The Medicare landscape isn’t always easy to navigate, and if you have a Medicare Advantage plan, you might be wondering if you can switch to Medigap, also referred to as a Medicare Supplement.
The short answer is yes, but there are some caveats and requirements. We also have some recommendations about how to make the switch from Medicare Advantage to a Medigap plan to ensure that you don’t incur higher premium costs or gaps in coverage.
Ideally, the best time to get Medigap is as soon as possible after you enroll in traditional Medicare – ideally within six months. However, that’s not always possible, so this article outlines various timelines for changing your insurance plan if you find that your Medicare Advantage plan has not met your health or budget needs.
Medicare Advantage Versus Medigap
Before answering the question of “Can I switch from Medicare Advantage to Medigap,” it helps to understand how these different Medicare plans work and what you get when you enroll in each one.
About Medicare Advantage Plans
Also called as Medicare Part C, Medicare Advantage plans are offered by a private insurance company.
A Medicare Advantage plan includes Medicare Part A and Medicare Part B (known as Original Medicare), as well as extra benefits, such as vision, dental care. Most Medicare Advantage plans also include prescription drug coverage.
About Medigap Policies
Medigap plans are also referred to as a Medicare Supplement plan. Medicare beneficiaries add Medicare Supplement plans to their Original Medicare to help cover the costs of copayments, coinsurance, and deductibles.
It’s important to note, however that a Medicare Supplement plan does not offer Medicare prescription drug coverage. This benefit must be purchased separately with a Medicare Part D prescription drug plan.
How to Switch from Medicare Advantage to Medigap
First things first. If you have Medicare Advantage, you can’t have Medigap coverage at the same time. You will have to first cancel Medicare Advantage and revert to Original Medicare. You can do this your insurance agent, through Medicare, or visit a Social Security Office.
Keep in mind that you are limited to changing your Medicare plan to certain enrollment periods discussed below:
- Open Enrollment Periods: The Medicare Advantage open enrollment period (OEP) happens every year from January 1st through March 31st. During this time, Medicare beneficiaries can make a change to the Medicare Advantage plans. Therefore, this can be an ideal time to switch from Medicare Advantage to Medigap through your insurance company.
However, note that the switch doesn’t work both ways during the OEP. You can switch from a Medicare Advantage plan to Medigap, but you can’t switch from a Medigap policy to Medicare Advantage. - Annual Election Period: Another potential window for moving from Medicare Advantage to Medigap is during the annual enrollment period, which happens each year from October 15th through December 7th.
During this time, you can switch back to Original Medicare and get a Medigap policy if you have had your Medicare Advantage plan for three months or less.
If you are outside of these periods, you can still leave Medicare Advantage in favor of Medicare Supplemental Insurance. Beneficiaries are eligible to switch to a Medicare Supplement plan in the following circumstances:
- You relocate to a new address, including to a zip code out of your plan’s service area or you have moved back to the United States after living abroad
- A Medicare Advantage plan ends its Medicare contract
- You move in or out of nursing home
- You are released from jail
Pros and Cons of Making the Switch from a Medicare Advantage Plan to Medigap
Before you switch plans, it can be helpful to know what you’re getting into. This list summarizes the pros and cons of moving a Medicare Advantage plan to a Medigap policy.
Pros of Switching to a Medigap Plan
- More predictable healthcare costs
- Fewer out-of-pocket expenses
- Larger provider network
- Ability to get healthcare overseas
Cons of Switching to a Medigap Plan
- Potential to pay higher monthly premiums
- May not have additional benefits like health, vision, and prescription drugs
- Medical underwriting may be required
- You may not qualify for a Medigap plan
Medical Underwriting and Medicare Supplement Plans
For Medicare beneficiaries, it’s not uncommon to make several policy adjustments to move from Original Medicare with a Medicare Supplement to Medicare Advantage and back again.
In these cases, if you had a Medicare Supplement plan in the past and switched to Medicare Advantage, and want to go back to Medigap, you can return to your same policy or enroll in a new one. The obstacle many beneficiaries face, however, comes in the form of guaranteed issue rights – or specifically not having them.
With few exceptions, people looking to switch Medicare services from Medicare Advantage to a Medicare Supplement Medigap plan will have to answer answer health questions from the insurance company regarding health status and other health factors. As a result, if your health status has changed, it can result in higher premiums and out-of-pocket costs, or a denial of coverage from Medigap companies.
You can potentially avoid the underwriting requirement if you enrolled in Medicare Advantage during the initial enrollment period and then switched back to Original Medicare before having Medicare Advantage for less than a year. This special enrollment period authorizes you to use guaranteed issue rights and get guaranteed coverage options through Medigap insurance plan.
Another option is to take advantage of the Medigap Open Enrollment Period, which lasts for the six months after enrolling in Original Medicare and selecting Medigap coverage. If you have health concerns or pre-existing conditions, this route may be recommended.
Conclusion
A knowledgeable and experienced Medicare advisor can guide you through the process of making the switch from Medicare Advantage to a Medicare Supplement plan, specifically addressing key concerns like guaranteed issue rights.
Further, your advisor can help you determine whether a Medicare Advantage plan is best for you or you would be better off financially with a Medigap policy. For more details about changing my Medicare Supplement plan, contact us today.