep any notices you receive from your Medicare Advantage plan because they can be important documentation when establishing your guaranteed-issue rights.
Federal Medigap protections establish a minimum set of rights, but some states provide additional opportunities to change Medicare Supplement coverage without medical underwriting.
Those rules vary significantly by state.
This means advice that applies to someone in one state may not apply to someone living somewhere else.
Before assuming you cannot qualify for Medigap — or assuming you automatically can — check both the federal protections and the rules in your state.
If you want to move from Medicare Advantage to Medigap, the order of operations matters.
When medical underwriting applies, you generally want to understand whether you can obtain the Medicare Supplement policy before relying on that coverage for your transition.
You also need to coordinate the effective dates so you do not accidentally create a gap in coverage.
If you are leaving a Medicare Advantage plan that includes prescription drug coverage, you may also need to enroll in a separate Medicare Part D plan when returning to Original Medicare.
The goal is to coordinate the Medicare Advantage termination, Original Medicare coverage, Medigap policy, and Part D coverage so they work together.
When you are first eligible for Medicare and have your Medigap Open Enrollment Period, you have strong federal protections for purchasing Medicare Supplement coverage.
Those protections do not necessarily continue indefinitely.
If you choose Medicare Advantage and later want Medigap, your health history may become relevant if you do not qualify for a guaranteed-issue right or other state protection.
That does not mean Medicare Advantage is automatically a bad choice. It means your ability to change coverage later should be considered when making the original decision.
Before leaving Medicare Advantage, determine:
The safest approach is to understand both sides of the transition before changing either one.
Yes, but there are two separate issues: when Medicare allows you to leave Medicare Advantage and whether you can obtain the Medigap policy you want. Medical underwriting may apply unless you have a guaranteed-issue right or another protection.
You can generally leave during certain Medicare enrollment periods, including the Annual Enrollment Period from October 15 through December 7 and, if you are already enrolled in Medicare Advantage, the Medicare Advantage Open Enrollment Period from January 1 through March 31. Special Enrollment Periods may also apply in certain situations.
Outside your Medigap Open Enrollment Period or another guaranteed-issue protection, an insurance company may be allowed to use medical underwriting and potentially deny an application, depending on your state and circumstances.
Certain people who try Medicare Advantage for the first time may have a 12-month trial right allowing them to return to Original Medicare and obtain certain Medigap coverage without medical underwriting. Specific eligibility requirements apply.
You may qualify for a Special Enrollment Period and certain Medigap guaranteed-issue rights. Review the notice from your plan carefully because it should explain your options and deadlines.
No. Federal law establishes certain protections, but some states provide additional Medigap enrollment or switching rights. Your options can therefore depend on where you live.
If your Medicare Advantage plan included prescription drug coverage and you return to Original Medicare, you will generally need a separate Part D plan if you want outpatient prescription drug coverage. Medigap policies sold today do not include prescription drug coverage.
Do not assume you should cancel your existing coverage first. Determine your Medigap eligibility, application requirements, enrollment dates, and Part D needs so the transition can be coordinated without an unintended coverage gap.
I’m David Lowe, RSSA® — Registered Social Security Analyst® and a licensed Medicare agent.
I help people understand their Medicare coverage options, including the rules involved when moving between Medicare Advantage and Medicare Supplement, and how those decisions fit into their broader Medicare and Social Security planning.
You work directly with me. No call center. No rotating team of agents.
My goal is to help you understand your enrollment rights, Medigap eligibility, potential underwriting, and timing before you change coverage.
I am not employed by Medicare or any insurance carrier.
Medicare Advantage enrollment periods, Medigap guaranteed-issue rights, medical underwriting, and Medicare Supplement availability can vary depending on your circumstances and state.
Do not assume that leaving Medicare Advantage automatically guarantees your ability to purchase the Medigap policy you want.
For official information about switching Medicare coverage and Medigap rights, you can also review Medicare.gov.
I provide Medicare guidance in the states where I am licensed:
If you’re considering leaving Medicare Advantage for Original Medicare and Medigap, I can help you understand the enrollment timing, potential underwriting, and Medicare Supplement options available in your state.
If you’re thinking about switching from Medicare Advantage to Medigap, check your Medigap eligibility before making changes to your existing coverage.
We can look at your enrollment period, guaranteed-issue rights, state protections, potential medical underwriting, Part D needs, and the timing required to make the transition.
David Lowe, RSSA®
Registered Social Security Analyst®
Licensed Medicare Agent
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