How to Switch from Medicare Advantage to Medigap

If you are currently enrolled in a Medicare Advantage plan and want to switch to a Medicare Supplement (Medigap) plan, you are not alone. Many people realize that the network restrictions and prior authorization requirements of Advantage plans don't fit their needs, especially when a serious health issue arises. However, making this switch is not as simple as just signing up for a new plan.

The first thing to understand is that Medigap and Medicare Advantage are not two versions of the same product. They represent two entirely different paths. The real choice you are making is between Traditional Medicare (Parts A and B) and Medicare Advantage (Part C). A Medigap policy is simply a component of the Traditional Medicare path - it fills the gaps in coverage that Traditional Medicare leaves behind. You cannot have both a Medigap policy and a Medicare Advantage plan at the same time.

To switch to Medigap, you must first leave your Medicare Advantage plan and return to Traditional Medicare. You can only do this during specific enrollment periods. The most common times are the Annual Enrollment Period (October 15 to December 7) and the Medicare Advantage Open Enrollment Period (January 1 to March 31). During these windows, you can drop your Advantage plan and return to Original Medicare.

However, returning to Traditional Medicare is only half the battle. The bigger hurdle is qualifying for a Medigap policy. When you first turned 65 and enrolled in Medicare Part B, you had a six-month Medigap Open Enrollment Period. During that time, insurance companies were required by federal law to sell you a policy regardless of your health history. If you are past that window, you will likely have to go through medical underwriting to get a Medigap policy.

Medical underwriting means the insurance company will review your health history and current medical conditions. They can charge you a higher premium or deny you coverage entirely based on your health. This is why we always tell people: protect what you've earned by understanding the rules before you make a move. If you have developed significant health issues while on your Advantage plan, you might find it difficult or impossible to get approved for a Medigap policy.

There are a few exceptions to this rule, known as "guaranteed issue rights." For example, if you joined a Medicare Advantage plan when you first became eligible for Medicare at age 65, and you decide within the first year that you want to switch back to Traditional Medicare, you have a "trial right." This allows you to buy any Medigap policy sold in your state without medical underwriting. Another exception is if your Medicare Advantage plan leaves Medicare or stops providing care in your area. In these specific situations, you are protected.

If you do not have a guaranteed issue right, you will need to apply for Medigap and pass underwriting before you cancel your Medicare Advantage plan. You never want to drop your current coverage until you have written confirmation that your new Medigap policy has been approved.

Switching from Advantage to Medigap requires careful timing and a clear understanding of your health status. It is not a decision to make lightly, and it is certainly not something you should try to navigate alone. We are on your side of the table, and we will walk you through every option to see if a switch is possible and makes financial sense for you.