Missing the 6-month Medigap enrollment window at 65 allows insurers to deny coverage or charge more based on pre-existing conditions like diabetes. Only 4 states offer meaningful Medigap protections beyond the federal window: Connecticut, New York, Massachusetts, and Maine. Most beneficiaries are left subject to medical underwriting.
Before leaving Medicare Advantage, confirm remaining protected rights, compare multiple Medigap insurers, and secure approval before finalizing any switch to Original Medicare. Many financial professionals are salespeople paid on what they push, not whether you end up wealthier. A fiduciary is the opposite.
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At 65, an Ohio woman picked a zero-premium Medicare Advantage plan because she was healthy and the sales brochure looked cheaper than adding a Medigap policy to Original Medicare. Two years later, her doctor diagnosed Type 2 diabetes, started her on insulin, and referred her to an endocrinologist outside the plan's network. Now 67, she wants to switch to Original Medicare with a Medigap Plan G so she can use a broader range of specialists.
Leaving Medicare Advantage is allowed. Buying the Medigap policy that would make Original Medicare affordable is where she may hit a wall. Medigap has one federally protected open enrollment period: six months beginning the first month someone is 65 or older and enrolled in Medicare Part B.
During that window, an insurer cannot deny a policy or charge more because of the applicant's health. The clock runs even if the beneficiary chooses Medicare Advantage instead. Our Ohio retiree's six months passed while she was happily using her Advantage plan.
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