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
MI KY IN OH

Gary Church · Answer

Most cases no you can only change during annual enrollment. If you’re on a Medicare advantage plan and you’re diagnosed with a serious illness. The likelihood of you being able to qualify for Medicare supplement is pretty slim to none due to your health issue and pre-existing health condition.

Answered by Gary Church on May 19, 2025

Broker Licensed in Ca, AZ, NV & TX

Answered by Gary Church Medicare Insurance Agent

Daniel Brechin · Answer

No, once you chose either a Medicare Advantage plan or a Supplement. You may only change at specific times in the year. AEP from 10/15-12/7 each year. If you make a decision you may also change from Jan 1-Mar 31.

Answered by Daniel Brechin on September 1, 2025

Agent Licensed in AL, FL, KY, MS & TN

Answered by Daniel Brechin Medicare Insurance Agent

Norman Smith · Answer

No. You will have to wait for Open Enrollment. Even then you will have to pass through Underwriting in order to go back to Original Medicare and add a Supplement plan. This is the EXACT REQSON why it is soooo important to choose properly when there is NO UNDERWRITING when you enter your Open Enrollment when turning 65. Unfortunately you can’t wait for the fire and then call to get Homeowner’s Insurance. Same thing here.
But I wish you well in your health. I hope they can help you.

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

Christopher Boyd · Answer

No, Generally standard Annual Enrollment Period rule restrictions prevent switching mid year. However, if you have a supplement and switch to MAPD, you have a one time, limited, 12 month trial period to switch back to the supplement with no health questions.

Answered by Christopher Boyd on November 15, 2025

Agent Licensed in IN, KY, MI, OH, PA & TN

Answered by Christopher Boyd Medicare Insurance Agent

Charise Karjala · Answer

This question is one that I have to answer in the negative. It is, 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? The answer is no, you just can't. There's no special enrollment period for that. If there is a special enrollment period, like if you move from one state to another, then yes, you can do that. In fact, I have had some of my clients do exactly that.

I'll tell you a story. A woman who had a Medicare Advantage policy in one state went to visit her grandchildren. At that point, she had horrible atrial fibrillation. She went to the hospital, they diagnosed her with A-fib, and they wanted to do a procedure on her. It’s a cardiac ablation, a pretty common procedure, and her insurance company said no because she wasn't in her service area.

So she came home, talked to me about it, and I said, "Hmm, maybe you want to move in with your grandchildren for a while." So she did. She moved back to the other state, got her Medigap policy, went to that wonderful cardiologist, got her ablation, stayed with the grandchildren for another few months, and then moved back to California to go back to her Medicare Advantage policy.

There's a tale, and there are ways around this. But if you get sick, you can't move unless you have a qualifying life event. Your policy doesn't go bankrupt, and you don't have a special election period. You can't do it; it's one of the limitations. So when you get into a Medicare Advantage policy each year, you want to make sure that that's what you want, that that's what you truly want.

So hit up your agent, hit me up, Charise Karjala. I'll do a policy review for you for free, and you can select your options every year. You can do this, and if there's a way to get into a gap policy without underwriting, let's do it if that's what you want.

Nikki Rowland · Answer

No, you generally cannot switch from a Medicare Advantage plan to Original Medicare with a Medigap plan mid-year solely because of a serious illness. Changes are restricted to specific enrollment periods, and Medigap plans often require medical underwriting outside of guaranteed issue rights. There are special circumstances that you can switch but that would have to be determined per CMS requirements.

Answered by Nikki Rowland on December 17, 2025

Broker Licensed in SC & NC

Answered by Nikki Rowland Medicare Insurance Agent

Michael Denniston · Answer

The answer to this question is, if it is your first year in a Medicare Advantage plan, the year you turn 65, the answer is yes. After the first year in most states, the answer is no. After the first year IEP (initial enrollment period), you would wait until October 15th to fill out the application so you are underwritten. Once under writing takes place, you will be accepted or not. Depending on your medical history. During your IEP, you have guaranteed acceptance. This is the only time there is no underwriting required, the first year on Medicare.

Answered by Michael Denniston on May 27, 2025

Agent Licensed in FL, AL, AR & 11 other states

Answered by Michael Denniston Medicare Insurance Agent

Nick Mangini · Answer

NO NO NO! You cannot get Medigap plans if you have certain pre-existing conditions because when you apply for the Medigap plan, you will have to pass the health underwriting questions. You cannot "beat" the insurance system! This is why you should get a Medigap plan at 65 so you are guaranteed acceptance and never worry about being denied coverage later.

Answered by Nick Mangini on March 29, 2026

Broker Licensed in FL, AL, AZ & 32 other states

Answered by Nick Mangini Medicare Insurance Agent

William Gray · Answer

Outside of special circumstances, the answer is no. The issue is in the question itself, whether you have a serious illness diagnosis. The diagnosis itself may very well make you uninsurable for any Medicare Supplement in the future. 

Those circumstances could be that you have a Medicare Advantage plan for the first time and are within your first 12 months, you have a Medicare Advantage through an employer "group" and have a right to pick a plan if you leave. These are just a couple of the special circumstances, but for the vast majority, the answer is no. 

William Gray
Contact me.

Richard Moreno · Answer

You may be able to switch if you qualify for a special enrollment. However, you would also have to go through underwriting if you don’t qualify for guaranteed issue and can possibly be denied medigap coverage.

Answered by Richard Moreno on October 8, 2025

Broker Licensed in TX, CA, FL, LA, NM & OH

Answered by Richard Moreno Medicare Insurance Agent

Luke Rhoads · Answer

A serious illness by itself does not qualify you for a special enrollment period. You need to be eligible to make plan changes according to your enrollment eligibility. Examples are new to medicare, moving out of the area, being affected by a disaster, loss of creditable coverage. If you are outside your initial enrollment period (6 months after you are enrolled in part B) you would not be guaranteed issue of a medigap policy, and would have to go through underwriting. Depending on the illness may be denied coverage or have to pay higher premiums.

Answered by Luke Rhoads on August 3, 2025

Broker Licensed in OK

Answered by Luke Rhoads Medicare Insurance Agent

Michelle Sparks · Answer

Before you make a decision to go with an Advantage Care plan, you will want to understand the rules for switching to a Medicare Supplement Plan. Rules may vary from state to state, so you will want to work with a Medicare broker that is familiar with your state rules. Some states allow you to change plans with guarantee issue on the anniversary date of the policy, and others allow changing on your birthday month. Some do neither.

If you do not have either of those two options, and you are beyond your first 12 months on Medicare, you will more than likely need to wait until the Annual Enrollment Period  (10/15-12/7) to make a change. Additionally, you will be required to go through Medical underwriting. You only have a guarantee issue for a Medicare Supplement for the first six months following your 65 birthday or from when your Part B begins. So, depending on the severity of your illness, you could be denied coverage or have an increased premium. 

If you have already started with a Medicare Advantage Plan, it is a good idea to contact a local broker who can help you navigate your best options.

Sandra Teel · Answer

Unfortunately no, UNLESS you are within the first year of being on Medicare Part B AND your choice of a Medicare Advantage plan was they only choice you made in that year. 
If you are beyond that first year of being on Medicare Part B, the insurance company will look at your health history to determine if they will sell you the plan.  Most serious illnesses will not allow you to be accepted.

Sherry Rose · Answer

Thank you for asking. We would love to help answer that question for you. If you could please contact us for further assistance.

Stella Hattox · Answer

It depends on the plan you want and the illness.  But yes, there are exceptions.  You’re welcome to call and discuss your situation. 
Stella 
Contact me.

Karen Murray · Answer

Usually, you can’t switch mid-year just because of a new illness—you’re limited to certain times like the Jan–Mar Medicare Advantage Open Enrollment Period or a Special Enrollment Period (SEP).

If you move back to Original Medicare and want a Medigap plan, you’ll typically need to health qualify through medical underwriting, unless you have a guaranteed issue right.

Starting July 1, 2025, however, Virginia’s new Birthday Rule gives current Medigap policyholders a 60-day window beginning on their birthday each year to switch to another Medigap plan with equal or lesser benefits without medical underwriting.

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, ID, NM, NV & TX

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

Cris Zimmerman · Answer

Very likely no. A Medigap plan after your initial enrollment, (six months after your part B date) Could require medical underwriting and also have pre-existing waiting periods.

Colton Fisher · Answer

Most likely, you would be denied a Medicare supplemental plan outside of a guaranteed issue period. This is a conversation best served over the phone. Happy to help you. Contact me.

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

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

Answered by Leslie Kaz Medicare Insurance Agent

Barbara Barnes, CMIP® · Answer

Probably not. It will depend on when you started the Medicare Advantage plan and your specific circumstances. IF you qualify for a Specual Election Period (SEP), you might be able to do this, but it can be difficult to accomplish and it may take several months. Your diagnosis alone will NOT qualify you for a SEP. You should make your plan choice based on the coverage that you would want when you get sick. This is not something to play around with. Usually, once you are sick, it will be too late to get a Medicare supplement plan. You will, however, be able to switch back to original Medicare at the next annual enrollment period. You should not try to do this without speaking to a professional Medicare insurance agent before you make your plan choices.

Answered by Barbara Barnes, CMIP® on June 29, 2025

Agent Licensed in PA

Answered by Barbara Barnes, CMIP® Medicare Insurance Agent

James Stang · Answer

I won't say it's impossible but to change from a MA plan to a Medicare Supplement would necessitate going through medical underwriting unless you are in a Guarantee Issue period, which is rare outside of your Initial Election period. If you are diagnosed with a serious illness it would be difficult to pass through medical underwriting.

Answered by James Stang on July 11, 2025

Agent Licensed in OH

Answered by James Stang Medicare Insurance Agent

Hannah Skinner · Answer

The answer to this is no for two reasons. 

1. You cannot leave your advantage plan in the middle of the year. You can only change from advantage to Original Medicare during the Annual Election Period (October 15th-December 7th), Medicare Advantage Open Enrollment Period (January 1st - March 31st) or under special circumstances such as moving to a new service area.

2. In most states, you have to be able to health qualify for a Medigap plan. This means that having a serious illness would likely disqualify you. 

If you are contemplating moving to Original Medicare with a Supplement, I would recommend speaking with an agent now instead of waiting. Trying to change your plan once you are sick will be too late.

Melanie Blackston · Answer

You can, but generally only under special circumstances that qualify you for a Special Enrollment Period-SEP.

Cheryl Lockhart · Answer

Getting diagnosed with a serious illness can make you want more flexibility in your coverag, but unfortunately it does not automatically allow you to switch to a Medigap plan mid-year.

You can leave a Medicare Advantage plan and return to Original Medicare during certain times of the year or if you qualify for a Special Enrollment Period. However, in most cases, Medigap plans require medical underwriting. This means insurance companies can review your health history and may deny coverage or charge more based on your condition.

There are a few situations where you have “guaranteed issue” rights such as when you turn 65 years old when you first try a Medicare Advantage plan or if your plan ends, but outside of those approval is not guaranteed.

While you may be able to change your Medicare coverage, getting a Medigap plan after a serious diagnosis can be challenging. This is why it is  important to understand your options early and choose coverage that fits both your current and future needs.

Nancy Courser · Answer

Generally, you cannot drop a Medicare Advantage plan mid-year unless you have a Special Election Period (i.e. moved to a different state). If you have a Special Election Period, most likely you would have to medically qualify for the Medigap and having a serious illness would probably end up in a decline. Every insurance carrier has a list of declinable conditions and medications.

Answered by Nancy Courser on December 29, 2025

Agent Licensed in MI, FL & TN

Answered by Nancy Courser Medicare Insurance Agent

Kathy Olejniczak · Answer

Most likely no- if you have been on Advantage awhile definitely no- supplement ms have health underwriting questions at this point. If your are first eligible for Medicare and with 12 month of your A and B dates, you may have guaranteed issue rights

Answered by Kathy Olejniczak on November 25, 2025

Agent Licensed in FL, GA, MI & 6 other states

Answered by Kathy Olejniczak Medicare Insurance Agent

Duane Boebel · Answer

The answer is more than likely would be no. Reason being the serious illness may be a disqualifying medical condition for a Medicare Supplement underwriting. The only exception would be if the Medicare Advantage member is in their 12 month guarantee period after coming over from a previous Medicare Supplement and the Medicare Advantage was the first time they had tried it.

Answered by Duane Boebel on June 27, 2025

Broker Licensed in AL, FL, GA & 9 other states

Answered by Duane Boebel 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:
.
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:
.
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:
.
You can also switch during the Annual Enrollment Period (October 15 to December 7). 
Medigap Enrollment:
.
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:
.
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:
.
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:
.
For more specific information about your eligibility and the process for switching, it's recommended to contact Medicare.

Andrew Kramer · Answer

First of all, you need to be in a valid enrollment period, in order to make a change from an Advantage plan to original Medicare, and that only happens during the Annual Enrollment Period, Oct 15 to Dec 7, and then again during the Open Enrollment Period from Jan 1 to Mar 31. Secondly, with a supplement, you would have health underwriting in most states, and with a serious illness, you would be turned down.

Answered by Andrew Kramer on August 30, 2025

Agent Licensed in FL

Answered by Andrew Kramer Medicare Insurance Agent

Mark Boone · Answer

You can switch to a medigap plan at any time during the year, but you will most likely be subject to underwriting and could be denied. Also you would not be able to add a prescription drug plan unless it is during the annual enrollment period or you have a special enrollment period

Answered by Mark Boone on February 24, 2026

Agent Licensed in MN, FL, MI & NC, OH, SC & VA

Answered by Mark Boone Medicare Insurance Agent

Todd Bostic · Answer

The simple answer that is yes, however, you would have to pass underwriting and if you’ve got been diagnosed with a serious illness, then you probably wouldn’t pass underwriting so if you’re gonna change to a supplement, you need to do that before you are diagnosed with an illness.

Answered by Todd Bostic on February 23, 2026

Broker Licensed in TX, AL, AZ & 12 other states

Answered by Todd Bostic Medicare Insurance Agent

Jack Mayer · Answer

The quick answer is no and beyond your Initial Coverage Period, turning 65 , one year later, at that point you must answer health questions to qualify for a Medicare Supplement. They can turn you down for health reasons. Also, you would need to wait until AEP to apply.

Answered by Jack Mayer on October 6, 2025

Agent Licensed in CA & NV

Answered by Jack Mayer Medicare Insurance Agent

Rodolfo Rojas · Answer

You could possibly change, but not knowing all the details is hard to say for sure. 
How long have you been in Medicare?   If you change to Medigap, and you pass the original enrollment, they have a right to ask to do underwriting for your health. 
They can also deny the coverage. The guaranteed Issue Right lasts for 12 months. 
Have you looked at the Chronic Medicare Advantage plan?

Don Hansford · Answer

Unless there are extenuating circumstances the general answer is no. Enrollment into a Medicare Supplement plan varies from state to state. Some states have a guaranteed enrollment feature with no health questions around someone's birthday, others require underwriting so that someone with a serious illness would not qualify.

Answered by Don Hansford on October 24, 2025

Broker Licensed in TX

Answered by Don Hansford Medicare Insurance Agent

Gary Haft · Answer

Your contract with your Medicare Advantage Plan is set up for a "Calendar Year" and therefore you cannot leave that plan until the next enrollment period effective date (January).
Simply speaking - When you sign up for a calendar year plan, you are basically stuck with the plan for that calendar year. 
The Annual Enrollment Period (AEP) October 15th thru December 7th each year with a start date of January 1st of the following year.

Mark Murphy · Answer

Unfortunately, no, you can’t switch mid-year to a Medigap plan.  Those plans are medically underwritten and if you get sick, they won’t even consider your application.  It’s best to buy them when you’re aging into Medicare or are still very healthy.  Everyone is eligible for Medicare Advantage.  It makes it easy to switch to when the Medigap plans become too expensive.

Hope that helps.

Take care,
Mark B Murphy
Broker

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

Christopher Akers · Answer

You can apply for a Medigap policy at any time, but if you are outside of your guaranteed issue period, you will have to answer health questions on the application and likely face medical underwriting. This means an insurer can deny you coverage, or rate you up (or charge you more for having health conditions).

Answered by Christopher Akers on October 23, 2025

Agent Licensed in TN, FL, OH & VA

Answered by Christopher Akers Medicare Insurance Agent

Tim J Harris · Answer

If you have been diagnosed with a serious illness, you most likely will not pass Medical Underwriting to be accepted into a Medicare Supplement (Medigap)Plan.

The only point where Medicare Supplement (Medigap) Plans are guaranteed issue are when you were first eligible for Medicare.

Sophia Davis · Answer

There are a couple pain points with this question. Firstly, dropping a Medicare Advantage Plan and returning to Original Medicare can only be done during an available Election Period ie AEP(Annual Election Period; October 15th-December 7th), MAOEP (Medicare Advantage Open Enrollment Period; Jan 1-Mar 31; Restrictions Apply), or if you qualify for a SEP (Special Election Period; Restrictions and Limitations Apply). Secondly, If you are diagnosed with a Serious Illness it is very likely that you will either be denied coverage or have a severe rate increase for a Medicare Supplement Plan. The rate increase would likely void out the benefit of having this type of coverage. If you still wish to attempt the application, make sure to do so during one of the available election periods and DO NOT cancel current coverage until you have been approved for the Medicare Supplement and reviewed the numbers to ensure that the cost is feasible.

Answered by Sophia Davis on September 11, 2025

Broker Licensed in OH & PA

Answered by Sophia Davis 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

Kendra Siemiesz · Answer

Yes you can, however you may have to answer health questions (called underwriting) and if you have a serious illness which could affect the price you pay for a premium (depending on the condition). When you turn 65, you have 6 months to choose a Medigap plan with no underwriting required.

Answered by Kendra Siemiesz on November 6, 2025

Broker Licensed in FL, AL, AR & 19 other states

Answered by Kendra Siemiesz Medicare Insurance Agent

Mark Mabaquiao · Answer

Generally no. There are, however, two scenarios where you might be able to switch from a Medicare Advantage (MA) plan to Original Medicare with a Medigap policy mid-year.

The first scenario is if you moved or are about to move. Your new location might have guaranteed issue options for a new Medigap plan when you are coming from an MA plan. You have a two month window to utilize this option.

The second scenario is a concept called "Medicare trial rights (MTR)". According to Medicare.gov this is how MTRs work:

MTR #1 - If you drop a Medigap policy to join an MA plan for the first time, you’ll have a single 12-month period (your trial right period) to get your Medigap policy back if the same insurance company still sells it once you return to Original Medicare. If it isn't available, you can buy a Medigap policy you qualify for that's sold by an insurance company in your state (except for Plans M and N). You may also have an opportunity to enroll in a Medicare drug plan at this time.

MTR #2 - If you joined an MA plan when you were first eligible for Medicare Part A at 65, you can choose from any Medigap policy that's sold by an insurance company in your state if you switch to Original Medicare within the first year of joining the MA plan. You may also have an opportunity to enroll in a Medicare drug plan at this time.

As always, check with a local and reputable licensed Medicare expert. You can also check with Medicare.gov, 1-800-Medicare, and your local SHIP counselor.

Collette Rance · Answer

Not for Medigap plans.  SEP's are specifically for Medicare Advantage plan.  You could switch to a Medicare Advantage plan designed for a diagnosed Chronic Condition such as diabetes, COPD, etc.

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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