Can You Switch From Medicare Advantage Back to Original Medicare?

The Short Version of Your Options

Switching is a two-part decision. The first part is whether you can leave Medicare Advantage, and the answer is yes at predictable times. The second is what you will use to cover the gaps in Original Medicare, which pays 80% of most Part B services and has no annual cap on what you owe. Most people who return to Original Medicare want a Medigap policy for that reason, and getting one is where timing and health history can matter most.

Keep both parts in mind as you read. A switch that makes sense on paper can leave you with less protection than you expected if the Medigap question is not sorted out first.

When You Can Leave

Way out	Typical timing	Medigap guaranteed?
Annual enrollment	October 15 to December 7, effective January 1	No, unless another right applies
Medicare Advantage Open Enrollment	January 1 to March 31	No, unless another right applies
Plan ends or you move out of its area	Special Enrollment Period	Yes, generally within 63 days
First-year trial	Within 12 months of joining	Yes, for people who qualify

There are several doors out of Medicare Advantage. Which one applies depends on the calendar and your circumstances.

Annual enrollment, October 15 to December 7. During this period each fall, you can change Medicare Advantage plans, join one, or drop it and return to Original Medicare. The change takes effect January 1. If this is your window, the dates and rules are covered in our post on the annual enrollment period.

Medicare Advantage Open Enrollment, January 1 to March 31. If you are in a Medicare Advantage plan, you get a second chance early in the year. During this window you can switch to a different Advantage plan or leave for Original Medicare. It is a one-time change, and it does not let you move from Original Medicare into an Advantage plan. Changes made this way generally take effect the first of the month after the plan receives your request, so confirm the date when you ask.

Special Enrollment Periods. Certain life events open a window outside those dates. Common ones include moving out of your plan’s service area, your plan leaving Medicare or being discontinued, losing or gaining certain other coverage, and a few situations involving Medicaid or Extra Help. Medicare says people with Medicaid or Extra Help can make changes once per calendar month, while a move or a plan ending opens a window of about two full months after the event, so some windows are shorter than you would think. If one of these applies to you, call Medicare or your plan promptly to learn how long you have. Keep in mind that a Special Enrollment Period lets you leave Advantage, but it does not by itself give you a Medigap guaranteed-issue right. That depends on the reason you are leaving, as described below.

The first-year trial. If you joined Medicare Advantage when you were first eligible for Medicare, or if you left a Medigap policy to try Advantage for the first time, federal rules give you a trial period of 12 months. That window carries special Medigap protections, which we describe below.

Outside those windows, you generally cannot just decide in June to go back to Original Medicare. That is why people who realize mid-year that a plan is not working for them often have to wait for the next opportunity.

How the Switch Actually Works

The mechanics are simpler than most people expect. You can contact the plan directly to disenroll, or call 1-800-MEDICARE. Do not stop paying your premium and assume that cancels your coverage, and do not simply stop using the plan. You need to make an actual disenrollment request.

When you leave, you automatically return to Original Medicare, which means your Part A and Part B remain in place. You will keep paying your Part B premium, and you will use your red, white and blue Medicare card at doctors and hospitals that accept Medicare, with no network restrictions.

Medicare Advantage plans commonly include drug coverage, so leaving one means your drug plan goes with it. This is the step people forget. If you want drug coverage after you return to Original Medicare, you need to join a standalone Part D plan at the same time. Going without creditable drug coverage for 63 days or more can lead to a permanent late enrollment penalty added to your Part D premium later. Our overview of Medicare Part D explains how that penalty works, and when you disenroll, ask how to line up the standalone plan so there is no gap in your prescriptions.

If you are in the middle of treatment, tell your doctors about the change before it takes effect, and make sure any approved procedures or pending authorizations are not disrupted.

The Catch: Medigap Is Not Guaranteed

Here is where the answer gets complicated. Medigap, also called Medicare Supplement insurance, pays some or all of what Original Medicare leaves to you, such as the 20% coinsurance. It is sold by private insurers and regulated by each state.

When you first enroll in Medicare Part B at 65 or older, you get a six-month Medigap open enrollment period. During it, insurers must sell you any policy they offer, at standard rates, no matter your health. That window does not come back. If you spent those first months in Medicare Advantage, or if you are leaving Advantage years later, your Medigap application will usually be subject to medical underwriting. In plain terms, the insurer can ask about your health, can decline to sell you a policy, can charge more, or can apply a waiting period for pre-existing conditions.

KFF, the nonprofit health policy organization, analyzed 2022 data and found that roughly nine in ten Medicare Advantage enrollees age 65 and older lacked guaranteed access to Medigap beyond the initial trial period. Ohio, where our agency is based, follows this approach. As our page on Ohio’s Medigap regulations explains, once your initial window has closed, Ohio has no annual window that lets you change Medigap plans without underwriting. Ohio’s rules do list a guaranteed-issue window for people who lose Medicaid coverage that supplemented Medicare, so ask about that if it fits your situation. Some other states are more generous, and a few have newer rules, so if you live somewhere else or plan to move, check your state’s rules.

This does not mean you cannot get a Medigap policy. Some applicants are approved and some are not, depending on their health history and the insurer’s rules. It means you should find out what you would qualify for before giving up your current coverage, not after.

Situations With Guaranteed Access

There are circumstances in which federal rules require an insurer to sell you certain Medigap policies regardless of health. Each comes with a deadline. For the Advantage-related rights, you can generally start applying about 60 days before your Advantage coverage ends, or by the date in your plan’s termination notice, and no more than 63 days after it ends. Other events, such as losing employer or retiree coverage, usually run 63 days from the latest of the coverage end date and the date on your notice.

• Your plan leaves Medicare, stops giving care in your area, or makes a significant change to its network. In these cases you have the right only if you switch to Original Medicare rather than join another Advantage plan.
• You move out of the plan’s service area.
• The first-year trial, as described above, for people who joined Advantage when first eligible at 65 and for some people who left a Medigap policy to try Advantage for the first time.
• Certain other events, such as the loss of employer or union retiree coverage that supplemented your Medicare, or a plan that violated its contract with you.

Which Medigap plans you can buy depends on the event. For the plan-ending and move situations, Medicare’s guide lists Plans A, B, C, D, F and G sold in your state, with a note that Plans C and F are no longer sold to people who became eligible for Medicare on or after January 1, 2020. For the first-year trial, people who joined Advantage when first eligible can buy any Medigap policy sold in your state, while people who dropped a Medigap policy can buy that policy back if the insurer still sells it, or otherwise one of the plans above. Ask the insurer or a licensed agent exactly what you are entitled to before applying, and keep copies of any termination notices, since you may need to send proof with your application. Our page on the Medigap open enrollment period covers the initial window that guaranteed-issue rights are measured against.

Why People Switch, and Why Some Stay

People return to Original Medicare for a few common reasons. A network that does not include their specialist or hospital. Prior authorization that delays care, which we describe in our post on how prior authorization works. A plan that no longer covers a drug or provider they depend on. Wanting to travel without worrying about out-of-network rules. Or experiencing a large medical bill and wishing for simpler cost-sharing.

People stay in Medicare Advantage for equally valid reasons. Lower monthly premiums, often zero beyond the Part B premium. A cap on annual out-of-pocket costs, which Original Medicare lacks by itself. Extras such as dental, vision, hearing or a flex card. A care-coordination feel that some members like.

Neither path is right for everyone. Original Medicare with a Medigap plan generally offers the broadest choice of providers and the most predictable cost per visit, but at the price of a monthly premium that can rise over time. Advantage offers lower upfront cost and extra benefits, but with network rules and a possibility of higher bills when care is extensive. Our post on Medicare Advantage out-of-pocket maximums explains the cap in more detail, and the post on checking a plan’s network shows how to test whether the doctors you want are covered.

Sequence Matters: Medigap First, Then Disenroll

If you are thinking about leaving Advantage and you do not have a guaranteed-issue right, a commonly recommended order of operations is to apply for Medigap while you are still in your current plan, find out whether you are approved, and only then request disenrollment. That way you are not left without coverage if the application is declined.

Medicare’s Medigap guide confirms that you can apply while you are still in your Advantage plan if you are leaving it, and it advises asking that the new policy start when your Advantage enrollment ends so you have continuous coverage. A Medigap policy cannot begin while Advantage coverage is still in force. Do not cancel the old plan until you have written confirmation that the new coverage is approved and when it begins. An independent agent can help you coordinate these dates, but the responsibility to confirm them in writing stays with you.

If you cannot qualify for a Medigap policy, you still have options. You may decide to stay in your current plan or switch to a different Advantage plan with a better network. You may add a Part D plan and use Original Medicare alone, accepting the 20% coinsurance risk. If your income is limited, a Medicare Savings Program or Medicaid might reduce your cost-sharing. And if you have retiree coverage or TRICARE For Life, Original Medicare may work well without Medigap, as our page on TRICARE For Life describes. We’re an independent agency, not affiliated with the VA, TRICARE, or the Department of Defense.

A Step-by-Step Plan for Leaving Advantage

Whatever your reason for leaving, the order in which you do things matters more than most people expect. Here is a sequence that keeps you covered at every point.

• Step 1: Identify which door you are using. Is it the fall enrollment period, the January to March window, a Special Enrollment Period, or a first-year trial? The answer sets your deadline and tells you whether a Medigap guaranteed-issue right comes with it.
• Step 2: Find out whether you have a guaranteed-issue right. If you do, note the exact start of the window, usually 60 days before your Advantage coverage ends and no more than 63 days after. If you do not, plan for underwriting.
• Step 3: Gather your information. Collect your medication list, your diagnoses and dates of treatment, the names of your doctors, and any notice from your plan that explains why your coverage is ending.
• Step 4: Apply for Medigap while still in your plan. Medicare’s Medigap guide says you can apply before Advantage ends if you are leaving it, and that the policy cannot start until Advantage coverage ends.
• Step 5: Wait for written approval and a start date. Do not request disenrollment until the insurer confirms in writing that you are accepted and when the policy begins.
• Step 6: Choose a Part D plan. Enroll in a standalone drug plan with a start date that matches the end of your Advantage coverage.
• Step 7: Request disenrollment. Contact the plan or 1-800-MEDICARE, and ask for the effective date and a written confirmation.
• Step 8: Check the transition. After the change, confirm that your new Medicare card is in use, your pharmacy has your new drug plan on file, and any ongoing treatment is being billed correctly.

If you are using the fall period, the sequence has a built-in cushion because the change takes effect January 1, and you can do Steps 3 to 6 in the weeks before December 7. If you are using the January to March window, the timing is tighter, so start gathering information early.

Three Scenarios

These are hypothetical, and your own situation will differ, but they show how the same question can have very different answers.

Picture a retiree whose plan is leaving the county. The plan sends a termination notice. Because the plan is stopping service in the area, this person generally has a guaranteed-issue right, as long as they choose Original Medicare rather than another Advantage plan. They keep the notice, apply for Medigap within the window, and can choose among the plans Medicare’s guide lists. Health history does not matter for the Medigap application.

Picture someone in their third year of Advantage who has developed a serious heart condition. They are unhappy with specialist access and want to leave. There is no plan termination, no move, and no trial right. In Ohio, a Medigap insurer can ask about the heart condition and may decline. This person might still leave Advantage in the next window, but without Medigap they would have Original Medicare with the 20% coinsurance and no yearly cap. A reasonable alternative to weigh might be switching to a different Advantage plan with a network that includes the specialist. Neither choice is obviously right, which is why it helps to look at the numbers before the window opens.

Picture a new enrollee six months into Advantage after turning 65. They joined Advantage when first eligible, and the plan is not working. This person is inside the 12-month trial, so they can return to Original Medicare and buy any Medigap policy sold in their state without health questions. The main task is meeting the deadline.

Costly Mistakes to Avoid

• Disenrolling first and shopping later. Once you are back in Original Medicare without a guaranteed-issue right, a decline leaves you with no supplement and no easy way back to your old plan.
• Forgetting drug coverage. Leaving an Advantage plan that included drugs without joining a standalone plan can start the clock on a late enrollment penalty after 63 days without creditable coverage.
• Assuming you can use a Medigap policy while in Advantage. Medigap cannot pay Advantage copays, deductibles or premiums, and it is illegal for an insurer to sell you one while you remain in Advantage, unless Advantage ends before the Medigap start date.
• Missing the 63-day deadline. A guaranteed-issue right is time-limited. Keep your termination notice and note the date it was issued.
• Ignoring pending treatment. If you are in the middle of a course of care, ask your providers whether they accept Original Medicare and whether any authorizations will carry over.
• Choosing only on premium. Medigap premiums, Part D premiums and the Part B premium together can be more than an Advantage plan costs. They can also protect you from large bills. Compare your total expected costs, not one line.

What to Ask Before You Decide

When you talk to an insurer, an agent or 1-800-MEDICARE, these questions bring out the details that matter.

• Do I have a guaranteed-issue right, and what is the exact deadline?
• Which Medigap plans can I buy under that right?
• If I do not have a right, what health questions will the application ask, and how far back do they go?
• Will the Medigap policy start on the same day my Advantage coverage ends?
• Which Part D plan covers my medications, and what will they cost?
• Are my doctors accepting Medicare patients as Original Medicare patients?
• What happens if my Medigap application is declined, and can I stay in my Advantage plan?

What to Do If It Goes Wrong

If your Medigap application is declined during a period when you believed you had a guaranteed-issue right, do not accept the answer at face value. Medicare’s guide recommends calling your State Insurance Department if you are denied Medigap coverage in a guaranteed-issue situation, and your State Health Insurance Assistance Program counselor can help you work out whether the right applies. Have your proof of coverage ending ready, such as the termination notice and the postmarked envelope.

If you have already disenrolled and have a gap in coverage, call 1-800-MEDICARE or your plan right away to ask what options remain. If you ended up without a drug plan, ask whether a Special Enrollment Period is available to you. If you are declined for Medigap with no right, you can still stay with Original Medicare and add other protections, apply to a different Medigap insurer whose rules may differ, or return to an Advantage plan in the next enrollment window.

Frequently Asked Questions

Can I switch from Medicare Advantage to Original Medicare at any time?

Not usually. The main opportunities are the fall annual enrollment period, the January to March Medicare Advantage open enrollment, and Special Enrollment Periods tied to specific life events. A trial period applies in your first year of Advantage in some situations.

Will I have to give a reason to leave my plan?

No. During the annual and open enrollment periods you can leave without a reason. Special Enrollment Periods require that you meet the qualifying circumstance.

Can I be denied a Medigap policy if I leave Medicare Advantage?

Yes, unless you have a guaranteed-issue right. Outside those situations, insurers in Ohio and many other states can use medical underwriting. They may deny the application, charge more, or add a waiting period for pre-existing conditions.

Do I need to join a Part D plan when I go back to Original Medicare?

If you want drug coverage, yes. Leaving an Advantage plan with drug coverage ends that coverage, and a gap of 63 days or more without creditable coverage can lead to a late enrollment penalty.

Does switching affect my Part A and Part B?

No. Your Part A and Part B stay in place. You continue paying the Part B premium, and you will use your Medicare card at any provider that accepts Medicare.