Quick Read
Leaving Medicare Advantage requires one call, but Medigap insurers in most states can reject applicants based on medical history after the age-65 enrollment window closes.
Original Medicare carries no out-of-pocket cap, leaving beneficiaries on the hook for 20% coinsurance plus a $1,736 per-benefit-period hospital deductible in 2026.
Secure written Medigap approval before dropping Medicare Advantage coverage, since guaranteed-issue rights that bypass underwriting apply only in narrow, defined situations.
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A 71-year-old Medicare Advantage member watches his longtime cardiologist leave the plan’s network. During the Medicare Advantage Open Enrollment Period, he decides he has had enough. He can return to Original Medicare effective the first of the following month and regain access to any doctor who accepts Medicare. Then he calls a Medigap broker about Plan G.
The questions start almost immediately: heart disease, medications, hospitalizations, procedures. Two prescriptions taken together are enough for one carrier to decline him. Another will not take the cardiac history. Suddenly, leaving Medicare Advantage was the easy part. The coverage he wants on the other side is where the door gets narrower.
Medicare Advantage Has an Exit. Medigap Has an Entrance Exam of Its Own
Each fall, from October 15 through December 7, Medicare beneficiaries can leave Medicare Advantage and return to Original Medicare for January 1. People already enrolled in Medicare Advantage get another opportunity from January 1 through March 31, when they can make one change, including a move back to Original Medicare. Medigap follows a different calendar.
The federal Medigap open enrollment period lasts six months beginning when someone is 65 or older and enrolled in Medicare Part B. During that protected window, insurers cannot reject an applicant or charge more because of health.
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Years later, that protection is usually gone. In most states, someone applying for a new Medigap policy can face medical underwriting unless a guaranteed-issue right or stronger state rule applies. That is the mismatch: Medicare may let him leave Advantage without asking about his heart. The Medigap insurer she needs afterward may care very much about it.
