Medicare Advantage plans and Medicare supplement insurance policies, or Medigap plan plans, both help people pay the out-of-pocket costs left by Original Medicare.
But the differences in enrollment rules are significant, and simple client questions about the topic may have complicated answers.
A Medicare customer question:
"My mom is in a Medicare Advantage plan, but she's not getting the support she needs for her Alzheimer's care.
If she switches back to Original Medicare, can she get a Medigap plan to help cover her costs?"
The answer:
With new caregiver supports launching in 2025 — including initiatives like the GUIDE dementia care model — many families are re-evaluating whether Original Medicare better meets their needs.
But switching from a Medicare Advantage plan to Original Medicare isn't a simple exchange.
One of the most important factors to consider is access to a Medicare supplement insurance policy, which is also known as a Medigap plan.
Unfortunately, that access isn't always guaranteed.
Here's what to know and why financial professionals who are not Medicare specialists themselves need to be able to refer clients with Medigap questions to skilled Medicare specialists.
1. Understand the four parts of Medicare.
◆ Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). While it covers many essential services, it leaves beneficiaries responsible for deductibles, coinsurance and copays.
◆ Medicare Advantage (Part C) is offered by private insurers and includes all services under Parts A and B, often with additional benefits like prescription drugs, dental and vision. These plans can restrict provider networks.
◆ Medigap, or Medicare Supplement Insurance, is sold by private insurers and helps cover out-of-pocket costs under Original Medicare. It cannot be paired with Medicare Advantage.
◆ Prescription drug plans (Part D) are standalone plans offered by private insurers to cover medications.
2. Medigap protections are limited after initial enrollment.
Most people have a one-time, six-month Medigap guaranteed issue right that begins when they enroll in Medicare Part B at age 65 or for the first time.
During this window, insurers must offer any Medigap policy without regard to health history or preexisting conditions.
After this window closes, insurers in most states may deny coverage or charge more based on health conditions.
Only a few states — such as New York, Massachusetts, Connecticut and Maine — offer broader protections.
Outside these areas, securing Medigap can become significantly more difficult without expert guidance.
3. Switching to Original Medicare doesn't guarantee Medigap access.
Beneficiaries can return to Original Medicare during certain periods, such as the annual enrollment period (Oct. 15 to Dec. 7) or the Medicare Advantage open enrollment period (Jan. 1 to March 31).
These windows do not automatically guarantee access to a Medigap plan.
Guaranteed issue rights are only available in specific situations: for example, if a Medicare Advantage plan is discontinued, the enrollee moves out of the plan's service area, or the plan was chosen under misleading circumstances.
A Medicare specialist can help determine whether a client qualifies and identify the most strategic time to switch.
4. Medical underwriting can be a barrier — especially for serious conditions.
When applying for Medigap coverage outside a guaranteed issue window, applicants may face medical underwriting.
This can include questions about Alzheimer's disease, cancer or recent hospital stays.
Based on responses, insurers may deny coverage or charge substantially higher premiums.
This is where a Medicare advisor adds real value: navigating insurer requirements, identifying more lenient carriers, and helping clients position themselves for the best possible outcome.
5. Know your Medigap options — and what they cost.
There are 10 standardized Medigap plans — labeled A through N — available in most states.
Each offers different coverage levels for expenses not paid by Original Medicare.
For example:
◆ Plan G covers nearly all out-of-pocket costs except the Medicare Part B deductible. It's the most popular plan, with 39% of enrollees — about 5.3 million people.
◆ Plan N typically has lower monthly premiums but includes copays for doctor and emergency visits and does not cover Part B excess charges.
Premiums vary by location, age and insurer.
In 2025, the average monthly premium for Medigap Plan G is estimated to range from $142 for newly eligible 66-year-olds to approximately $214 for 80-year-olds, depending on age and state.
Pricing models can vary by state:
Community rating: All enrollees pay the same premium.
Issue-age rating: Premiums are based on age at enrollment and do not increase with age.
Attained-age rating: Premiums increase as the beneficiary gets older.
Understanding which pricing model applies in your state — and how it impacts long-term affordability — is an area where Medicare advisors offer critical insight.
6. Plan ahead to protect your options.
If a family anticipates needing Original Medicare with Medigap coverage in the future — particularly in the case of chronic illness or increasing caregiving needs — switching early, while the applicant is still in good health, may be the best strategy.
The right timing can vary by individual and location.
Some states, including New York and Connecticut, allow ongoing or annual Medigap enrollment without underwriting.
A Medicare advisor can help interpret state-specific rules, compare plan pricing and time the transition to maximize benefits and minimize risk.
The 2025 caregiver enhancements make Original Medicare more appealing, especially for families managing long-term conditions.
But Medigap access is not automatic — and poor timing can leave beneficiaries without the supplemental coverage they need.
Medicare advisors play a vital role in helping clients understand their rights, evaluate Medigap options and navigate the complexities of switching plans.
With the right guidance, beneficiaries can avoid costly coverage gaps and secure the support they deserve.
Tricia Blazier, JD, is director of Healthcare Insurance Services at Allsup.
Credit: CMS
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