Switching Medicare Advantage to Medigap in Texas

Yes, you can switch from Medicare Advantage to Original Medicare in Texas during an applicable enrollment period. But getting a Medicare Supplement policy is a separate decision. The enrollment rules that let you leave Medicare Advantage do not automatically require a Medigap insurer to accept you without reviewing your health.

The two rules you need to understand

First, Medicare determines when you may leave your Medicare Advantage plan. Second, federal and Texas Medigap rules determine whether an insurer must offer you a policy without medical underwriting.

These two windows may overlap, but they are not identical. A person who can return to Original Medicare in January may still be denied a new Medigap policy. Review Texas guaranteed-issue rights before making a change.

When can you leave Medicare Advantage?

The annual Medicare Open Enrollment Period runs October 15 through December 7. During this period, eligible beneficiaries can switch from Medicare Advantage to Original Medicare, generally effective January 1.

People already enrolled in Medicare Advantage also have a Medicare Advantage Open Enrollment Period from January 1 through March 31, during which they can generally make one eligible change, including returning to Original Medicare.

Certain events create Special Enrollment Periods, including moving outside a plan's service area or a qualifying plan termination. Dates depend on the event. See Medicare's Special Enrollment Period guidance and Medicare enrollment periods explained.

When does Medigap medical underwriting apply?

Outside a Medigap open enrollment or guaranteed-issue period, insurers in Texas can generally ask about medical conditions, recent treatment, hospitalizations and medications. They may approve, decline or apply permitted policy conditions based on their underwriting rules.

An attractive premium quote is not an approval.

If you have ongoing specialist care or a serious medical condition, check your Medigap eligibility before making an irreversible change. Read Medigap underwriting questions and when you can be denied Medigap.

The first Medicare Advantage trial right

One federal trial right generally protects people who join Medicare Advantage when first eligible for Medicare at age 65 and decide within the first year to return to Original Medicare. If the conditions are met, the person can obtain certain Medigap policies under guaranteed-issue rules.

The date the Medicare Advantage coverage first began is important; this is not a new one-year opportunity every time someone changes plans.

The second Medicare Advantage trial right

Another trial right may apply when a person dropped a Medigap policy to join Medicare Advantage for the first time and decides within the first year to return. The person may have the right to restore the previous Medigap policy if it remains available, with other specified options if it does not.

The eligible plan letters and documentation depend on the situation. See Medicare.gov's Medigap information and Texas guaranteed-issue rights.

What if your Medicare Advantage plan is ending?

A formal nonrenewal, insurer withdrawal or qualifying service-area change can create a Special Enrollment Period and potentially Medigap guaranteed-issue rights. This is different from receiving an Annual Notice of Change that lists higher copayments or reduced extra benefits.

Keep the nonrenewal notice and verify the application deadline and available Medigap plan letters.

A doctor leaving a network is also not automatically the same as the plan terminating. Ask your insurer about continuity of care, provider alternatives and any applicable special rights before assuming Medigap acceptance is guaranteed.

Example: Switching after five years in Medicare Advantage

Suppose a Texas beneficiary has been enrolled in Medicare Advantage for five years and wants Plan G because a specialist is no longer in network. They may be able to return to Original Medicare during a valid election period, but they should not assume a first-year trial right applies.

If no other guaranteed-issue event exists, they may need to pass underwriting for Plan G.

The safest sequence is to establish Medigap eligibility before relying on the new coverage.

What about prescription drug coverage?

Most modern Medigap policies do not include outpatient prescription drug coverage. If you return to Original Medicare, you should evaluate a standalone Part D plan and coordinate its effective date with your Medicare Advantage disenrollment.

Check your actual medications, drug tiers, preferred pharmacies and prior authorization rules. See Part D coverage and Part D enrollment periods.

How to make the transition safely

Confirm your valid Medicare Advantage disenrollment period, then determine whether you have a Medigap guaranteed-issue right or must undergo underwriting. Compare Plan G, Plan N, and High-Deductible Plan G based on premiums and potential out-of-pocket costs.

Verify details with Texas Department of Insurance's Medigap guide and Medicare.gov's Medigap information.

Obtain written confirmation of Medigap approval and coordinate the effective dates of Original Medicare, Medigap and Part D. Do not treat a submitted application as an issued policy.

Frequently asked questions