AEP AND MEDIGAP ARE DIFFERENT
Can I Switch From Medicare Advantage to a Medicare Supplement During AEP?
Medicare Open Enrollment can let you leave Medicare Advantage and return to Original Medicare. It does not automatically create a right to buy any Medicare Supplement policy without medical underwriting.
During Medicare Open Enrollment, someone in Medicare Advantage can generally return to Original Medicare for January 1 and join a stand-alone Part D plan.
Medicare Supplement acceptance is separate. Outside your six-month Medigap Open Enrollment Period, a federal guaranteed-issue right, a trial right or another state protection, an insurer may be allowed to use medical underwriting.
Investigate Medigap eligibility and coordinate effective dates before completing the Medicare Advantage change.
THREE SEPARATE PIECES
Leaving Medicare Advantage Is Not One Application
| Coverage decision | What it does | What to verify |
|---|---|---|
| Return to Original Medicare | Ends Medicare Advantage and restores Original Medicare as the way you receive Part A and Part B benefits | Permitted enrollment period, effective date and how the election is submitted |
| Apply for a Medicare Supplement | May help pay certain costs left by Original Medicare | Eligibility, underwriting, guaranteed-issue rights, premium and effective date |
| Join a stand-alone Part D plan | Provides outpatient prescription coverage that Medigap does not include | Formulary, pharmacy, costs, restrictions and effective date |
The evergreen Medicare Annual Enrollment Period guide explains what can be changed from October 15 through December 7, and the Springfield AEP guide adds local 2026 planning. The broader coverage comparison is available in Medicare Advantage vs. Medicare Supplement.
WHY ACCEPTANCE IS NOT AUTOMATIC
When Can Medical Underwriting Apply?
Your federal six-month Medigap Open Enrollment Period generally begins when you are 65 or older and enrolled in Part B. During that period, an insurer cannot use health questions to deny the Medigap policy because of your medical history.
After that protected period, federal law does not give an unrestricted annual right to buy or switch Medigap. Unless another protected situation applies, the application may include medical questions and the insurer may be allowed to decline coverage or apply permitted pricing rules.
AEP is not Medigap Open Enrollment. October 15 through December 7 concerns Medicare Advantage and Part D elections. It does not reopen your original six-month Medigap enrollment period.
Learn more about the structure of coverage in the Medicare Supplements guide, then review Medigap underwriting and any applicable guaranteed-issue rights.
PROTECTED RIGHTS
When Might Guaranteed-Issue or Trial Rights Apply?
Federal Medicare guidance lists specific situations in which an insurer cannot deny certain Medigap coverage. Examples can include:
- Your Medicare Advantage plan leaves Medicare or stops serving your area and you switch to Original Medicare.
- You joined Medicare Advantage when first eligible at 65 and return to Original Medicare within the first year.
- You dropped a Medigap policy to join Medicare Advantage for the first time and return within the protected trial period.
- You move outside the Medicare Advantage plan’s service area and meet the applicable guaranteed-issue requirements.
- The coverage ends through no fault of your own in another situation recognized by federal or state law.
- The company materially violated the rules or misled you and the applicable protection is established.
This list is not exhaustive, and protected rights can limit which Medigap plan letters are available and when you must apply. Missouri and Illinois may provide additional rights beyond the federal minimum. Confirm the exact right before relying on it.
If the Advantage plan itself is ending, start with what happens when a Medicare Advantage plan ends.
If the change is being considered from January 1 through March 31, review the separate Medicare Advantage Open Enrollment Period. MA-OEP may permit a return to Original Medicare, but the election window still does not guarantee Medigap acceptance.
A SAFER ORDER
How Should You Coordinate the Transition?
- Compare the two coverage structures. Use the Medicare Advantage plan-selection framework to review premiums, provider access, medical cost exposure, prescriptions, travel and authorization rules.
- Identify your Medigap enrollment protection. Determine whether you are in open enrollment, have guaranteed issue, have a trial right or may face underwriting.
- Apply for Medigap when appropriate. Request the effective date that coordinates with Original Medicare and do not assume an application equals approval.
- Verify the Medigap decision in writing. Confirm acceptance, premium and effective date before relying on the policy.
- Select compatible Part D coverage. Check every prescription and pharmacy because Medigap does not include outpatient drug coverage.
- Complete the Medicare Advantage election correctly. Use the applicable enrollment period and verify the January 1 or other effective date.
- Do not cancel coverage early. Keep documentation showing how and when each piece begins.
COMPARE THE WHOLE STRUCTURE
When Might Each Approach Fit Differently?
Medicare Advantage
May combine medical and drug coverage with plan-specific networks, cost sharing, authorization rules, service areas and additional benefits. Compare the specific HMO, PPO and HMO-POS network rules rather than relying only on the plan label.
Original Medicare
Generally allows covered care from U.S. providers that accept Medicare, but Original Medicare alone has no single annual medical out-of-pocket limit.
Medigap plus Part D
Uses a separate Medigap premium and a separate Part D plan. Provider access and medical cost predictability may differ substantially from Medicare Advantage.
Do not compare only monthly premiums
The correct comparison includes likely healthcare use, premium stability, provider access, prescription coverage, travel, underwriting and the financial exposure you are comfortable carrying.
COMMON QUESTIONS
Medicare Advantage to Medigap FAQ
Can I leave Medicare Advantage during AEP?
Generally, yes. During Medicare Open Enrollment you may return to Original Medicare for January 1 and may join a stand-alone Part D plan.
Does AEP guarantee acceptance into Medigap?
No. Medigap acceptance depends on your open-enrollment status, guaranteed-issue or trial rights, state protections and, when permitted, medical underwriting.
Should I leave Medicare Advantage before applying for Medigap?
Do not create a coverage gap or rely on an unapproved application. Coordinate the permitted election, Medigap decision, Part D enrollment and effective dates before ending current coverage.
Does a Medicare Supplement include drug coverage?
No. Modern Medigap policies do not include outpatient prescription coverage. Someone returning to Original Medicare will generally evaluate a separate Part D plan.
Can state law give me additional Medigap rights?
Yes. States can provide protections beyond the federal minimum. Missouri and Illinois rights should be confirmed for the person’s exact policy and situation.
OFFICIAL INFORMATION
Official Medicare Advantage and Medigap resources
Independent Medicare guidance
Coordinate Medicare Advantage, Medigap and Part D
Thompson Medicare Brokerage helps Missouri and Illinois beneficiaries compare the private coverage choices that may accompany a return to Original Medicare.
Thompson Medicare Brokerage is not connected with or endorsed by the U.S. government or the federal Medicare program. This article provides general educational information. Enrollment rights, coverage, costs, provider participation, formularies and plan availability depend on individual facts, location and the applicable plan year. Thompson Medicare Brokerage does not offer every plan available in every area. Contact Medicare.gov, 1-800-MEDICARE or your State Health Insurance Assistance Program for information about all available options.