Can I switch from a Medicare Advantage plan to Original Medicare with a Medigap plan mid-year if I’m diagnosed with a serious illness?

Question

Harold Randolph · Accepted Answer

The short answer is no. Medicare advantage changes are generally only allowed during (AEP) annual enrollment period (Oct 15 - Dec 7). Then you get another chance to make one more change during (OEP) open enrollment period (Jan 1 - Mar 31). Any changes outside these dates need a special enrollment period (SEP) and a diagnosis of an illness isn’t necessarily a reason for one. 

Medigaps are underwritten. If you have a serious illness you may not qualify. If you are still in your initial enrollment period (3 months before your birthdate, the month of, and 3 months after) of 7 months. 

Harold Randolph
269.339.4433
MI KY IN OH

Larry Dalton · Answer

Yes, you can switch from a Medicare Advantage plan to Original Medicare, but this could require you to enroll back under a Special Enrollment Period (SEP). However, switching back to traditional Medicare Part A and Part B is available but may cause additional circumstances. Your Medicare Advantage generally comes with prescription drug plans. Therefore, you may need to add a stand-alone Part D prescription drug plan at that point, and the enrollment in these plans has special enrollment periods. You could find yourself without drug coverage in the middle of the year, and subject to penalties for not having a proper drug plan for the remainder of that year.

Answered by Larry Dalton on May 5, 2025

Broker Licensed in OK & TX

Answered by Larry Dalton Medicare Insurance Agent

Robert Vaughan, R.Ph., MBA · Answer

No, not mid-year. You can use the Medicare Advantage Open Enrollment Period (MA OEP), which runs from January 1 to March 31 each year, to return to Original Medicare and apply for a Medicare Supplement (Medigap) plan. The issue here is serious illness, which would likely disqualify you from Medicare Supplement plans. You have 6 months from your Medicare Part B effective date to enroll in a Medicare Supplement plan without going through underwriting. Insurance companies can deny your application for a Medicare Supplement if submitted outside of this 6 month window.

Answered by Robert Vaughan, R.Ph., MBA on May 5, 2025

Broker Licensed in CA, AZ, NM, NV & TX

Answered by Robert Vaughan, R.Ph., MBA Medicare Insurance Agent

Leslie Kaz · Answer

Yes, you can switch from a Medicare Advantage (MA) plan to Original Medicare mid-year if diagnosed with a serious illness, and you may be able to enroll in a Medigap plan, but there are specific rules and considerations:

Answered by Leslie Kaz on May 6, 2025

Broker Licensed in CA, AL, AZ & 7 other states

Answered by Leslie Kaz Medicare Insurance Agent

Fred Manas · Answer

Yes, you can switch from a Medicare Advantage plan to Original Medicare with a Medigap plan mid-year if you're diagnosed with a serious illness. However, it's important to understand the timing and enrollment periods that apply. 
Elaboration:
Special Enrollment Periods:
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A serious illness diagnosis can qualify you for a Special Enrollment Period, allowing you to switch outside the normal open enrollment periods. 
Medicare Advantage Open Enrollment:
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If you are already enrolled in a Medicare Advantage plan, you can switch to Original Medicare during the Medicare Advantage Open Enrollment Period (January 1 to March 31). 
Annual Enrollment Period:
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You can also switch during the Annual Enrollment Period (October 15 to December 7). 
Medigap Enrollment:
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Switching from Medicare Advantage to Original Medicare also gives you an opportunity to enroll in a Medigap plan, which can help cover the cost-sharing requirements of Original Medicare. 
Guaranteed Issue Rights:
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If you disenroll from a Medicare Advantage plan during your first year, you have guaranteed issue rights to a Medigap policy, meaning an insurer cannot deny you coverage or charge you a higher premium. 
Guaranteed Issue Rights in Other Situations:
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You also have guaranteed issue rights to a Medigap policy if your Medicare Advantage plan terminates or if you move outside the plan's service area. 
Contact Medicare:
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For more specific information about your eligibility and the process for switching, it's recommended to contact Medicare.

Kevin Chaikin · Answer

It depends but in most cases, probably not. First, you would need to find a valid enrollment period to switch from Medicare Advantage to Part D (standalone) and then you would likely need to qualify for the Medigap plan via medical underwriting. There are exceptions to every rule however so it could depend where you live, how long you've been on Medicare Advantage or other factors that may plan into your situation. It is important to make your initial enrollment decision for the long-term however since you may not be able to get a Medigap plan after you first enroll in Part B.

Answered by Kevin Chaikin on May 5, 2025

Broker Licensed in VA, AL, AZ & 31 other states

Answered by Kevin Chaikin Medicare Insurance Agent

Alexander Lehn · Answer

In general, the answer is yes. A major illness diagnosis would typically be considered a "qualifying life event" that would allow for a change like this. This kind of change would come at a cost and may not be approved by a Medigap carrier. They can require medical underwriting and deny coverage coverage under circumstances like this. It is best to be approved for a Medicap plan before cancelling your advantage plan.

Answered by Alexander Lehn on May 6, 2025

Agent Licensed in NV, CA, FL & TX

Answered by Alexander Lehn Medicare Insurance Agent

Michael Hixson · Answer

In most cases, No. After you have passed your Medicare Supplement Open Enrollment, you must pass underwriting to be able to qualify for a Medicare Supplement. There are exceptions in some States. There are states offer a Birthday Rule like Oklahoma. In Oklahoma you have 60 days from your birthday to enroll into a Medicare Supplement Plan without answering Health Questions. You will need to check with your state for any exceptions.

Answered by Michael Hixson on May 6, 2025

Broker Licensed in OK, AR & TX

Answered by Michael Hixson Medicare Insurance Agent

Can I switch from a Medicare Advantage plan to Original Medicare with a Medigap plan mid-year if I’m diagnosed with a serious illness?

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Can I switch from a Medicare Advantage plan to Original Medicare with a Medigap plan mid-year if I’m diagnosed with a serious illness?

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