Switch Medicare Advantage to Medigap: When You Can (and Can't) Change

Regretting your Medicare Advantage decision? You're not alone. Many people who chose Medicare Advantage discover that network restrictions, prior authorization requirements, or unexpected out-of-pocket costs don't work for their healthcare needs. The question is: can you switch to a Medigap supplement plan?

The short answer is yes, you can leave Medicare Advantage. But whether you can get a Medigap policy without medical underwriting depends entirely on when you make the switch and where you live. This guide explains your options, the rules that apply, and how to navigate the transition successfully.

When You CAN Switch From Medicare Advantage

There are several situations where you can leave Medicare Advantage and return to Original Medicare:

Annual Enrollment Period (October 15 - December 7)

Every year, you have the right to leave your Medicare Advantage plan during the Annual Enrollment Period. If you switch:

• Your Original Medicare coverage begins January 1
• You can enroll in a standalone Part D drug plan
• You can apply for a Medigap policy (but underwriting may apply)

Medicare Advantage Open Enrollment Period (January 1 - March 31)

If you're currently in a Medicare Advantage plan, you can use this period to:

• Switch to a different Medicare Advantage plan
• Drop Medicare Advantage and return to Original Medicare
• Enroll in a Part D plan if you switch to Original Medicare

Note: This enrollment period is only for people already enrolled in Medicare Advantage. If you're on Original Medicare, you cannot join a Medicare Advantage plan during this time.

Special Enrollment Periods

You may qualify for a Special Enrollment Period (SEP) to leave Medicare Advantage if:

• You move out of your plan's service area
• Your plan is ending or leaving your area
• You qualify for Extra Help (Low Income Subsidy)
• You're in a nursing home or other institution
• Your plan violated its contract or misled you

The Trial Right: Your 12-Month Escape Hatch

The Medicare Advantage Trial Right is the most valuable protection for people who want to try Medicare Advantage without permanent consequences. If you qualify, you can switch back to Original Medicare AND get a Medigap policy with guaranteed issue (no medical underwriting).

How the Trial Right Works

1. You must be in your first year of Medicare Advantage - This applies to people who enrolled in MA when first eligible for Medicare
2. You have 12 months - The trial period is 12 months from when your MA coverage began
3. Guaranteed issue for Medigap - Insurance companies cannot deny you or charge more due to health conditions
4. Any Medigap plan available - You can choose any Medigap plan sold in your state

Who Qualifies for the Trial Right?

• People who enrolled in Medicare Advantage when first eligible for Medicare at 65
• People who dropped a Medigap policy to join Medicare Advantage for the first time (additional protections may apply)

Medical Underwriting: Why It Matters

If you don't qualify for a Trial Right or other guaranteed issue protection, Medigap insurers can use medical underwriting to decide whether to sell you a policy and how much to charge.

What Is Medical Underwriting?

Medical underwriting means the insurance company reviews your health history to determine:

• Whether to accept you - They can deny coverage entirely
• What to charge - They can charge higher premiums based on health conditions
• Whether to exclude conditions - They may exclude coverage for pre-existing conditions for a waiting period

Conditions That Often Cause Denial

While each company has different standards, these conditions commonly result in Medigap application denials:

• Cancer (current or recent)
• Heart disease, recent heart attack, or stroke
• Diabetes with complications
• COPD or emphysema
• Kidney disease or dialysis
• Alzheimer's or dementia
• HIV/AIDS
• Multiple sclerosis
• Parkinson's disease

The Medigap Open Enrollment Period

The single best time to get a Medigap policy is during your Medigap Open Enrollment Period - a one-time, 6-month window that starts when you're both 65 or older AND enrolled in Medicare Part B.

Why This Period Is Critical

• Guaranteed issue - Companies must sell you any Medigap policy they offer
• No health questions - Your health history doesn't matter
• Standard pricing - You pay the same rate as healthy applicants
• No pre-existing condition exclusions - Full coverage from day one

The Problem: Most People Miss It

Many people choose Medicare Advantage when they turn 65, which means their Medigap Open Enrollment Period expires while they're in an MA plan. Once it's gone, they can only get a Medigap policy through:

1. Medical underwriting (may be denied or charged more)
2. A Trial Right (if still within 12 months of MA)
3. Another guaranteed issue situation
4. Living in a state with special protections

States With Guaranteed Issue Rights

Some states have passed laws that give residents additional rights to purchase Medigap policies without medical underwriting. These protections go beyond federal rules.

What If You Have Pre-Existing Conditions?

If you have health conditions and want to switch from Medicare Advantage to Medigap, here are your realistic options:

Option 1: Use Your Trial Right (If Available)

If you're within your first 12 months of Medicare Advantage and enrolled when first eligible at 65, use your Trial Right immediately. This guarantees you can get a Medigap policy regardless of health.

Option 2: Check State Protections

If you live in California, Connecticut, Maine, Massachusetts, Missouri, New York, Oregon, or Washington, you may have guaranteed issue rights that don't depend on your health.

Option 3: Apply Anyway

Even with health conditions, some insurers may approve you - especially if your conditions are well-controlled. Different companies have different underwriting standards. It's worth applying to multiple insurers.

Option 4: Stay on Medicare Advantage

If you can't get a Medigap policy due to health conditions, staying on Medicare Advantage may be your best option. MA plans cannot deny you coverage or charge more due to health conditions. You can switch to a different MA plan during Annual Enrollment if your current plan isn't meeting your needs.

Option 5: Consider Moving

In rare cases, people have moved to states like New York that offer year-round guaranteed issue. This is an extreme option but may be worth considering if healthcare access is critical and you have flexibility.

Step-by-Step Process for Switching

If you've decided to switch from Medicare Advantage to Medigap, follow these steps:

Step 1: Determine Your Guaranteed Issue Status

• Are you within 12 months of joining Medicare Advantage for the first time?
• Do you live in a state with special protections?
• Do you qualify for any other guaranteed issue situation?

Step 2: Choose Your Enrollment Period

• Annual Enrollment (Oct 15 - Dec 7): Most common time to switch; coverage starts January 1
• MA Open Enrollment (Jan 1 - Mar 31): Can drop MA and return to Original Medicare
• Special Enrollment Period: If you qualify due to moving, plan changes, etc.

Step 3: Disenroll From Medicare Advantage

You can disenroll from your MA plan by:

• Calling your MA plan directly
• Calling Medicare at 1-800-MEDICARE
• Enrolling in a standalone Part D plan (this automatically disenrolls you from MA)
• Using your Medicare.gov account online

Step 4: Apply for Medigap

Timing matters. If you have guaranteed issue rights, apply for Medigap before or soon after your MA coverage ends. Contact multiple insurance companies to compare rates - even with the same plan letter, premiums vary significantly by insurer.

Step 5: Enroll in Part D

Medigap policies (except a few older plans) don't include drug coverage. You'll need a standalone Medicare Part D plan for prescription coverage. Apply during the same enrollment period you're using to leave MA.

Step 6: Confirm Effective Dates

Make sure your Original Medicare and Medigap coverage begin when your Medicare Advantage coverage ends to avoid gaps in coverage.

Questions to Ask Before Switching

Before making the switch from Medicare Advantage to Medigap, ask yourself these questions:

About Your Health

• Do I have health conditions that might cause a Medigap denial?
• Am I within my Trial Right period (first 12 months of MA)?
• Does my state offer guaranteed issue protections?

About Costs

• What will my monthly costs be with Original Medicare + Medigap + Part D?
• How does that compare to my current MA plan?
• Am I willing to pay higher premiums for fewer restrictions?

About Healthcare Needs

• Do my current doctors accept Original Medicare?
• Am I frustrated by prior authorization requirements?
• Do I need access to specialists outside my current network?
• Do I travel frequently and need coverage anywhere in the US?

About Timing

• When does my MA coverage end and Original Medicare begin?
• Will there be any gap in coverage?
• Have I started the Medigap application process early enough?