Leaving Medicare Advantage Takes One Phone Call. Getting the Medigap Policy That Makes Leaving Affordable Can Require Medical Underwriting.

Leaving a Medicare Advantage plan is a simple phone call, but finding affordable Medigap coverage afterward can be challenging, especially due to medical underwriting. Original Medicare has no out-of-pocket limit, requiring beneficiaries to pay 20% coinsurance plus a $1,736 hospital deductible in 2026. To avoid issues when dropping Medicare Advantage, it's crucial to secure written Medigap approval beforehand, as guaranteed-issue rights during enrollment only apply in limited situations.

A 71-year-old Medicare Advantage member faced this challenge when his cardiologist left the plan's network, prompting him to switch to Original Medicare and seek Medigap Plan G coverage. However, medical history, such as heart disease and medications, often leads to rejection by Medigap insurers. The Medicare Advantage open enrollment period allows beneficiaries to switch to Original Medicare from October 15 to December 7, while Medigap has its own six-month open enrollment period starting at age 65.

After this protected window, medical underwriting typically applies in most states. Original Medicare offers wider provider access but lacks a limit on out-of-pocket costs, which can be problematic for those with cardiac histories, as specialist visits and procedures can accumulate costs. Plan G Medigap coverage helps bridge some gaps, but approval depends on medical underwriting.

Federal guaranteed-issue rights and trial periods may offer limited exceptions in specific cases, but state laws play a significant role in determining eligibility. Proper planning is essential, including confirming enrollment periods, applying for Medigap before losing existing coverage, and waiting for written approval. If Medigap proves unavailable or too expensive, beneficiaries should compare the costs and provider access of staying in Medicare Advantage or switching to another plan.