Choosing your Medicare coverage is one of the most important decisions you’ll make as you approach age 65 — but there’s a common misstep that many people don’t see coming. It’s not widely talked about, and yet it can have a lasting impact on your access to care and out-of-pocket costs later on.

We call it the Medigap Misunderstanding — and understanding how it works now can help you make smarter, more confident choices.

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Your Two Main Coverage Paths

When you first enroll in Medicare, you generally have two ways to get your benefits:

• Option 1: Original Medicare (Parts A & B) + a Medigap (Supplement) Plan
• Option 2: A Medicare Advantage (Part C) Plan

Medigap is popular because Original Medicare only covers about 80% of approved costs — and there’s no annual out-of-pocket maximum on the remaining 20%. For people on a fixed income, even routine medical expenses can add up over time.

Here’s a quick side-by-side:

Original Medicare + Medigap	Medicare Advantage (Part C)
Visit any doctor who accepts Medicare	Limited to plan’s network
No referrals usually needed	Referrals often required
Medigap (like Plan G) covers most costs after Part B deductible	Copays and coinsurance up to an out-of-pocket max (often $8,000+)
Doesn’t include extras like dental or vision	Includes extras like dental, vision, hearing, gym
Requires separate Part D plan	Drug coverage typically included

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Where Things Get Complicated

Many people assume they can easily switch between Medicare Advantage and Medigap each year during Medicare’s Annual Enrollment Period. But that’s not the case in most states.

After your initial Medigap enrollment window (a 6-month period when you first sign up for Part B), most Medigap plans require medical underwriting — meaning you’ll need to answer health questions.

Depending on your health, an insurer can:

• Decline your application
• Charge you a higher premium
• Or limit your coverage

This means if you begin with a Medicare Advantage plan and try to move to Medigap later due to changing health needs, you may face unexpected barriers.

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Are There Any Exceptions?

Yes — a few.

You’re guaranteed Medigap coverage without health questions only under certain conditions, such as:

• Moving out of your Medicare Advantage plan’s service area
• Losing coverage through no fault of your own
• Leaving a Medicare Advantage plan within your first year (a “Trial Right”)

And in a few states (like New York, Connecticut, Massachusetts, and Maine), you can apply for Medigap without underwriting at any time.

Outside of those situations, eligibility is based on your health — and many people don’t learn this until they’re already facing challenges.

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Another Concern: Rising Premiums

Even if you get into a Medigap plan, it’s important to know that premiums typically increase over time. Rates are influenced by:

• Age
• Inflation
• Healthcare usage in your area
• Your plan’s pricing structure (community-rated, issue-age-rated, or attained-age-rated)

In some areas, premiums may rise modestly each year, while in others, the increases may be more significant — especially with smaller or older policyholder groups.

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Tips to Protect Yourself

• ✅ Work with an experienced AHIP certified Medicare broker
  They can help you compare plans, understand rate histories, and know which companies are more likely to approve you.
• ✅ Make an informed choice at age 65
  This is your best chance to enroll in a Medigap plan without health questions.
• ✅ Re-evaluate your plan regularly
  If your premium rises or your needs change, a broker can help you explore alternatives — including companies with more favorable underwriting.
• ✅ Understand how your premiums may change
  Know whether your plan increases with age or is priced based on your community or the year you first enrolled.

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The Bottom Line

The Medigap decision is one many people revisit — sometimes too late. Choosing your Medicare path without knowing how future eligibility and costs work can lead to frustration and fewer options later on.

Take the time now to understand the rules, your rights, and how your choices today can affect your flexibility tomorrow.

If you’d like help reviewing your Medicare options or understanding how Medigap works in your state, we’re here to guide you every step of the way — with clarity, care, and no pressure. CLICK HERE TO LEARN MORE & GET YOUR FREE PERSONALIZED MEDICARE PLAN QUOTES

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Written by Greg O’Rourke, a multi-state independent licensed Life, Health, and Annuities agent. Contact me to help you find the best rates with no obligation or pressure. 904-373-8374 / Goinsuredirect.com