There are many reasons to like a Medicare Supplement plan. First, it’s a great option for people on a budget because the cost sharing for healthcare services is predictable. Medigap beneficiaries can also see any doctor that accepts Medicare assignment and typically don’t need referrals for specialty care. Those who are frequent travelers likely have coverage for trips outside of the United States.
You may have signed up for Medicare Advantage at 65 because you didn’t know about benefits like these that can come with Medigap. Or your circumstances may have changed over the years, and you have different healthcare needs. Whatever the reason for considering something new, you can switch from Medicare Advantage to a Medicare Supplement in 2026. Read on to find out how this works and if Medigap could be right for you.
What to know about switching to a Medigap plan
Anyone over 65 on Medicare Advantage can switch to a Medicare Supplement plan. But there are rules, deadlines, and costs to understand before you change. One major factor is timing.
When you first enroll in Medicare at 65, you have a 12-month window to switch from the plan you choose to another one. The Centers for Medicare and Medicaid Services (CMS) does this for new members to ensure they have a plan that fits their needs.
Aside from this, there are two enrollment periods throughout the year when you can switch your Medicare plan.
Medicare open enrollment – October 15 to December 7 is the annual enrollment period for changing or leaving Medicare Advantage plans and Part D drug plans. You can move from Medicare Advantage to Original Medicare (with a Medicare Supplement plan) during this time. The plan change will begin on January 1 of the following year.
Medicare Advantage open enrollment – From January 1 to March 31, you can also drop your Medicare Advantage plan and move to Original Medicare and a supplement plan. Your coverage begins the month after you change plans.
Medicare Supplement limitations and considerations
Though you may be able to sign up for a Medicare Supplement plan during these time periods, if it’s past your Initial Enrollment Period, you will go through medical underwriting, unless your state has a birthday rule or guaranteed issue rights for special circumstances. Insurance companies use medical underwriting to understand the risk you have of filing costly medical claims throughout the year.
When you go through underwriting, the plans have a couple of options if they think you’re a high-risk person (you have certain pre-existing conditions). The plans can give you coverage – but charge higher monthly premiums – or deny coverage altogether. Before getting rid of your Medicare Advantage plan, it’s a good idea to talk to a United Medicare Advisors agent to make sure you’ll be eligible for a Medicap policy.
Questions that will be asked during medical underwriting when you switch to a Medicare Supplement plan include your:
- Age,
- Chronic health conditions,
- Heart health,
- Use of alcohol and tobacco,
- Drug use, including prescriptions, over-the-counter medications, and other substances,
- Gender,
- Family health history,
- Medical history,
- Weight,
- Mental health history.
Insurers will often charge higher premiums rather than deny you coverage for pre-existing conditions. But some health conditions could make you more likely to be denied during underwriting. These include:
- AIDS,
- Chronic obstructive pulmonary disease (COPD),
- Kidney failure,
- Alzheimer’s disease,
- Multiple sclerosis (MS),
- Parkinson’s disease,
- Heart attack, stroke, or having an implantable cardiac defibrillator.
There are a couple of other things to consider before moving to a Medigap plan, aside from underwriting issues. You’ll need to consider supplemental benefits and signing up for a drug plan.
Missing extra benefits: Medicare Supplement plans don’t have dental, vision, or hearing benefits. They also lack some additional benefits that specific Medicare Advantage plans may offer, including fitness memberships, flex cards to help pay for food and over-the-counter medications, and free or discounted rides to doctor’s appointments.
Prescription drug plan: You’ll also need to sign up for a separate Part D prescription drug plan on your own. Prescription drug coverage isn’t included in Medicare Supplement plans. If you don’t enroll in a Part D plan when signing up for Medigap, you could face a Part D late enrollment penalty for going without prescription drug coverage.
What to know about switching to Medigap in 2026
Medicare is challenging to understand because of the rules surrounding enrollment, prescription drug plans, and policy pricing and benefits. Here are a few more things to know when considering whether a Medigap plan is right for you.
Birthday rules
It’s no fun going through your entire medical history with someone. Luckily, some states have guaranteed issue (no underwriting required) rules that make it easier and potentially less expensive to switch when it’s not your initial enrollment period.
State exceptions, some known as birthday rules, allow you to change Medicare plans during a certain window – often 30 to 60 days around your birthday or the anniversary of the month when you started the plan. Here are some states that allow you to switch with guaranteed issue outside of initial enrollment. In many states, the plan you choose has to be similar to, or have fewer benefits, than the one you are currently on.
- New York, Vermont, and Connecticut allow changes at any time of year without underwriting;
- Maine and Washington have some year-round protections;
- Massachusetts has a two-month window – February 1, through March 31 – every year when people can enroll without underwriting;
- California, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maryland, Nevada, Oregon, Utah, Virginia, Wyoming, Oklahoma, Missouri, and Delaware have birthday or anniversary windows.
If you do not live in one of these states, keep an eye on your state legislators, as more states are adding birthday rules every year.
Higher premiums
Medigap plans tend to have higher premiums than Medicare Advantage plans, but what you pay for out of pocket for healthcare costs throughout the year would be minimal. Here’s a look at what’s typically covered:
- Medigap covers your coinsurance for hospital stays and, if you need to stay in a hospital long term, it covers much of the costs that Original Medicare doesn’t.
- Medigap pays for nearly all of your 20% coinsurance costs for hospitals and healthcare provider visits.
- Medigap covers emergency healthcare when traveling outside of the United States.
Premium costs for Medicare Advantage plans vary widely, depending on the plan type, but the average is about $15 per month. Medigap premium costs have risen double digits year over year. For Plan G, one of the most common Medicare Supplement plans, premiums range from $142 to about $180 per month.
Medicare Supplement plans don’t come with a prescription drug benefit, so you also have to pay for a Part D plan when switching from Medicare Advantage. The average cost for a Part D plan in 2026 is $34.50 per month. United Medicare Advisors can help you find a Part D plan that covers your prescriptions at a price that fits into your budget.
Prior authorization pilots
Prior authorization – often seen in Medicare Advantage plans – is used by insurers to reduce waste and fraud in the system. It can, however, make it more difficult to get the healthcare you need. You should know that you may need prior authorization for some care with Original Medicare as well.
Starting in 2026, the Centers for Medicare and Medicaid Services (CMS) is testing a pilot program for prior authorization in Original Medicare (and therefore, Medicare Supplement). Through the pilot, six states – Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington – will begin reviewing the medical necessity of claims for services that CMS has deemed low value, like knee arthroscopy and implantation of electrical nerve stimulators, for example. The program will run through the end of 2031.
Switching from Medicare Advantage to a Medigap plan isn’t always a simple process. But if you want a wider array of doctors and more consistent healthcare costs, a Supplement may be right for you. Before doing anything, talk with a United Medicare Advisors representative to understand if you’re eligible for a Medigap plan. Your advisor can also assist you in finding the best Supplement and Part D insurance to keep your health, and your budget, on track.
