Goodsurance

Enrollment & timing

Medigap Access Barriers May Leave Many Medicare Advantage Enrollees With Fewer Real Choices During Open Enrollment

As the Medicare open enrollment period opened October 15, the Medicare Rights Center warned that most Medicare Advantage enrollees face health-based barriers to buying Medigap coverage, which could make switching to Traditional Medicare financially impractical even for those who want out.

By the Goodsurance editorial teamOctober 16, 2026

Medicare's fall open enrollment period, which runs from October 15 through December 7, allows people in Medicare Advantage to switch back to Traditional Medicare. But the Medicare Rights Center, publishing on the first day of enrollment, says a structural barrier narrows that choice for many: obtaining the Medigap supplemental coverage that makes Traditional Medicare affordable is often not possible once the initial enrollment window has closed.

Under federal law, people have a guaranteed right to buy any Medigap plan only during a six-month window that begins when they first enroll in Medicare Part B at age 65. Outside that window, insurers in most states may use medical underwriting, meaning they can charge higher premiums, impose waiting periods for preexisting conditions, or decline to sell a policy at all.

Open enrollment is open, but Medigap health barriers may limit real switching options for millions in Medicare Advantage.

A KFF analysis found that 74 percent of Medicare Advantage enrollees have at least one condition that could lead a Medigap insurer to deny coverage. Without Medigap, Traditional Medicare has no annual out-of-pocket cap, leaving beneficiaries exposed to potentially large costs for hospital stays and physician services.

The Medicare Rights Center argues that this dynamic makes the decision to leave Medicare Advantage less free than it may appear. People who are dissatisfied with prior authorization requirements or narrow provider networks in their current plan may nonetheless stay because switching without supplemental coverage carries financial risk.

A small number of states have laws that extend Medigap guaranteed-issue rights beyond the federal six-month minimum, but most do not. The Medicare Rights Center advises anyone considering a switch to review their state's protections and their current health situation before making a decision during this enrollment period.

In plain words

Medicare open enrollment runs from October 15 to December 7. People in Medicare Advantage can switch to regular Medicare during this time. But switching may not be easy. Regular Medicare has no cap on what you can owe, so most people need a Medigap plan to help pay costs. The problem is that Medigap plans can turn people down because of health conditions. About 74 out of every 100 people in Medicare Advantage have a health condition that could lead to a Medigap refusal. If you cannot get Medigap, regular Medicare may cost too much to risk. This can make people feel stuck in Medicare Advantage even if they are unhappy with it. Some states have extra protections for buying Medigap, but most do not. Check your state's rules and your health status before you decide to switch.

Understand the basics first

Source: Medicare Rights Center
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