What it is
Medicare Advantage is a way to get your Medicare benefits through a private plan. Original Medicare is the traditional route, run by the federal government. Medigap plans are private policies that work alongside Original Medicare. They are designed to help with some of the costs Original Medicare does not pay.
Leaving Medicare Advantage usually means going back to Original Medicare, then adding a Medigap policy and, if you want drug coverage, a separate Part D plan. You cannot use a Medigap policy with a Medicare Advantage plan. So the Medigap piece is a separate step from leaving.
Medigap plans are sold in standard lettered plans. Only Plans A, B, D, G, K, L, M and N (and high-deductible Plan G) are sold to people newly eligible for Medicare. Plans C and F (and high-deductible F) are available only to people who became eligible before January 1, 2020. Plans E, H, I and J were discontinued and are not sold today. Massachusetts, Minnesota and Wisconsin standardize Medigap differently.
How it’s traditionally been approached
People often leave Medicare Advantage for personal reasons. Some want to see any doctor or hospital nationwide that accepts Medicare, without a network or referrals. Others want more predictable cost-sharing. Some have had a change in health or a move that made their plan a poorer fit.
Medicare Advantage has real strengths too. Many plans have lower monthly premiums, an annual out-of-pocket maximum, extra benefits and drug coverage. The trade-offs can include networks, prior authorization and copays. Neither path is right for everyone.
Medigap has trade-offs as well. Monthly premiums are generally higher. You need a separate Part D plan for drugs. Routine dental, vision and hearing are generally not included. Outside certain windows, a Medigap company may be allowed to ask health questions, which is called medical underwriting.
How the right licensed agent may help
A Medigap agent may help you understand whether you have a window to switch. Some situations carry guaranteed issue rights, which can limit a company's ability to turn you down or charge more for health reasons. Others do not. These rules vary by state and change over time, so it helps to confirm them.
A visit is generally a conversation. An agent may ask about your doctors, your medications, your budget and why you are thinking of leaving. They may explain how Plan G and other plans differ, and how timing can affect your options. Many agents can work with several carriers.
Good questions to ask: Do I have guaranteed issue rights right now? Will I face health questions? What happens to my drug coverage? When would each coverage start and end, so I avoid a gap? Call 1-800-MEDIGAP for more information.
The bigger picture
Changing coverage can feel stressful, especially when your health or budget is on your mind. Peace of mind often comes from knowing how you would handle a doctor visit or a hospital stay. Others value lower premiums and extra benefits more. Both views are reasonable.
Take your time and write down what matters most to you. Talk with family or someone you trust. If you are also looking for care providers, Providers.plus may be a place to explore. Your wellbeing and finances are both part of the decision.
Keep in mind
- Do not cancel your Medicare Advantage plan until you understand your Medigap options, since approval is not guaranteed.
- Medigap may involve health questions outside open enrollment or guaranteed issue periods.
- Open enrollment, guaranteed issue and birthday or anniversary rules vary by state and change over time. Confirm current rules at Medicare.gov, with your State Health Insurance Assistance Program (SHIP), or with a licensed agent.
- This page is education only, not insurance, legal, tax or medical advice. Official information is at Medicare.gov.
Licensed agents who often help
Get matched privatelyCall 1-800-MEDIGAP for more information
Frequently asked questions
Can I leave Medicare Advantage and buy medigap plans?
Possibly, but it depends on timing, your state and your health. Some people have guaranteed issue rights, and others may face medical underwriting. A licensed agent, your SHIP or Medicare.gov can help you confirm your situation.
Can I be denied a Medigap policy if I leave Medicare Advantage?
Yes, in some situations you can be. If you do not have guaranteed issue rights, a company may be allowed to ask health questions and may decline or charge more. Rules vary by state, so confirm yours before you cancel anything.
What is guaranteed issue for Medigap?
Guaranteed issue is a right in certain situations that limits a company's ability to deny you a Medigap policy or apply health-based conditions. Which situations qualify, and for how long, can vary. Confirm current rules with Medicare.gov, your SHIP or a licensed agent.
Do I need a separate drug plan if I move to Original Medicare with Medigap?
Generally yes, if you want prescription drug coverage. Medigap plans sold today do not include it, so people usually add a separate Part D plan. Many Medicare Advantage plans include drug coverage, so this is worth planning for.
Is Medigap Plan G a good choice after Medicare Advantage?
Plan G is a popular option, but whether it fits you depends on your needs and budget. It is sold to people newly eligible for Medicare, while Plans C and F are limited to those eligible before January 1, 2020. A Medigap agent can explain how Plan G compares.
Is Medigap better than Medicare Advantage?
Neither is better for everyone. Medigap offers any provider nationwide that accepts Medicare, no networks and predictable cost-sharing, but premiums are generally higher. Medicare Advantage often has lower premiums, an out-of-pocket maximum and extra benefits, but may have networks and prior authorization. Call 1-800-MEDIGAP for more information.
Educational resource. 1-800-MEDIGAP shares general information and connects people with independent licensed agents. It is not professional advice. Talk with a qualified professional about your own situation.