Switching Back to Original Medicare in Washington: Trial Rights and Medigap Switching

The basic problem

When you are 65 or older and first enrolled in Part B, you have a 6-month Medigap open enrollment period. During it, Medigap companies must sell you any policy they offer and can't charge you more because of your health (RCW 48.66.025). It happens once and doesn't repeat.

Outside that window, unless you have a guaranteed-issue right, Medigap companies can use medical underwriting: they can ask about your health history and may turn you down. That can make leaving Medicare Advantage for Original Medicare with Medigap harder.

Washington is different in one important way: once you have Medigap, state law lets you change Medigap policies at any time without health questions.

Washington's any-time Medigap switching right

Here is what RCW 48.66.045 and WAC 284-66-064(4) allow:

• Any time of year, not a birthday window. Washington has no birthday rule; the switching right isn't tied to a date.
• Plan A can be replaced only by another company's Plan A.
• Any other plan can be replaced by a company's Plan B, D, G, high-deductible G, K, L, M or N (and C, F or high-deductible F if you were eligible for Medicare before 2020), including a different letter, such as Plan G to Plan N.
• The company can't require evidence of insurability. The Office of the Insurance Commissioner (OIC) explains this as not having to take a written health screening questionnaire.
• The law sets no waiting time before you can switch. If the policy you are replacing has been in effect at least 3 months, the new policy can't impose a waiting period for pre-existing conditions; if less, your time on the old policy counts toward any wait (RCW 48.66.130; WAC 284-66-170).
• Washington Medigap premiums are community-rated and can't rise because of your age (RCW 48.66.045(3); WAC 284-66-310).

The right covers only plans the new company sells. See our full Medigap Washington guide.

Important: the switching right helps you move between Medigap policies. It doesn't give you a right to leave a Medicare Advantage plan and buy Medigap without a health review. For that you need your Medigap open enrollment period, a trial right or another guaranteed-issue right below. The OIC says that when you switch to Medigap from another type of health plan, rules can vary and a company may require a written health screening. Once you have any Medigap policy, the switching right applies from then on.

Federal and Washington trial rights and guaranteed-issue rights

Federal law and Washington's RCW 48.66.055 give you the right to buy certain Medigap policies, with no health questions and no pre-existing condition exclusion, when you leave Medicare Advantage in these situations:

The 12-month trial right (joined at 65)

If you joined a Medicare Advantage plan (or PACE) when you first became eligible for Part A at 65, and you leave within the first 12 months, you can buy any Medigap policy a company sells in Washington, without health questions.

The Medigap-then-Medicare Advantage trial right

If you dropped a Medigap policy to join a Medicare Advantage plan for the first time, and you leave within 12 months, you can get the same Medigap policy back if the same company still sells it. If it doesn't, you can buy Plan A, B, D, G, K or L (Plan A, B, C, D, F, K or L if you were eligible before 2020).

Your plan ends or leaves your area

If your Medicare Advantage plan leaves Medicare, stops serving your area or loses its Medicare contract, you can buy Plan A, B, D, G, K or L (Plan A, B, C, D, F, K or L if you were eligible before 2020) from any company that sells it. The right starts when you get the notice that your plan is ending and lasts until 63 days after your coverage ends. Keep the notice; send a copy with your application.

You move out of the plan's area

If you move out of your Medicare Advantage plan's service area, you can switch back to Original Medicare and have the same Medigap right. You can apply as early as 60 days before your plan coverage ends and no later than 63 days after.

How to switch back to Original Medicare

Step 1: Confirm you can switch now

You can leave Medicare Advantage for Original Medicare during:

• Annual Enrollment Period (October 15 to December 7), with Original Medicare starting January 1
• Medicare Advantage Open Enrollment Period (January 1 to March 31), if you are in a Medicare Advantage plan on January 1; one change, starting the first of the next month
• Special enrollment periods for situations such as a move, your plan ending, or getting Apple Health or Extra Help (see when you can change plans)
• A trial right (within the first 12 months, as above)

Step 2: Apply for a Medigap policy first

This is the critical step. Apply to a Medigap company while your guaranteed-issue right or trial right applies, so the company can't review your health. If you don't have one, apply and wait for written approval before you leave your Medicare Advantage plan; the OIC advises not cancelling a Medicare Advantage plan until you have that approval.

If a company turns you down for health reasons, it must tell you in writing and give you information about Medicare Advantage plans in your area and the Washington State Health Insurance Pool (RCW 48.66.057), which sells a Medicare Basic plan to people on Medicare turned down by a Medigap plan for health reasons. A licensed insurance agent can tell you which companies they work with sell which plans; find a licensed insurance agent in Washington.

Step 3: Join a standalone Part D drug plan

Medigap policies sold today don't include drug coverage, so you'll need a standalone Part D plan during a valid enrollment period. Joining a standalone Part D plan automatically ends your enrollment in a Medicare Advantage plan with drug coverage. See our Part D Washington guide.

Step 4: Leave your Medicare Advantage plan, if needed

If joining a Part D plan didn't end it, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) and ask to switch to Original Medicare, or send your plan a written request to disenroll.

Step 5: Confirm your start dates

Make sure your Medigap and Part D coverage start the day after your Medicare Advantage coverage ends, so there is no gap.

The Medigap underwriting reality

If you have no guaranteed-issue right and you're past your Medigap open enrollment period, here is what to expect from a company's health review:

• Applications usually ask about specific conditions, medications and recent hospital stays.
• Some answers can lead the company to decline the application.
• Companies' health questions and decisions differ, so being turned down by one doesn't mean all will.
• Washington Medigap premiums are community-rated, so if you're accepted, the company can't charge you more because of your health or age under the same plan form (RCW 48.66.045(3)).

Washington's switching right still helps later: once you have any Medigap policy, you can change Medigap policies any day of the year without health questions.

Why someone would switch back

Common reasons people move from Medicare Advantage back to Original Medicare:

• Network concerns. A doctor leaving the network, prior authorization requirements or a narrow network.
• Travel. Wanting coverage with any provider who accepts Medicare when away from Washington.
• A new diagnosis. Preferring a predictable premium over copays for ongoing care.
• Moving. Medicare Advantage plans have service areas; Original Medicare works across the country.
• Specialty care. Needing a specialist or hospital outside the plan's network.
• Your plan is ending. See plans ending in 2027.

Where to get help

The decision to switch back deserves careful thought:

• 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) and Medicare.gov, for enrollment periods and trial-right questions.
• A licensed insurance agent with Benefits Life, at no cost to you: call (206) SENIORS (206-736-4677), TTY 711 about Medigap and Part D options from the companies they work with, or see plans in your ZIP code.
• The Office of the Insurance Commissioner, for questions about Washington Medigap law or a complaint about an insurer.

Sources

• Washington State Legislature — RCW 48.66.045, Mandated coverage for replacement policies; rates on a community-rated basis
• Washington State Legislature — RCW 48.66.055, Guaranteed issue: eligible persons, types of policies, time periods
• Washington State Legislature — RCW 48.66.025, Medigap open enrollment period
• Washington State Legislature — RCW 48.66.057, Rejection of Medicare eligible person; notice required
• Washington State Legislature — RCW 48.66.130, Preexisting condition limitations
• Washington State Legislature — WAC 284-66-064, Replacement without evidence of insurability
• Washington State Legislature — WAC 284-66-170, No preexisting condition or waiting periods in replacement policies
• Washington State Legislature — WAC 284-66-310, Attained age rating prohibited
• Washington Office of the Insurance Commissioner — Medigap (Medicare Supplement) plan coverage and costs
• Washington Office of the Insurance Commissioner — Is your Medicare Advantage plan changing or leaving?
• Washington Office of the Insurance Commissioner — The Washington State Health Insurance Pool (WSHIP)
• Medicare.gov — When can I buy Medigap?
• Medicare.gov — Special Enrollment Periods
• Medicare.gov — Costs in Part D drug plans (late enrollment penalty)

Frequently asked questions

Can I switch from Medicare Advantage back to Original Medicare in Washington?

Yes, during the Annual Enrollment Period (October 15 to December 7), the Medicare Advantage Open Enrollment Period (January 1 to March 31), or a special enrollment period, for example when your plan is ending or you move. The harder part can be getting a Medigap policy without a health review, so line that up first.

Does Washington's Medigap switching right help me leave Medicare Advantage?

Not directly. Under RCW 48.66.045, a person who already has a Medigap Plan B through N can switch to another Plan B through N at any time without health questions (Plan A to Plan A only). The Office of the Insurance Commissioner says that when you switch to Medigap from another type of plan, rules can vary and a company may require a written health screening. Once you get into Medigap, the switching right applies from then on.

What is a Medicare Advantage trial right?

If you joined a Medicare Advantage plan when you first became eligible for Part A at 65 and leave within the first 12 months, you can buy any Medigap policy sold in Washington with no health questions. If you dropped a Medigap policy to try Medicare Advantage for the first time and leave within 12 months, you can get your old policy back if the same company still sells it, or certain other plans (RCW 48.66.055).

My Medicare Advantage plan ends December 31, 2026. Do I have a Medigap right?

Yes. When a plan stops serving your area, you have a guaranteed right to buy Medigap Plan A, B, D, G, K or L (Plan A, B, C, D, F, K or L if you were eligible for Medicare before 2020) with no health questions, until 63 days after your plan ends. You also have until February 28, 2027 to pick new coverage; choosing by December 31 avoids a gap.

Do I need a Part D plan if I switch back to Original Medicare?

Most likely yes. Medigap policies sold today don't include drug coverage, so you'd join a standalone Part D plan. If you go without creditable drug coverage for 63 days or more in a row, you may owe a late enrollment penalty, so time the two so there's no gap.

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