Leaving a Medicare Advantage plan is simple during the right enrollment window. Buying a Medigap policy afterward can be harder. Here's how North Carolina residents can tell whether they have a guaranteed right to buy one.
Written by the licensed agents at Health Plans of NC, an insurance agency authorized by Blue Cross NC.
Every fall, some North Carolina Medicare beneficiaries decide their Medicare Advantage plan is no longer the right fit. Maybe a specialist left the network, travel plans changed, or prior authorizations became a frustration. Moving back to Original Medicare is allowed at set times each year. The harder question is whether a Medicare Supplement (Medigap) insurer will sell you a policy to cover the costs Original Medicare leaves behind.
This guide explains the enrollment windows for leaving Medicare Advantage, the federal "guaranteed issue" rights that require a Medigap company to accept you, and what happens in North Carolina when none of those rights apply. It draws on the Centers for Medicare & Medicaid Services' official Medigap guide (March 2026 edition) and guidance from the North Carolina Department of Insurance.
Most people can leave a Medicare Advantage plan during one of two yearly windows.
Open Enrollment (October 15 – December 7). You can switch from Medicare Advantage to Original Medicare and join a stand-alone Part D drug plan. Your new coverage starts January 1.
Medicare Advantage Open Enrollment (January 1 – March 31). If you're already in a Medicare Advantage plan, you can make one change: switch to a different Medicare Advantage plan, or return to Original Medicare and join a separate drug plan. Coverage starts the first of the month after your request is received.
Special Enrollment Periods can also apply outside these windows, for example if you move out of your plan's service area. Medicare.gov lists the qualifying situations.
Returning to Original Medicare doesn't automatically come with a Medigap policy. Under federal rules, your one-time Medigap Open Enrollment Period is the six months that start the first month you're 65 or older and enrolled in Part B. During that window, a Medigap insurer can't turn you down or charge more because of your health.
Outside that window, and without a guaranteed issue right, insurers in North Carolina may use medical underwriting. That means they can ask health questions, charge a higher premium, or decline your application. The NC Department of Insurance notes that people who don't apply during their Open Enrollment Period may lose the right to buy a policy without regard to their health.
That's why the order of steps matters. Someone with significant health conditions who drops a Medicare Advantage plan first and then applies for Medigap could end up with Original Medicare alone, which has no annual out-of-pocket limit.
Federal law gives two groups a guaranteed right to buy Medigap after trying Medicare Advantage. Both are called trial rights.
You joined Medicare Advantage when you first became eligible at 65. If you joined a Medicare Advantage plan (or PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining you decide to switch to Original Medicare, you can buy any Medigap policy sold in North Carolina.
You dropped a Medigap policy to try Medicare Advantage for the first time. If you've been in the plan less than a year and want to go back, you can repurchase the Medigap policy you had, as long as the same company still sells it. If it doesn't, you can buy Plan A, B, D or G (or C or F if you were eligible for Medicare before January 1, 2020) from any company selling in the state.
In both cases, you can apply as early as 60 days before your Medicare Advantage coverage ends and no later than 63 days after it ends. CMS notes these rights may last an extra 12 months in certain circumstances, and the NC Department of Insurance can confirm whether that applies to you.
Several other events create a guaranteed issue right for people leaving Medicare Advantage. In each, you can buy Medigap Plan A, B, D or G (or C or F if you were eligible before 2020), and the right applies only if you switch to Original Medicare rather than another Medicare Advantage plan.
Your plan leaves Medicare or stops serving your area. If your plan exits or stops giving care where you live, you'll receive a notice.
You move out of the plan's service area. A move to another county or state can trigger this right.
Your plan's network has a significant change. CMS's 2026 Medigap guide lists a significant network change as a qualifying event.
The plan broke the rules or misled you. If you leave because the company didn't follow Medicare's rules or misled you, you have a right to buy.
For these, you can generally apply 60 days before your coverage ends, by the date on your plan's termination notice, or no more than 63 days after coverage ends. A Medigap policy can't start until your Medicare Advantage coverage ends.
Most Medicare Advantage plans include drug coverage. Original Medicare doesn't, and Medigap policies sold today don't either. When you return to Original Medicare, you'll usually want to join a stand-alone Part D plan at the same time.
Going 63 days or more in a row without Part D or other creditable drug coverage after you're first eligible can lead to a late enrollment penalty added to your Part D premium, generally for as long as you have Medicare drug coverage. You can read more in our guide to Medicare Part D in North Carolina.
Rates vary by company. The NC Department of Insurance lists age, gender, tobacco use, where you live, discounts and, when it applies, medical underwriting as factors that affect Medigap premiums. Plans with the same letter have the same benefits, so price and company service are what differ.
Under-65 beneficiaries have a state protection. North Carolina law guarantees people who qualify for Medicare because of a disability the right to buy Medigap Plan A, D or G during their Open Enrollment Period. They get a new six-month Open Enrollment Period when they turn 65.
Free counseling is available statewide. The Seniors' Health Insurance Information Program (SHIIP), part of the NC Department of Insurance, offers free, unbiased Medicare counseling in all 100 counties at 855-408-1212. SHIIP counselors don't sell insurance.
Local plan options vary. Medicare Advantage and Medigap choices differ by county. Our Medicare pages by county and by city outline what's available locally.
Check for a guaranteed issue right first. Look at when you joined Medicare Advantage, whether you dropped a Medigap policy to do it, and whether your plan sent a notice about leaving your area or changing its network.
Apply for Medigap before you leave your plan. If you have a guaranteed issue right, you can apply up to 60 days before your Medicare Advantage coverage ends. If you don't, apply and wait for an approval before dropping your current plan.
Line up a Part D plan. Choose a drug plan that covers your prescriptions so there's no gap in drug coverage.
Watch the deadlines. Open Enrollment ends December 7. The Medicare Advantage Open Enrollment Period runs January 1 through March 31.
Get help if you need it. Medicare.gov's Plan Finder and 1-800-MEDICARE (1-800-633-4227) list every plan in your area. SHIIP offers free counseling, and a licensed agent can compare the Medigap and Part D plans they offer at no cost to you.
We do not offer every plan available in your area. Currently we represent 10 organizations which offer 56 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
This article is for general information and is not insurance, legal, or tax advice. Contact a licensed agent or the Health Insurance Marketplace for guidance specific to your situation.