Nearly Three-Quarters of Medicare Advantage Enrollees Could be Denied a Medigap Policy Due to a Pre-Existing Condition

This analysis examines the share of Medicare Advantage enrollees who have a pre-existing condition that could result in a Medigap denial if they seek to switch to traditional Medicare outside their one-time 12-month trial period, including national estimates and estimates by age and by state. KFF finds that nearly three-quarters of Medicare Advantage enrollees (74%) or 20.9 million people in 2023 had a pre-existing medical condition identified from KFF’s review of Medigap applications that could result in a denial for a Medigap policy.

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