What it is
Medicare Advantage (Part C) is a private plan that replaces Original Medicare for hospital and medical coverage. Many plans use networks and often include drug coverage and extra benefits. Medigap, also called Medicare Supplement, works differently. It pairs with Original Medicare and helps with some of the costs Original Medicare leaves behind.
Switching means leaving a Medicare Advantage plan and returning to Original Medicare, then adding a Medigap policy. You cannot have both at once. Medigap does not work with a Medicare Advantage plan. Medigap also does not include drug coverage, so many people add a separate Part D plan.
Medigap plans are sold by private insurance companies and use standardized letters. 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 move from Medicare Advantage to Medigap when their needs change. Some want to see doctors or specialists without a network. Others travel often, or want more predictable cost-sharing. Some simply find the plan no longer fits their health or budget.
There are usually set windows to change coverage. These can include the annual enrollment period each fall and a Medicare Advantage open enrollment period early in the year. Some people also qualify for special enrollment periods. Leaving Medicare Advantage for Original Medicare is generally the first step, and Medigap is added alongside it.
The harder question is often Medigap itself. Outside of a person's Medigap open enrollment period or a guaranteed issue right, insurers in many states may ask health questions and can sometimes decline or charge differently. Guaranteed issue rights can apply in certain situations, such as when a plan ends or when someone tries Medicare Advantage for the first time and changes their mind. These rules vary by state and change over time, so it is wise to confirm them.
How the right licensed agent may help
A Medigap agent may help you sort out where you stand. A licensed agent can explain whether you may have a guaranteed issue right, or whether health questions could apply. They can also explain how timing may affect when your old coverage ends and new coverage begins. Agents are independent and may represent several carriers, but they cannot promise acceptance.
A conversation is generally relaxed. You may be asked about your current plan, your doctors, your prescriptions and what you like or dislike about your coverage. You might also be asked about your state and when you first had Medicare. Having your Medicare card and plan details nearby can make the visit smoother.
Good questions to ask include: Do I have a guaranteed issue right? What happens if I am turned down? When would my Medicare Advantage coverage end? How would I get drug coverage? How do the plan letters differ, including Medigap Plan G? Call 1-800-MEDIGAP for more information.
The bigger picture
Changing coverage can feel stressful, especially when health is on your mind. Some people feel relief when they know they can see any provider that accepts Medicare. Others feel more comfortable with the lower monthly premiums or extra benefits a Medicare Advantage plan may offer. Neither choice is wrong. The right fit depends on your health, budget and peace of mind.
Take your time and talk with people you trust. Think about how you will feel if you need care next year, not only today. If you are also looking for health care providers, Providers.plus may help you explore options. For official Medicare information, visit Medicare.gov.
Keep in mind
- Do not cancel your Medicare Advantage plan until you know your Medigap coverage is approved and when it starts.
- Medigap may involve medical underwriting outside open enrollment or guaranteed issue, so acceptance is not guaranteed.
- Medigap generally has higher monthly premiums than many Medicare Advantage plans, and it does not include routine dental, vision or hearing or drug coverage.
- Rules vary by state and change over time. Confirm current rules with Medicare.gov, your State Health Insurance Assistance Program (SHIP), or a licensed agent. This page is education only, not insurance, legal, tax or medical advice.
Take the next step
- Talk with a Medigap agent ↗Jeff Cline on contacts.plus — a person, not a call center.
Not sure where to start? Answer a few gentle questions and choose who you’d like to hear from.
Call 1-800-MEDIGAP for more information
Frequently asked questions
Can I switch from Medicare Advantage to Medigap?
Often yes, but it depends on timing and your state's rules. You generally return to Original Medicare first, then apply for a Medigap policy. Whether you must answer health questions depends on your situation, so confirm with a licensed agent, your SHIP or Medicare.gov.
When can I switch from Medicare Advantage to Medigap?
You can usually leave Medicare Advantage during certain enrollment windows, such as the annual fall period or the early-year Medicare Advantage open enrollment period. Some people qualify for special enrollment periods. Dates and rules can change, so check Medicare.gov for the current schedule.
Can I be denied Medigap if I leave Medicare Advantage?
Yes, in some cases. Outside your Medigap open enrollment period or a guaranteed issue right, insurers in many states may review your health history and can decline coverage. Some people have guaranteed issue rights, which vary by state. A Medigap agent may help you understand where you stand.
Do I need to cancel my Medicare Advantage plan before applying for Medigap?
Not necessarily, and cancelling too early can be risky. It is generally wise to confirm your Medigap application is approved and know the start date before leaving your current plan. A licensed agent can help you plan the timing.
Does Medigap cover prescription drugs after I switch?
No. Medigap does not include drug coverage. Many people add a separate Medicare Part D plan when they return to Original Medicare. Ask about this early, since your Medicare Advantage drug coverage may end when you switch.
Which Medigap plan can I choose when switching from Medicare Advantage?
It depends on when you became eligible for Medicare and what your state allows. Newly eligible people can choose Plans A, B, D, G, K, L, M or N, including high-deductible Plan G. Plans C and F are for those eligible before January 1, 2020. 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.