Switching from Medicare Advantage to Medigap: Timing, Underwriting, and Your Options

Last updated September 22, 2026

Naming note: On September 3, 2026, CMS and the SBA renamed ICHRA to CHOICE Arrangement (Custom Health Option and Individual Care Expense).

As your budget, healthcare needs, and benefits change, you may be considering switching up your Medicare coverage. If you’re enrolled in a Medicare Advantage plan and have been considering a switch to a Medicare Supplement (Medigap) plan, you’re not alone. The first half of this article answers the crucial questions about making the switch. The second half explains medical underwriting, the step that trips up the most people.

Can I switch from Medicare Advantage to Medicare Supplement?

Yes, you can absolutely switch from Medicare Advantage to a Medicare Supplement plan. However, there are a few key things to keep in mind:

• Timing: The best time to make this switch is during the Medicare Annual Enrollment Period (AEP), which runs from October 15th to December 7th each year. Any changes you make during this period will take effect on January 1st of the following year. You can also drop a Medicare Advantage plan and return to Original Medicare during the Medicare Advantage Open Enrollment Period, January 1 through March 31.

• Underwriting: Unlike Medicare Advantage plans, Medicare Supplement plans require you to undergo medical underwriting unless you meet the criteria for an exception. This means the insurance company will review your health history to determine your eligibility and premium rates. If you have pre-existing health conditions, you may face higher premiums or even be denied coverage for certain plans. The second half of this article walks through the process.

• Guaranteed Issue Rights: There are certain situations where you may have a guaranteed issue right to a Medigap plan, even if you have pre-existing conditions. This typically occurs when you lose your current coverage due to circumstances like your employer group health plan ending or you moving out of your Medicare Advantage plan’s service area. The full list is below.

What is the advantage of switching from MA to Medigap?

Medicare Supplement plans offer several advantages that appeal to many beneficiaries:

• More Predictable Costs: With a Medigap plan, you’ll typically have more predictable out-of-pocket costs. While premiums may be higher, you’ll have lower copays, coinsurance, and deductibles when you receive care. This can offer greater peace of mind, especially if you have significant healthcare needs. Medicare Supplement premiums are usually raised each year, but one of the key benefits over Medicare Advantage is that you won’t lose any benefits or coverage year-to-year.

• Greater Provider Choice: Original Medicare paired with a Medicare Supplement plan gives you the freedom to see any doctor or specialist who accepts Medicare, anywhere in the country. You’re not limited to a network like you are with many Medicare Advantage plans.

• No Referrals Needed: You won’t need referrals to see specialists with Original Medicare and a Medigap plan. This can simplify the process of getting the care you need.

Can I have both Medicare Advantage and Medicare Supplement?

No, you cannot have both a Medicare Advantage plan and a Medicare Supplement plan at the same time. You’ll need to choose one or the other.

Pros and Cons of Switching from Medicare Advantage to Medigap

Pros:

• Predictable Costs

• Greater Provider Choice

• No Referrals Needed

• Coverage Nationwide

Cons:

• Higher Monthly Premiums

• Medical Underwriting

• May Need to Purchase a Separate Part D Drug Plan

Medigap Underwriting: What to Expect

The phrase “medical underwriting” might sound daunting, especially when you’re researching Medigap plans. Whether you’re aging into Medicare, switching from a Medicare Advantage plan, or experiencing a qualifying life event, understanding this process is key. Here is what Medigap underwriting means, why it’s important, and how it could affect your plan options.

Why Medical Underwriting Matters

Medigap, also known as Medicare Supplement Insurance, helps fill the “gaps” in Original Medicare (Parts A and B) coverage. It helps pay for out-of-pocket costs like deductibles, copayments, and coinsurance, providing valuable financial protection.

However, unlike Original Medicare, Medigap plans are offered by private insurance companies, and these companies use a process called medical underwriting to assess your health risk before offering you a policy. The medical underwriting process helps them determine your premium costs or even your eligibility for coverage.

Understanding Medigap underwriting is crucial because:

• It affects your premium: Your health status can significantly influence how much you pay for a Medigap plan.

• It can impact your eligibility: In some cases, you might be denied coverage altogether due to pre-existing health conditions.

• It helps you make informed decisions: Knowing the process of underwriting helps you choose the right plan for you at the right time.

Medigap Open Enrollment: Your Guaranteed Issue Window

“Best” is a subjective term, but there’s not a debate here: The best time to enroll in a Medigap plan is during your Medigap Open Enrollment Period. This is a one-time, six-month window that starts when you turn 65 and are enrolled in Medicare Part B.

During this period, you have guaranteed issue rights, which means:

• No medical underwriting: Insurance companies cannot deny you coverage or charge you higher premiums based on your health status.

• More plan choices: You have access to all Medigap plans available in your state.

Important Note: If you’re switching from Medicare Advantage to Medigap, you typically do not have guaranteed issue rights outside of the specific circumstances listed below.

What Underwriting Involves

Outside of your Medigap Open Enrollment Period, you’ll likely face medical underwriting when applying for a Medigap plan. This process typically involves:

• Health questionnaire: You’ll be asked questions about your medical history, current health conditions, and medications.

• Medical records review: The insurance company may request access to your medical records to verify the information you provide.

• Medical exam: In some cases, you may be required to undergo a physical exam.

Based on the underwriting assessment, the insurance company can:

• Approve your application: Offer you the Medigap plan at the standard premium rate.

• Approve with a higher premium: Offer you the plan, but at a higher cost due to your health risks.

• Deny your application: Refuse to offer you coverage due to your health status. This is often referred to as a “Health Knockout.”

According to the Kaiser Family Foundation, the list of “potentially deniable medical conditions” includes:

• Alzheimer’s disease

• Asthma

• Cancer

• Congestive heart failure

• Diabetes with complications

• End-stage renal disease (ESRD)

• High blood pressure

• Limitations of daily activities

• Stroke

(Some of these conditions, however, may potentially qualify you for a Medicare Advantage Chronic Condition Special Needs Plan.)

What About The Affordable Care Act and Pre-Existing Conditions?

This might sound strange, as the Affordable Care Act (colloquially known as “Obamacare”) does not allow insurers to deny coverage or increase premiums based on pre-existing conditions. However, these protections do not apply to Medicare Supplement plans.

Guaranteed Issue Rights: When Underwriting is Waived

Even outside your open enrollment period, there are certain situations where you have guaranteed issue rights and cannot be denied Medigap coverage or charged higher premiums due to your health. These situations include:

• Loss of creditable coverage: If you lose coverage from an employer, union, or other source that’s considered “creditable,” you have the right to buy a Medigap plan.

• Medicare Advantage trial period: If you join a Medicare Advantage plan when first eligible for Medicare and decide to switch back to Original Medicare within the first year, you have guaranteed issue rights.

• Medicare Advantage plan issues: If your Medicare Advantage plan leaves Medicare, stops providing services in your area, or you move out of their service area, you have guaranteed issue rights.

• Medigap plan issues: If your Medigap insurer goes bankrupt or your coverage ends for reasons outside your control, you have guaranteed issue rights.

• Medicare Advantage plan misconduct: If you leave your Medicare Advantage plan due to the company not following rules or misleading you, you have guaranteed issue rights.

If you’re looking for a full list of situations that may afford you guaranteed issue rights, Medicare.gov has a short survey that gives you an answer.

Tips for Getting Through Underwriting

If you’re facing Medigap underwriting, here are some tips to increase your chances of approval:

• Be prepared: Collect your medical record. This should include dates of diagnoses, treatments, and medications.

• Be thorough: Answer all health questions honestly and completely. Don’t leave anything blank or say “I don’t know” if you can avoid it.

• Be proactive: If you have any pending medical procedures or tests, consider completing them before applying for Medigap.

• Be honest: Disclose all health conditions and medications, even if you think they might be disqualifying.

While some conditions might make it more challenging to get approved, it’s always worth applying. Insurance companies have some flexibility, and you might qualify for a plan even with pre-existing conditions. If you’re curious what you may be asked, insurers publish the health questions in their Medigap applications, so you can preview them before you apply.

Denied Coverage? You Have Options

If your Medigap application is denied, it doesn’t mean your options are over. Here are some steps you can take:

• Appeal the decision: Each insurer has an appeal process. Contact them to learn more.

• Contact Medicare: Call 1-800-MEDICARE (800-633-4227) for assistance.

• Seek help from SHIP: Your State Health Insurance Assistance Program (SHIP) offers free, unbiased counseling on Medicare and Medigap issues.

• Consider alternatives: Explore other options like Medicare Advantage plans, but be aware of their differences from Medigap plans (networks, prior authorizations, etc.).

Where to get help: This can be a difficult process. Licensed insurance agents at SmartConnect, Benepicks’ Medicare enrollment partner, can help you explore options if you’re denied coverage, whether you applied through another agent or on your own.

State-Specific Underwriting Considerations

It’s important to note that Medigap regulations can vary from state to state. Some states have more generous guaranteed issue rights or offer additional protections for consumers. One of the clearest examples is the Birthday Rule, which a number of states use to provide guaranteed issue rights around a beneficiary’s birthday.

To learn more about the rules in your state, contact your state insurance department or SHIP.

Making the Decision on Switching Plans

The decision to switch from Medicare Advantage to Medicare Supplement is a personal one. Carefully weigh the pros and cons based on your individual health needs, financial situation, and preferences. It’s also a good idea to compare plans and get quotes from different insurance companies. Remember these key points:

• Mind the calendar: Switch during the Annual Enrollment Period or the Medicare Advantage Open Enrollment Period.

• Medigap Open Enrollment is key: If you’re new to Medicare, take advantage of your guaranteed issue rights during this time.

• Know your rights: Understand when you have guaranteed issue rights outside of open enrollment.

• Be prepared for underwriting: Gather your medical information and be honest in your application.

• Don’t give up: If you’re denied coverage, explore your options and seek help from resources like SHIP or a trusted licensed insurance agent.

By being proactive and informed, you can navigate the switch with confidence and find the plan that best meets your needs and budget.

Remember: If you’re considering a switch, don’t wait until the last minute. Benepicks partners with SmartConnect, whose licensed insurance agents can walk you through the pros and cons for your exact care needs, at no cost. Contact support@benepicks.com for more help.

This article is for educational purposes only and is not tax, legal, or insurance advice. Benepicks is not connected with or endorsed by the U.S. government or the federal Medicare program.