The Medigap Trap That Surprises Seniors

May 5, 2025 Medicare, Medicare Coverage

When it comes to Medicare, one of the most important — and often misunderstood — decisions you’ll make is how to get your coverage. And for many seniors, there’s a hidden danger lurking in this choice that most don’t find out about until it’s too late. It’s what we call The Medigap Trap, and it can have serious consequences for your healthcare and your wallet down the road.

Let’s break this down so you can stay ahead of it.

The Basics: Medicare Coverage Paths

When you go on Medicare, you typically have two options for how to receive your benefits:

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

Over 40% of Medicare beneficiaries choose a Medigap Plan to help cover what Medicare doesn’t. Why? Because Original Medicare only covers about 80% of your medical expenses — and there’s no cap on the remaining 20%. For those on a fixed income, large unexpected medical bills can be financially devastating.

So Where’s the Trap?

Most people assume they can simply switch back and forth between Medicare Advantage and a Medigap Plan every year during Medicare’s Annual Enrollment Period. Unfortunately — that’s not the case in most states.

Medigap Plans are usually medically underwritten after your initial open enrollment window closes.
This means that, outside of specific guaranteed issue situations, you’ll need to answer health questions, and the insurance company can:

  • Deny you coverage
  • Charge you a higher premium
  • Or exclude coverage for certain pre-existing conditions

You only get one chance for guaranteed Medigap approval without health questions — when you’re new to Medicare Part B (usually at age 65) during your 6-month Medigap Open Enrollment Period.

If you start on a Medicare Advantage Plan because you’re healthy and attracted by the $0 premium, but later want to switch to Medigap due to declining health — you might not be able to.

Are There Any Exceptions?

Yes. There are a few states (CT, MA, ME and NY) that allow you to switch to a Medigap plan without underwriting. Also, a few situations (called Guaranteed Issue Rights) let you get a Medigap Plan without medical underwriting, such as:

  • Moving out of your Medicare Advantage plan’s service area
  • Losing your current coverage through no fault of your own
  • Exercising a “Trial Right” within the first year of trying a Medicare Advantage Plan

But outside of those exceptions, your health status will determine your eligibility — and many seniors don’t realize this until it’s too late.

The Other Medigap Trap: Rising Premiums

Even if you start with a Medigap Plan, you’re not entirely free of traps.
Medigap premiums go up over time — typically every year around your policy anniversary. These increases are based on:

  • Inflation
  • Healthcare costs
  • Your increasing age
  • Your state’s average Medicare spending
  • Your insurance company’s financial performance

And premiums can vary widely by insurer and state. In 2023, the average monthly premium for Plan G was around $164, ranging from $140 in D.C., Hawaii, and New Mexico to $236 in New York.

Some states or insurers see annual increases of over 20%, especially for newer policies or policies with a shrinking enrollment base.

How to Protect Yourself

  • Work with an experienced, independent Medicare broker. They’ll know which companies have more stable rate histories and how underwriting works.
  • Enroll in the right plan at age 65. Take the time to carefully weigh your options when you first become eligible.
  • If premiums rise sharply, shop around. Even with underwriting, some companies may accept you while others won’t — a knowledgeable broker can help.
  • Understand your plan’s pricing structure (Community-rated, Issue-age-rated, or Attained-age-rated) as this affects how premiums increase over time.

Bottom Line

The Medigap Trap catches seniors off guard when they realize they’re locked out of the plan they need, or trapped with rising premiums they can’t afford — all because of decisions made when they first went on Medicare.

Don’t fall into it.

Make sure you understand your rights, options, and limitations from the start. And when in doubt, consult a trusted, licensed Medicare broker who can advocate for you and help navigate the fine print.

If you’d like help reviewing your options or if you’re worried you might already be in a trap, reach out today — our agents are experts at finding creative, compliant solutions. CLICK BELOW to watch Stephanie’s video explaining the Medigap Trap: