I have had the same conversation about two hundred times. Someone rings, usually in their late sixties, usually calm, and asks whether they can move from the Medicare Advantage plan they picked at 65 to a supplement instead. And I have to explain that the answer is “you can apply”, which is a different sentence from “yes”.
Nobody hides this. It is in the official handbook. It is just that at 65, when you are told it, you are being told forty other things at the same time, and this one does not sound urgent. It is the most expensive thing on the list.
What the window is
Your Medigap open enrollment period starts on the first day of the month in which you are both 65 and enrolled in Part B. It runs for six months. Then it is over, and it does not come back.
During those six months, any insurance company selling Medigap policies in your state must sell you any plan they offer, at their standard rate. They may not ask about your health. They may not charge you more because of it. They may not say no.
That is the whole protection, and it is a good one. It exists precisely once.
What happens after it closes
In most states, once those six months are gone, a Medigap company may put you through medical underwriting. They will ask what you have been treated for, what you take, whether you have been advised to have surgery. And on the strength of the answers they may decline you, or offer you a policy at a higher rate.
People are often surprised by how ordinary the disqualifying conditions are. It is not exotic illness. It is the recent joint replacement, the medication for atrial fibrillation, the biopsy scheduled for next month.
A few states are kinder. Connecticut and New York require companies to accept applicants year round. Some states give you a birthday window each year in which you can move to an equal or lesser plan without questions. Ohio, Michigan and Indiana, where we work, have none of those.
The plan that quietly depends on this
Here is why it matters more than it sounds. A very common piece of thinking at 65 goes: “I am healthy, the Advantage plan costs almost nothing a month, I will take that now and switch to a supplement later if my health changes.”
That plan has an assumption buried in it. It assumes a supplement will be available later. But “later” in that sentence means “when my health has changed”, which is exactly the moment a company is allowed to decline you.
I am not saying do not choose Medicare Advantage. We place people in Advantage plans every week and for many of them it is clearly the right call. I am saying choose it because it is right for you, not because you believe you can undo it on demand.
The trial right
There is one useful exception. If you join a Medicare Advantage plan when you first become eligible at 65, and you leave it within the first twelve months, you have a guaranteed issue right to buy a Medigap policy. No health questions.
Twelve months from the start of that plan. Not thirteen. If you are in your first year of an Advantage plan and having doubts, this is a real door and it is closing.
The other doors
Guaranteed issue rights also appear in a handful of other situations. If your employer or union coverage ends. If your Medicare Advantage plan leaves your county or loses its contract. If you move out of your plan’s service area. If a plan misled you or broke its own rules.
Each has its own deadline, usually 63 days from the event, and each requires proof. Keep the letter. Keep every letter. If any of these is happening to you, call somebody the same week rather than the following month.
What to do if you are inside the window right now
- Work out which letter you want. Plan G for most people, Plan N if you want a lower premium and can live with small copays, high-deductible G if you are healthy and would rather insure against a disaster.
- Price that letter across every company licensed in your state. The benefits are identical by law; only the premium and the company’s habits differ.
- Ask how each company prices as you age, and what their rate increases have looked like. The cheapest policy at 65 is regularly not the cheapest policy at 78.
- Apply before the six months are up. Being accepted is the whole point of doing it now.
And if you are already past it
Then it is worth finding out where you actually stand rather than assuming. Underwriting is not a coin toss and it is not a mystery: each company publishes what it will and will not accept, and we keep those. Plenty of people who assume they would be declined are not.
One rule, though, and it is absolute. Apply for the new policy and get accepted in writing before you cancel the one you have. Never the other way round.
How we run a Medigap comparison, or just call and ask.