Understanding the Right Time to Make the Switch
One of the most important aspects of moving from a Medicare Advantage plan to a Medigap plan is timing. You cannot make this change whenever you wish. There are specific windows during the year when this is allowed. The primary opportunity is the Medicare Advantage Open Enrollment Period (MA OEP), which runs from January 1 through March 31 each year. During this period, if you are currently enrolled in a Medicare Advantage plan, you can leave your plan and return to Original Medicare (Part A and Part B). As part of that move, you can also add a standalone Medicare Part D Prescription Drug Plan. It's crucial to understand this period is exclusively for people already in an Advantage plan. This is different from the Fall Open Enrollment (Oct 15 - Dec 7), where anyone can make a variety of changes. Another opportunity comes from having a Special Enrollment Period (SEP). SEPs are triggered by specific life events, such as moving out of your plan's service area, qualifying for Extra Help, or if you're in your first year of a Medicare Advantage plan after joining at age 65 (this is a 'trial right'). Understanding which window applies to you is the first critical step in the process, as missing it could mean waiting another year.
Step 1: Confirm Your Medigap Eligibility and Underwriting Rules
Once you've identified your enrollment window, the next step is to determine your eligibility for a Medigap plan. This is where many people get tripped up. When you first become eligible for Medicare at 65, you have a six-month Medigap Open Enrollment Period where you can buy any Medigap plan sold in Ohio with no medical questions asked. However, once that initial window closes, your ability to buy a plan is not always guaranteed. Outside of that initial period, or a few specific 'guaranteed issue' situations, Medigap insurance carriers can require you to go through medical underwriting. This means you will have to answer a series of health questions on your application. Based on your answers, the insurance company can approve you, deny you, or potentially charge you a higher premium. Some common guaranteed issue rights that allow you to bypass underwriting include moving out of your Advantage plan's service area or exercising your 'trial right' if you joined an Advantage plan when you first turned 65 and want to switch to Medigap within the first 12 months. It's important to be honest about your health history and know your rights. The Ohio Senior Health Insurance Information Program (OSHIIP) is a state resource that can explain these rights, but as government counselors, they cannot recommend a specific path or company for your situation.
Step 2: Gather Your Documents and Information
Before you can apply for new coverage, you need to have all your personal information organized. Taking the time to do this upfront will make the process much smoother. Think of this as preparing a complete file on your healthcare needs. You should have the following items ready:
* Your red, white, and blue Medicare card: Make sure you have the card with your Medicare Beneficiary Identifier (MBI). This number is essential for any enrollment or disenrollment action. * A complete list of your prescription medications: Write down the name of each drug, the exact dosage (e.g., 20mg), and how often you take it. This is vital for selecting a Part D drug plan that covers your medications at the lowest cost. * A list of your doctors and preferred hospitals: Note the names and locations of all your primary care physicians, specialists, and the hospital systems you prefer to use (e.g., University Hospitals, Cleveland Clinic, MetroHealth). This helps ensure the new path you choose aligns with your providers. * A general overview of your health history: Be prepared to recall major health events, chronic conditions, and recent treatments. If you have to go through medical underwriting for a Medigap plan, you'll need this information for the application.
Having this information handy allows an agent to quickly check Part D plan formularies and advise you on the likelihood of passing Medigap underwriting.
Talk to a licensed Northeast Ohio Medicare agent — free
Get plan options matched to your ZIP, doctors, and prescriptions. Callback within 24 hours.
or call (234) 380-6282 — United Medicare Club, our partner agency
Step 3: Apply for Medigap and a Standalone Part D Plan
This is the active part of the process where you choose and apply for your new coverage. Since you are leaving a Medicare Advantage plan (which usually includes drug coverage), you will need to secure two separate policies: a Medigap supplement and a standalone Part D Prescription Drug Plan. The most critical piece of advice here is to apply for the Medigap plan first and wait until you have a formal approval letter from the insurance company before you take any action to leave your Medicare Advantage plan. This prevents a scenario where you disenroll from your current coverage only to find out you were denied for Medigap, leaving you with only Original Medicare and no cap on your out-of-pocket costs. Medigap plans are standardized by letters (e.g., Plan G, Plan N), meaning a Plan G from one company offers the exact same medical benefits as a Plan G from another. However, their monthly premiums can vary significantly. At the same time, you'll select a Part D plan that best covers your specific list of medications. Failing to enroll in a Part D plan when you leave your Advantage plan will not only leave you without drug coverage but also expose you to a permanent late enrollment penalty.
Step 4: Formally Disenroll from Your Advantage Plan and Confirm
Once you have your Medigap approval letter in hand, you can proceed with disenrolling from your Medicare Advantage plan. There are a few ways to do this correctly. You should never just stop paying the premium, as this can lead to collections and other problems. During the MA OEP (Jan 1-Mar 31), the simplest method is to enroll in a standalone Part D plan. The act of enrolling in a new Part D plan will automatically trigger your disenrollment from your previous Medicare Advantage Prescription Drug (MA-PD) plan. You can also disenroll by calling Medicare directly or by submitting a written request to your current plan provider. Some independent agents can also facilitate this process for you. It's important to note that this action is handled through Medicare and the insurance companies, not an agency like the Social Security Administration field office in downtown Cleveland, which handles your initial Medicare enrollment and benefits. After you've taken action, be on the lookout for mail. You should receive a confirmation letter from your old Advantage plan stating that your coverage is ending, as well as welcome kits and ID cards from your new Medigap and Part D plan providers. Do not throw this mail away; file it for your records.
Common and Costly Mistakes to Avoid
We have helped thousands of Ohio families with their health insurance, and we see the same avoidable mistakes every year. Being aware of them can save you a great deal of trouble. The most significant error is dropping your Medicare Advantage plan before you have an approved Medigap policy in hand. If you are subject to medical underwriting and get denied, you could be left with large gaps in your coverage. Another frequent mistake is forgetting about prescription drugs. When you switch to Original Medicare and Medigap, you must actively enroll in a separate Part D plan. If you don't, you'll face a lifelong late enrollment penalty and have to pay 100% for your prescriptions. People also misunderstand the timing. Trying to switch during the Fall Open Enrollment period can be complicated, as this period is not designed for this specific change. The MA OEP from January 1 to March 31 is the correct time for most people. Finally, many assume they have a 'guaranteed issue' right to a Medigap plan when they do not. Unless you meet very specific criteria, you will likely face health questions. An experienced agent can review your specific situation and guide you through the correct sequence of steps. To get personalized help and avoid these common pitfalls, use the form on this page to request a call from one of our licensed Ohio agents.
Frequently asked questions
Can I switch from Medicare Advantage to Medigap at any time?
No, you cannot switch at any time. The main window for this change is the Medicare Advantage Open Enrollment Period from January 1 to March 31. This period is only for individuals already enrolled in an Advantage plan. You may also be able to switch if you have a Special Enrollment Period (SEP) due to a specific life event, like moving out of your plan's service area or losing employer coverage. Outside of these specific windows, you must remain in your plan for the rest of the calendar year.
Will I have to answer health questions to get a Medigap plan?
Most likely, yes. Unless you are in your initial six-month Medigap Open Enrollment Period when you first turn 65, or you qualify for a specific 'guaranteed issue right,' you will have to go through medical underwriting. This involves answering health questions on the application. The insurance company can use this information to determine your eligibility and premium. Situations that grant guaranteed issue rights are limited, such as moving, or exercising a 'trial right' in your first year with Medicare Advantage.
What happens to my drug coverage when I switch to Medigap?
When you switch from Medicare Advantage back to Original Medicare with a Medigap supplement, you lose the prescription drug coverage that was bundled with your Advantage plan. Medigap plans do not cover prescription drugs. You must enroll in a standalone Medicare Part D Prescription Drug Plan to have coverage for your medications. Failing to do so at the time of the switch will result in you paying 100% for your prescriptions and likely incurring a permanent late enrollment penalty from Medicare.
What's the difference between Fall Open Enrollment and the MA Open Enrollment Period?
The Fall Open Enrollment Period (AEP) runs from October 15 to December 7. During AEP, any Medicare beneficiary can switch between Original Medicare and Medicare Advantage, change MA plans, or change Part D plans. The Medicare Advantage Open Enrollment Period (MA OEP) runs from January 1 to March 31. This period is only for people who are already in a Medicare Advantage plan. It allows them to switch to another MA plan or drop their MA plan and return to Original Medicare (and pick up a Part D plan).
If I get sick, can my Medigap insurance company cancel my policy?
No. Your Medigap policy is guaranteed renewable. This means the insurance company cannot cancel your policy as long as you continue to pay your premiums on time. Your coverage cannot be terminated because of any health problems you may develop after you are enrolled. This is one of the key protections and benefits of having a Medigap plan, providing stability in your health coverage regardless of future health changes.
I just moved to a new part of Ohio. Can I use this move to switch from Advantage to Medigap?
Yes, moving out of your Medicare Advantage plan's service area creates a Special Enrollment Period (SEP). This SEP allows you to make a change in your coverage. More importantly, in this specific situation, you are typically granted a 'guaranteed issue right' to purchase a Medigap plan without going through medical underwriting. You generally have about two months after Your Advantage plan coverage ends to choose a Medigap plan under this right, so it is important to act promptly.
Is Medigap the same thing as Original Medicare?
No, they are different but they work together. Original Medicare consists of Part A (Hospital Insurance) and Part B (Medical Insurance), which are provided by the federal government. Medigap, also known as Medicare Supplement Insurance, is private insurance that you can buy to help pay for your share of the costs in Original Medicare, like deductibles, copayments, and coinsurance. You must be enrolled in Original Medicare Part A and Part B to be eligible to purchase a Medigap policy.
Get a free, no-pressure Medicare review
A licensed Ohio agent will reach out within 24 hours and walk you through the right plan for your doctors, prescriptions, and budget.
- A real, licensed local insurance agent — no call center
- No cost, no obligation, no robocalls
- Your information stays private and is never sold
Prefer to skip the form? Call (234) 380-6282 — United Medicare Club, our partner agency.
Let's start with your name
🔒 Your information is private and is only used to have a licensed agent help you. We never sell your data.