Medicare Advantage open enrollment runs through March 31, giving people already in a private managed-care plan the option to pick a different one or return to original Medicare. What the enrollment calendar does not advertise is that leaving Medicare Advantage does not guarantee you can rebuild the coverage you had before. Medigap supplemental policies, which pick up many of the out-of-pocket costs original Medicare leaves behind, can generally be refused to applicants whose medical history or current conditions look expensive to an insurer. That screening process is called medical underwriting.
Kata Kertesz, managing policy attorney at the Center for Medicare Advocacy, told KFF Health News that people need to weigh this before they act. Someone who spends several years in a Medicare Advantage plan and then decides to move to original Medicare may discover that the move is possible but the Medigap policy is not.
The stakes are highest for exactly the households most likely to want out. Medicare Advantage plans are often cheaper and add benefits original Medicare does not cover, such as vision and hearing services, but they run narrower provider networks and can impose extensive prior authorization requirements. Families managing a dementia diagnosis frequently run into both of those walls when they need a specialist outside the network or approval for a service, and a long medical record is also the kind of history a Medigap underwriter may look at unfavorably.
The practical takeaway from the reporting is one of sequence: the decision to leave a Medicare Advantage plan and the ability to buy a Medigap policy are two separate questions, and the second one is not automatically answered yes. Anyone considering the switch during this enrollment window has reason to find out where they stand on Medigap eligibility first rather than after.