Can I Switch From Medicare Advantage to Medigap?
Yes, most beneficiaries can switch from Medicare Advantage to a Medicare Supplement plan (Medigap), but only during these periods:
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AEP
- Medicare Annual Enrollment Period – October 15th through December 7th each year.
- *Medical underwriting may be required.
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OEP
- Medicare Advantage Open Enrollment Period – January 1st through March 3st each year.
- *Medical underwriting may be required.
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SEPs
- Special Enrollment Periods – if you lose coverage due to certain life events.
- Medical underwriting not required.
*Important to note: If you switch from Medicare Advantage to Medigap outside of a Special Enrollment Period, insurance providers may require medical underwriting to assess your medical history and current health. The insurer might deny you a plan or charge higher premiums depending on the risk.
Special Enrollment Periods
According to Medicare.gov, you can switch your Medicare Advantage coverage during Special Enrollment Periods (SEPs) triggered by specific life events.
Here are some scenarios that may qualify you for a SEP:
- Moving to an area not covered by your current plan
- Losing health insurance from your current employer
- Medicare discontinuing the plan’s contract
Additional situations may qualify you for an SEP, which is evaluated on a case-by-case basis.
How Do I Switch From Medicare Advantage to Medigap?
If you are eligible to switch from your Medicare Advantage plan to a Medicare Supplement plan, you can follow these steps:
#1. Apply for Medigap: Before leaving your Medicare Advantage plan, you must apply for coverage through the Medigap provider you wish to enroll with. Applying for coverage beforehand ensures that you are approved and not left without insurance if you are denied during underwriting.
#2. Disenroll from your Medicare Advantage plan: Once approved for a Medigap plan, you must drop your Medicare Advantage plan before the new Medigap coverage becomes active. You can also enroll in a standalone Part D plan to maintain prescription drug coverage.
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How Do I Disenroll?
You can contact your Medicare Advantage plan provider directly, or you can choose to enroll in a prescription drug plan, which will disenroll you from Medicare Advantage.
Can I Have Medicare Advantage and Medigap at the Same Time?
No, you can’t have active Medicare Advantage and Medigap plans simultaneously because they’re both based on Original Medicare.
Medicare Advantage replaces Original Medicare, while Medigap fills the coverage gaps.
Also, an insurance company can’t legally sell you a Medigap plan if they know you’re enrolled in an Advantage plan (unless you prove in writing that you’re switching).
How Do Medicare Advantage Plans Work?
Medicare Advantage plans (or Medicare Part C) are private insurance plans that must cover everything Original Medicare (Part A and Part B) does, but they often come with additional benefits such as dental, vision, hearing, and even fitness programs.
While these extras may seem appealing, Medicare Advantage plans have significant downsides, including:
- Prior authorization requirements
- Network restrictions
- Lower reimbursement rates (which can impact access to care and cause plan changes year over year)
Let’s look at the limitations of Medicare Advantage plans in a little more detail.
Prior Authorization Requirements
Medicare Advantage plans frequently require prior authorization for services, meaning patients need insurer approval before receiving many treatments.
This can lead to delays, denials, and additional administrative burdens for both patients and providers. A necessary procedure could be delayed for weeks or even denied altogether.
Network Restrictions
Unlike Original Medicare, which allows access to any provider that accepts Medicare, most Medicare Advantage plans operate within HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) networks.
If a patient sees a provider outside the plan’s network in an HMO, they may have to pay 100% of the cost, except in emergencies. PPOs offer more flexibility but still impose higher costs for out-of-network care.
Lower CMS Reimbursement Rates
Medicare Advantage plans are reimbursed at lower rates than traditional Medicare, which can lead to providers dropping out of networks or limiting the number of MA patients they accept.
This can result in plan changes each year, forcing beneficiaries to switch doctors or find a new plan altogether.
Coverage Limitations
Despite offering extra benefits, these plans often come with high out-of-pocket costs, copays, and strict rules about referrals and approvals.
A service covered under one Medicare Advantage plan may not be covered under another, making it difficult to anticipate long-term costs.
HMO vs. PPO Plans: A Real-Life Scenario
John is a 70-year-old Medicare Advantage beneficiary who requires routine check-ups, a specialist visit, outpatient surgery, and emergency room care.
Here’s how his experience differs depending on whether he is enrolled in an HMO or a PPO Medicare Advantage plan:
| Medical Service | HMO Medicare Advantage Plan | PPO Medicare Advantage Plan |
|---|---|---|
| Primary Care Visit | $0–$20 copay (must see an in-network doctor) | $0–$20 copay (in-network), or higher cost out-of-network |
| Specialist Visit | Requires referral; $40–$50 copay | No referral needed; $40–$60 copay (higher out-of-network) |
| Outpatient Surgery | Requires prior authorization; $250–$500 copay | Prior authorization likely; $300–$600 copay (higher out-of-network) |
| Emergency Room Visit | Covered at any ER; $90–$120 copay | Covered at any ER; $90–$120 copay |
| Hospital Stay (5 days) | $300–$400 per day (network only) | $300–$500 per day (higher if out-of-network) |
| Out-of-Network Care | Not covered (except for emergencies) | Covered but at a higher cost |
In a nutshell:
- HMO plans offer lower premiums but require strict network adherence and referrals for specialists.
- PPO plans have more flexibility but higher costs for out-of-network care.
- Both plans require prior authorizations and are subject to plan changes due to lower CMS reimbursement rates.
Medicare Advantage plans might seem appealing with their low or even $0 premiums, but the restrictions, prior authorizations, and network limits can often make it harder to get the care you need.
Medigap: A Better Option Than Medicare Advantage
As someone who has been helping people navigate Medicare for over 15 years, I can confidently say that Medigap plans offer superior coverage compared to Medicare Advantage (MA) plans.
While Medicare Advantage plans may seem attractive at first glance due to their lower upfront costs, they come with a host of restrictions, unpredictable out-of-pocket expenses, and network limitations that can leave beneficiaries frustrated.
Let me explain how Medigap works and why it’s the better choice over HMO and PPO Medicare Advantage plans.
How Medigap Plans Work
Medigap, also known as Medicare Supplement insurance, is designed to work alongside Original Medicare (Parts A & B). It helps cover the gaps in Medicare, including deductibles, copayments, and coinsurance.
Here’s how Medigap benefits you:
Freedom to See Any Doctor – Medigap plans allow you to see any doctor or specialist who accepts Medicare, anywhere in the U.S. No referrals, no networks – just full flexibility.
Predictable Costs – Depending on the plan you choose, you can eliminate most out-of-pocket expenses. For example, Medigap Plan G covers nearly all costs after you pay the small Part B deductible.
No Pre-Authorizations or Restrictions – Unlike Medicare Advantage, Medigap doesn’t require approvals for treatments or services. If Medicare covers it, your Medigap plan will cover it too.
Guaranteed Renewable Coverage – As long as you pay your premium, your Medigap policy can’t be canceled, even if your health declines.
No Annual Plan Changes – Medicare Advantage plans change benefits, provider networks, and drug formularies every year. With Medigap, your coverage remains stable.
Medicare Advantage vs. Medigap – Why Medigap is Better
Let’s look at the differences between Medigap and Medicare Advantage (HMO and PPO) even further and see why Medigap is a better option.
Provider Access and Networks
Medicare Advantage HMO limits you to a small network of doctors and hospitals. Going out-of-network typically means paying 100% of the costs. Medicare Advantage PPO offers some out-of-network coverage but at much higher costs. You still deal with limited network and provider restrictions.
With Medigap, you can see any doctor or specialist in the country who accepts Medicare. There are no networks or restrictions; you don’t have to worry about losing access to your preferred doctors or hospitals.
Out-of-Pocket Costs
With both Medicare Advantage HMO and PPO, you’ll face copays, coinsurance, and a maximum out-of-pocket limit that can be as high as $8,850 in 2025. Even routine visits can add up quickly.
Plans like Medigap Plan G cover nearly all out-of-pocket costs. You owe nothing for Medicare-approved services once you pay your Part B deductible ($257 in 2025).
Prior Authorizations and Delayed Care
Medicare Advantage HMO and PPO plans require prior approval for many services, leading to care delays. Insurers may also deny coverage for treatments your doctor deems necessary.
No prior authorizations are required with a Medigap plan. If Medicare covers it, your Medigap plan covers it—no questions asked.
Emergency and Out-of-State Coverage
With a Medicare Advantage HMO plan, you’re typically only covered for emergencies out of state – routine care must be within your network. A PPO plan may get some out-of-network coverage but comes with higher out-of-pocket costs.
Medigap offers full nationwide coverage with any Medicare-accepting provider. Some plans (like Plan F & G) even offer limited foreign travel emergency coverage.
Stability and Plan Changes
Medicare Advantage HMO & PPO plans can change their benefits, provider networks, drug coverage, and costs annually.
Medigap benefits never change. Your plan stays the same year after year, so there are no surprises, network changes, or unexpected cost increases due to plan redesigns.
Bottom Line: Medigap Is the #1 Choice
If you value freedom, predictable costs, and comprehensive coverage, a Medigap plan is the best option.
Medicare Advantage plans might seem appealing due to their lower premiums, but they come with major trade-offs—restricted networks, out-of-pocket unpredictability, and insurer control over your healthcare decisions.
When choosing between Medigap and Medicare Advantage, ask yourself: Do you want an insurance company making decisions about your healthcare, or do you want full control over where and when you receive care?
For me, the answer is simple – Medigap wins every time.
The Medicare Advantage Trap: What They Don’t Tell You at 65
One of the biggest pitfalls I see new enrollees fall into is what I call the Medicare Advantage trap.
If you’re turning 65 and new to Medicare, you need to understand this next section before making a decision that could impact your healthcare for the rest of your life.
The Initial Open Enrollment Period: Your One-Time Opportunity
When you first become eligible for Medicare at 65, you have a six-month Medigap Open Enrollment Period. This window is critical because, during this time, you have guaranteed issue rights – meaning you can get a Medigap policy with no health questions asked. Insurers cannot deny you coverage or charge you more based on your health conditions.
Unfortunately, most people don’t even realize this window exists because they are bombarded with Medicare Advantage marketing from TV ads, mailers, and phone calls.
Medicare Advantage plans are often pitched as having low or even zero-dollar premiums and sound incredibly appealing. But those ads don’t tell you what happens if you’re unhappy later and want to switch to Medigap.
The Trap: Losing Your Guaranteed Issue Rights
Many new Medicare enrollees jump into a Medicare Advantage plan without realizing that once their six-month Medigap Open Enrollment Period ends, their ability to get a Medigap plan later is no longer guaranteed.
If you’re in a Medicare Advantage plan for a year or two and decide you don’t like it – maybe you’re struggling with network restrictions, high out-of-pocket costs, or denied coverage for certain procedures – you might think you can switch to Original Medicare and pick up a Medigap plan.
But here’s the catch: Medigap insurers will now require medical underwriting.
This means they can:
- Deny you coverage if you have pre-existing health conditions or
- Charge you significantly higher premiums.
This is the devastating reality that no one warns you about. Once you’ve lost your guaranteed issue rights, getting into a Medigap plan later can be difficult – or even impossible – depending on your health.
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Why Don’t Agents Say This?
The hard truth is that most insurance agents don’t bring this up because Medicare Advantage plans pay them much higher commissions than Medigap policies.
It’s in their financial interest to enroll you in a Medicare Advantage plan, not to warn you about the long-term consequences.
What To Do Before Choosing Medicare Advantage
If you’re turning 65, think carefully before enrolling in Medicare Advantage. I’ve seen too many people regret their decision to enroll in Medicare Advantage because they weren’t fully informed. It’s often too late once they realize the limitations and want to switch to Medigap.
Ask yourself these questions:
- Do you want the freedom to see any doctor or specialist without referrals or network restrictions?
- Do you want predictable out-of-pocket costs without surprise copays and high deductibles?
- Are you willing to risk being locked out of a Medigap plan in the future due to health issues?
If you value flexibility, lower long-term costs, and peace of mind, enrolling in a Medigap plan while you have guaranteed issue rights is better, even if it means paying a monthly premium.
Make sure you weigh all your options carefully. This is one decision you don’t want to get wrong. If you have questions, speak with someone who will give you unbiased advice – not just an agent trying to sell you the highest-commission plan.
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Bonus tip:
If you currently have a Medigap policy and decide to switch to a Medicare Advantage plan for the first time but later find that you’re unsatisfied with your new plan, there is a trial right period of 12 months.
You can switch back to your previous Medigap policy if the same insurance company still offers it during this trial period.
Bottom Line: Medigap Wins
While Medicare Advantage might seem attractive with its low or zero premiums, it often comes with limited provider networks, higher out-of-pocket costs, and referral requirements.
Medigap gives you predictable costs, nationwide coverage, and the freedom to see any doctor who accepts Medicare.
If you can qualify for a Medigap plan—especially during your initial enrollment period or a guaranteed issue right—it’s usually the more flexible, reliable, and cost-effective option in the long run.
For personalized advice on your plan options, contact one of our licensed insurance agents. We’ll walk you through the details, recommend plans that fit your needs, and help make the transition easy.
Sources: How Medigap Works | How to Enroll | AEP Info | Medicare Advantage
FAQs
- Can you cancel Medicare Advantage at any time?
- Why do people choose Medigap over Medicare Advantage?
- Can I drop my Medicare Advantage plan and go back to Original Medicare?
- Why are doctors and hospitals dropping Medicare Advantage?
- How much does Medigap Plan G cost?
