What it is
Switching medigap plans means moving from one Medicare Supplement policy to another, or moving from Medicare Advantage back to Original Medicare with a Medigap policy. People do this for many reasons, such as a change in budget, health needs, or how they like to see doctors.
Guaranteed issue is a right to buy certain Medigap policies without medical underwriting. Insurers must generally sell you a policy and may not deny you coverage or charge more because of your health. These rights apply only in certain situations, and the details vary by state and change over time.
Medical underwriting is when a company reviews your health history to decide whether to offer a policy and on what terms. Outside open enrollment or a guaranteed issue situation, many people may face underwriting when they switch. Some states, including Massachusetts, Minnesota and Wisconsin, standardize Medigap differently, so their switching rules can look different.
How it’s traditionally been approached
Many people keep the same Medigap policy for years. Others shop again when a premium changes or when they want a different level of coverage. Standardized plan letters make it easier to compare the same benefits across companies.
People leaving Medicare Advantage have traditionally looked at a few paths. Some use a trial right, which may apply if you joined Medicare Advantage when you first became eligible and later decide to go back. Others rely on guaranteed issue rights that may apply if a plan leaves your area or if certain other events occur.
Only Plans A, B, D, G, K, L, M and N, plus 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. Some states also have birthday or anniversary rules that allow switching at certain times. Confirm current rules with Medicare.gov, your State Health Insurance Assistance Program (SHIP), or a licensed agent.
How the right licensed agent may help
A Medigap agent may help you work out whether you have a guaranteed issue right, how long a window might last, and which deadlines matter. A licensed agent can also explain how your state handles switching. Timing can matter, so asking early may help.
A conversation is usually relaxed. An agent may ask about your current coverage, the doctors you see, how you use care, and what you want to change. Bringing your current policy details and your Medicare card can help.
Good questions to ask include: Do I have a guaranteed issue right right now? Will I face medical underwriting? What happens to my drug coverage if I switch? Are there state rules that apply to me? Call 1-800-MEDIGAP for more information.
The bigger picture
Changing coverage can feel stressful, especially if you worry about being turned down or losing access to a doctor you trust. Knowing your options and deadlines may bring some peace of mind. It can help to take your time and ask a trusted person to join you.
Health, budget and comfort all play a part. A plan that fits your life may let you focus more on your wellbeing and less on paperwork. If you are also looking for care, Providers.plus may be one place to explore.
Keep in mind
- Guaranteed issue rights are limited, and they depend on your situation, your state and the timing.
- Medigap and Medicare Advantage each have strengths. Medigap works with any provider nationwide that accepts Medicare, with no network or referrals, and has predictable cost-sharing. It often has higher monthly premiums, may involve underwriting, needs a separate Part D plan for drugs, and does not cover routine dental, vision or hearing.
- Medicare Advantage often has lower premiums, an annual out-of-pocket maximum, extra benefits and drug coverage in many plans. It may also involve networks, prior authorization and copays.
- This is education only, not insurance, legal, tax or medical advice. Official information is at Medicare.gov, and no outcome or acceptance is guaranteed.
Licensed agents
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Frequently asked questions
Can I switch medigap plans at any time?
In many cases you can apply to switch at any time, but the insurer may be allowed to use medical underwriting. That means you could be turned down or offered different terms. Some states have rules that give extra protection, so confirm yours with your SHIP or a licensed agent.
What is guaranteed issue for Medigap?
Guaranteed issue is a right to buy certain Medigap policies without being denied for health reasons. It applies only in specific situations, such as certain changes in your existing coverage. The details and time limits vary, so check Medicare.gov or call 1-800-MEDIGAP for more information.
How do I leave Medicare Advantage and get a Medigap policy?
You can generally return to Original Medicare during certain enrollment periods, then apply for a Medigap policy. Whether you can buy one without underwriting depends on your rights, such as a trial right or a plan ending. A Medigap agent may help you check timing before you cancel anything.
What is the Medicare Advantage trial right?
The trial right is a protection that may let you return to Medigap if you try Medicare Advantage and change your mind within a limited time. It generally applies in specific situations, such as when you first joined Medicare Advantage after becoming eligible. Confirm the current rules and deadlines with Medicare.gov or your SHIP.
Will I have to answer health questions to switch medigap plans?
Often yes, unless you are in open enrollment or have a guaranteed issue right. Health questions are part of medical underwriting. Rules differ by state, and Massachusetts, Minnesota and Wisconsin standardize Medigap differently.
Can I switch to Medigap Plan H or Plan F?
Plan H was discontinued and is not sold today, even though people still search for it. Plan F is available only to people who became eligible for Medicare before January 1, 2020. A Medigap agent can explain which plans you may be able to consider.
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.