When can I switch from a Medigap plan to a Medicare Advantage plan?

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You can switch from Medigap to a Medicare Advantage plan during the Medicare Open Enrollment Period from October 15 to December 7 each year, with coverage starting on January 1.

When You Can Make the Switch

  • Annual Enrollment Period (AEP): October 15 – December 7 (coverage starts January 1).
  • Initial Enrollment Period (IEP): When you first become eligible for Medicare (the 7-month window around your 65th birthday or initial Part B sign-up).
  • Special Enrollment Periods (SEPs): Certain life changes—like moving out of your plan's service area or losing other insurance—allow you to switch outside the standard dates.

Important Rules to Remember

  • No Medical Underwriting: Switching from Medigap to Medicare Advantage is generally easy and does not require health questions or medical underwriting.
  • Cancel Medigap Separately: Enrolling in a Medicare Advantage plan does not automatically cancel your Medigap policy. You must contact your Medigap insurance company to cancel it after your new Medicare Advantage coverage officially begins to avoid any coverage gaps.
  • Cannot Hold Both: You cannot have a Medigap policy and a Medicare Advantage plan at the same time.
  • The "Trial Right" Caveat: If you change your mind later and want to switch back to Medigap from Medicare Advantage, you might have to pass health underwriting unless you qualify for a one-time 12-month trial right.

Do doctors prefer Medigap or Medicare Advantage?

Most doctors prefer Medigap (Medicare Supplement) over Medicare Advantage because it avoids private insurance red tape.

Why Doctors Prefer Medigap

  • Less Paperwork: Doctors bill Original Medicare directly, meaning faster and more predictable payments.
  • No Prior Authorizations: Medigap does not require approval from a private insurance company before giving care. Studies show a vast majority of physicians are frustrated by Advantage plan pre-approval delays.
  • No Network Limits: Patients can see any doctor or hospital nationwide that accepts Medicare.

Why Doctors Dislike Medicare Advantage

  • Administrative Burden: Advantage plans require time-consuming referrals and pre-approvals.
  • Care Denials: Private insurers often delay or deny treatments, which creates friction between the doctor and the patient.
  • Restricted Networks: Doctors must navigate narrow HMO or PPO provider rules set by individual private companies.

Why do people say to stay away from Medicare Advantage plans?

Critics and beneficiaries advise caution with Medicare Advantage plans because of restrictions on care, unexpected costs, and administrative hurdles. While these private plans often feature low or zero monthly premiums and extra perks like dental or vision, they come with significant trade-offs.

Restricted Provider Networks

  • Local limitations: Most plans use specific HMO or PPO networks, meaning you must see doctors and go to hospitals within the plan’s local area.
  • No nationwide freedom: Unlike Original Medicare, which lets you see any accepting doctor nationwide, Medicare Advantage offers very limited coverage when traveling.
  • Frequent changes: Provider lists can change annually or even during the year, meaning your favorite doctor might leave the network unexpectedly.

Prior Authorization and Denials

  • Approval delays: Private insurers often require "prior authorization" (advance permission) for specialized care, MRIs, surgeries, or rehabilitation.
  • Care obstacles: This review process can delay or block medically necessary treatments.

High Out-of-Pocket Costs

  • Cost-sharing for serious illnesses: While plans have annual out-of-pocket maximums (up to thousands of dollars), treatments like chemotherapy or expensive infusions can trigger steep 20% coinsurance charges before you reach that cap.
  • End-of-life complications: High utilization during severe or chronic illness can result in major expenses or coverage friction.

The "Medigap" Trap

  • Locked-in coverage: If you try to switch back to Original Medicare after a 12-month trial period, moving to a Medicare Supplement (Medigap) plan often requires passing medical underwriting. Pre-existing health conditions can make it difficult or impossible to qualify for a good supplement later.

What is better, a Medicare Advantage or a supplemental plan?

Neither option is objectively "better" overall; a Medicare Advantage plan is better if you want lower upfront costs and extra benefits like dental and vision, while a Medicare Supplement (Medigap) plan is better if you want predictable medical bills and the freedom to see any doctor. You cannot have both at the same time.

Medicare Advantage (Part C)

  • How it works: Private companies offer these plans as an all-in-one replacement for Original Medicare (Parts A and B).
  • Pros: Often features $0 or low monthly premiums; usually includes prescription drug coverage (Part D); adds extra perks like routine dental, vision, and hearing; includes a yearly out-of-pocket maximum.
  • Cons: You must use specific local doctor and hospital networks (HMO or PPO); may require referrals to see specialists; out-of-pocket costs build up as you use care.

Medicare Supplement (Medigap)

  • How it works: Private insurance works alongside Original Medicare to pay for remaining costs like deductibles, copays, and coinsurance.
  • Pros: You can visit any doctor or hospital in the U.S. that accepts Medicare; you do not need referrals; medical bills are very predictable.
  • Cons: Higher monthly premiums; does not include extra benefits like dental or vision; requires a separate Part D plan for prescription drugs; medical underwriting may apply if you miss your initial enrollment window.

What is the average Medicare Advantage premium per month?

The projected average monthly premium for a Medicare Advantage plan is approximately $14.37 in 2026, and is projected to drop to around $12 per month in 2027.

Cost Breakdown

  • $0 Premium Plans: Roughly two-thirds to three-quarters of Medicare Advantage enrollees pay a $0 monthly plan premium.
  • Required Part B Premium: You must continue paying your standard Medicare Part B premium, which is $202.90 per month for most people in 2026, even if your Medicare Advantage plan has a $0 premium.
  • Additional Costs: While many plans include prescription drug coverage (Part D) and extra benefits like dental or vision, you may still be responsible for copays, coinsurance, and deductibles.

How To Switch From Medicare Advantage to Medicare Supplement Plans

9 related questions found

What is the biggest disadvantage of Medicare Advantage?

The biggest disadvantage of Medicare Advantage is the strict limitation on doctor and hospital networks, which can restrict your choice of care and require prior approval for treatments.

While these private plans often feature low or zero monthly premiums and extra perks like dental or vision care, they come with significant trade-offs.

Key Drawbacks of Medicare Advantage

  • Restricted Networks: You must generally see doctors who belong to the plan's specific network. Going out-of-network can mean paying full price or having no coverage at all.
  • Prior Authorization: Insurance companies often require you to get approval before receiving certain tests, surgeries, or specialist visits. This process can delay or deny necessary medical care.
  • Travel Limitations: Unlike Original Medicare, which is accepted nationwide, Medicare Advantage plans are tied to local or regional service areas. Routine care is typically not covered when you travel out of state.
  • High Out-of-Pocket Costs for Heavy Care: While plans have a yearly spending cap, frequent hospital stays or expensive treatments (like chemotherapy) can result in heavy copays and coinsurance.
  • Difficulty Switching to Medigap: If you want to switch back to Original Medicare later and buy a supplemental Medigap policy, you may face medical underwriting or be denied coverage based on your health history.

You can review official plan options and compare rules through the Medicare official site.

How much more is Medigap than Medicare Advantage?

Medigap features higher monthly premiums and lower out-of-pocket costs, while Medicare Advantage features lower monthly premiums and higher out-of-pocket costs.

Cost Comparison Breakdown

Medigap (Medicare Supplement)

  • Monthly Premiums: Average between $44 and $392 depending on the plan letter, age, and location, with popular options like Plan G averaging around $150 to $180 per month. You must also continue paying your standard Part B premium.
  • Out-of-Pocket Costs: Minimal or none. Once you meet the small annual Original Medicare Part B deductible, Medigap covers most or all remaining coinsurance and copays.
  • Additional Expenses: Does not include prescription drugs. You must buy a separate standalone Part D plan, which averages around $34.50 per month in 2026. Separate dental, vision, or hearing plans are also needed.

Medicare Advantage (Part C)

  • Monthly Premiums: Often $0 or low (averaging around $14 per month in 2026), paid in addition to your Part B premium.
  • Out-of-Pocket Costs: Variable copays, coinsurance, and deductibles every time you use care until you hit your plan's annual maximum out-of-pocket (MOOP) limit. In 2026, maximum out-of-pocket limits can reach up to $9,250 for in-network services.
  • Additional Expenses: Usually bundles Part D prescription drug coverage and extra benefits like dental, vision, and hearing into the single monthly plan price.

Summary of Trade-offs

  • Choose Medigap if: You prefer predictable, higher fixed monthly costs with fewer surprise bills when receiving medical care, especially if you have frequent medical needs.
  • Choose Medicare Advantage if: You prefer lower upfront monthly costs and are generally healthy, though you risk higher out-of-pocket spending if you experience a major medical event.

What company has the highest rated Medicare Advantage plan?

Kaiser Permanente and Alignment Healthcare rank highest for star ratings, with 100% of their members in plans rated four stars or higher.

Top-Rated National Companies

  • Kaiser Permanente: Achieves top marks with 100% of members in 4+ star plans, though its availability is limited to select states.
  • Alignment Healthcare: Also ties at 100% for members in highly rated plans, but operates in a smaller number of states.
  • Aetna Medicare: Leads among major national carriers with wide availability, having over 81% of members in plans rated 4 stars or higher.
  • UnitedHealthcare: Follows closely, with 78% of its members in 4+ star plans and the largest nationwide provider network.

Ratings vary significantly by location, and specific plan performance depends heavily on your local county and ZIP code. You can check specific plan quality using the Official Medicare Plan Finder.

What does Dave Ramsey say about Medicare Advantage?

Dave Ramsey and the Ramsey Solutions team explain that Medicare Advantage (Medicare Part C) is a bundled private alternative to Original Medicare, but they caution that it is not the best choice for everyone.

Key Views on Medicare Advantage

  • Bundled Coverage: Advantage plans combine Part A (hospital) and Part B (medical), and often include Part D (prescription drugs) and extra perks like dental or vision.
  • Network Restrictions: Ramsey points out that these private plans limit your choice of doctors and hospitals to specific networks, offering less provider flexibility than Original Medicare.
  • Referral Hurdles: Some plans may deny specialist coverage or refuse to pay for out-of-network care, even with a doctor's referral, leaving patients with unexpected out-of-pocket costs.
  • Premiums: Enrollees still have to pay their standard Medicare Part B premium alongside any costs tied to the Advantage plan.
  • Preference for Original Medicare: The Ramsey Solutions guidance generally suggests that most people do better with Original Medicare paired with a Medigap (supplemental) policy rather than a Medicare Advantage plan. They also warn retirees to watch out for insurance agents who push Advantage plans primarily for larger sales commissions.

Is it better to have straight Medicare or a Medicare Advantage plan?

Neither option is universally "better"; Original Medicare (straight Medicare) and Medicare Advantage suit different health needs, budgets, and preferences.

To decide which is right for you, compare how each option handles key factors:

Original Medicare (Parts A and B)

  • Doctor Choice: You can see any doctor or go to any hospital in the U.S. that accepts Medicare. You do not need referrals to see specialists.
  • Approvals: You rarely need prior authorization or permission from an insurance company for tests or treatments.
  • Costs: It does not have an annual out-of-pocket maximum unless you buy a separate Medigap (Medicare Supplement) policy.
  • Extras: It does not cover prescription drugs (you need a separate Part D plan) or routine dental, vision, and hearing.

Medicare Advantage (Part C)

  • All-in-One Bundles: These private plans combine Part A, Part B, and usually Part D (prescription drugs), often with low or zero monthly premiums.
  • Extra Benefits: They frequently include routine dental, vision, hearing, and gym memberships.
  • Financial Protection: They include a mandatory annual out-of-pocket spending cap (capped at $9,250 for in-network care).
  • Restrictions: You are usually limited to local provider networks (like HMOs or PPOs), and you may need referrals or prior authorization for care.

Which Should You Choose?

  • Choose Original Medicare (with Medigap) if you travel often within the U.S., want the freedom to see any specialist without a referral, and prefer predictable medical bills with fewer coverage denials.
  • Choose Medicare Advantage if you want lower monthly premiums, extra perks like dental or vision care, and a hard cap on your yearly out-of-pocket costs, and you are comfortable using a specific local network of doctors.

You can compare specific local options using the official Medicare Plan Finder.