We are often asked; “Can I switch from Medicare advantage to a Medicare supplement?”
A switch from Medicare Advantage to Medigap can make a lot of sense, but is not guaranteed. In most states you will need to qualify medically to be approved for a supplement plan. People with a history of critical or expensive chronic conditions may not be able to make a change. Keep in mind, the insurance company will not voluntarily take on known costs.
For those who can change, you will be limited to a specific annual enrollment period or special enrollment period when Medicare rules allow you cancel your Medicare Advantage plan.
What’s the difference between a Medicare Advantage and a Medicare Supplement plan?
There are several important differences between a Medicare Advantage Plan and Medigap insurance. Medicare Advantage (Part C) plans are comprehensive plans offered by private insurance companies. They replace original Medicare and combine the coverage of Parts A and B into a single plan. In addition, Advantage plans often bundle Part D prescription drug coverage, and can include some dental, vision, and or fitness programs.
However, most Medicare Advantage plans have network limitations. You may be required to use network providers or pay higher costs for out-of-network care if available.
Referrals from a primary care physician may also be required to see specialists. Medicare Advantage plans usually have an annual limit on out-of-pocket expenses, providing financial protection as long as you follow the Advantage plan rules. Services not approved by the insurance plan will not be covered and will not count toward your annual maximum out of pocket limit.
On the other hand, Medicare Supplement insurance (Medigap) plans work hand in glove with Original Medicare (aka Traditional Medicare). These Medicare plans help cover certain out-of-pocket costs that original Medicare doesn’t pay, such as deductibles, copayments, and coinsurance. Medicare supplement plans have monthly premiums in addition to Medicare.
Because a Medicare supplement does not include prescription drug coverage, you can shop for a stand-alone Part D drug plan annually, to provide the right plan for you without interfering with your health insurance. Stand alone Medicare prescription drug coverage offers more flexibility than a Part D plan bundled with your healthcare.
With a Medicare Supplement plan you keep the best benefits of Traditional Medicare. You can see any healthcare provider who accepts original Medicare patients without the need for referrals.
In addition, your benefits never change year-to-year like a Medicare Advantage plan. You do not have to shop every year for a new plan.
In summary, Medicare Advantage plans replace Original Medicare, but they come with network restrictions and may require referrals. A Medicare supplement plan works with Original Medicare, covering out-of-pocket expenses and providing flexibility in choosing providers.
Pros of switching from Medicare Advantage to Medigap
Switching from Medicare Advantage (Part C) to Original Medicare and a Medicare Supplement insurance (Medigap) plan can offer several benefits:
1) Provider Choice
With Medicare Supplement plans, you have the freedom to choose any healthcare provider that accepts Original Medicare patients without the need for referrals. This can be especially beneficial if you have a preferred doctor or specialist who may not be part of the network in your Medicare Advantage plan.
2) Nationwide Coverage
Medicare Supplement plans provide coverage throughout the United
States and in all US Territories. If you frequently travel or live in multiple locations throughout the year, having the flexibility to receive care anywhere in the country is an important benefit.
3) Comprehensive Coverage
Medicare Supplement plans are designed to fill the gaps in original Medicare coverage. Depending on the specific plan you choose, a Medigap plan can cover expenses such as deductibles, copayments, and coinsurance, potentially reducing your out-of-pocket costs for healthcare services.
4) Standardized Benefits
Medicare Supplement plans have standardized benefits across insurance companies, meaning that a specific plan offers the same coverage, regardless of the insurer. This makes it easier for Medicare beneficiaries to compare and select a plan that suits your needs.
5) Predictable Costs
Medicare Supplement insurance can provide more predictable costs. Your cost are primarily the monthly premium, without significant expense from medical bills. With Medicare Advantage plans, costs can vary depending on factors such as copayments, coinsurance, and out-of-network care and annual benefit changes.
6) Supplemental Coverage
Medicare Supplement plans do not typically include prescription drug coverage. However, you have the option to enroll in a standalone Medicare Part D plan to obtain prescription drug coverage, providing you with more control over your medication expenses.
What to know to switch from Medicare Advantage to Medicare Supplement insurance
When switching from Medicare Advantage to Medicare Supplement insurance, consider the following:
1) Understand the enrollment periods and potential medical underwriting. You cannot cancel a Medicare Advantage plan at any time during the year. You are limited to an Annual enrollment Period or Special enrollment periods.
2) Because your acceptance into a Medicare supplement is not guaranteed, you should apply for the supplement plan first, choosing a start date at least two weeks in the future. This give the insurance company time for medical underwriting. Only after you have been accepted by supplement insurer should you cancel your Medicare Advantage Plan.
3) You’ll need a separate Medicare drug plan for prescription drug coverage. It’s called a standalone Medicare Part D plan for prescription drugs. If you apply for a stand alone Part D plan while enrolled in a Medicare Advantage insurance plan, Medicare will automatically switch to original Medicare, canceling your Advantage Plan. Do not apply for a stand-alone Part D plan until after you have been accepted for a supplement.
How Do I Switch from Medicare Advantage to a Medigap plan?
To switch from a Medicare Advantage plan to a Medicare Supplement plan (aka Medigap), you just need to follow these steps (and you can always contact us for more tips) :
• Research available Medigap plans in your area. If you send us a
request to shop for a supplement plan, we will shop for you and provide a few recommendations for free.
Choose the supplement plan that best fits your needs and budget, with an insurance company whose pricing strategy assures longer term price stability.
• Confirm your eligibility and enrollment options and periods.
• Apply for a Medicare supplement plan with the desired insurance company and a start date two to four weeks in the future, but no more than 60-days after the date of the application.
• We help coordinate the timing to ensure you have no gap in coverage.
• After your supplement plan approval, apply for standalone Medicare Part D prescription drug coverage. Any stand-alone Medicare Part D application will automatically cancel Medicare Advantage Plans. You do not need to contact Medicare or your Medicare Advantage insurance plan.
When Can I Switch From a Medicare Advantage Plan to Medicare Supplement?
You can generally switch from a Medicare Advantage plan only during certain enrollment periods:
Initial Enrollment Period (IEP)
The initial enrollment period is the seven-month period that begins three months before your 65th birthday month, includes your birthday month, and extends three months after your birthday month. During this period, you can enroll in a Medicare Advantage plan for the first time or switch to a different Medicare plan. We have a free calculator to help you identify your initial enrollment period.
Annual Enrollment Period (AEP)
The Annual election Period from October 15th to December 7th each year. During this period you can change to a different Medicare Advantage plan or switch from Medicare Advantage to Medigap (if you qualify medically) with a January 01 start date.
Advantage Plan Open Enrollment Period
The Medicare Advantage Open Enrollment Period, is from January 01 through March 31 of each year. During this period you can make one decision with your Medicare Advantage plan. You can change Medicare Advantage Plans or switch from Medicare Advantage back to Original Medicare and apply for a Part D prescription drug plan.
Special Enrollment Periods
In addition to the annual enrollment periods, there are special enrollment periods (SEPs) that allow individuals to make changes to their Medicare Advantage plans outside of the typical enrollment periods. This includes New York, Connecticut, Maine and Massachusetts’s.
SEPs are triggered by specific life events or circumstances, and they provide an opportunity to enroll in, switch, or disenroll from a Medicare Advantage plan.
Common situations that may qualify you for a special enrollment period include:
Moving
If you move out of your Medicare Advantage plan’s service area, you may be eligible for a SEP to enroll in a new plan available in your new location. This includes some Medicare supplement plans.
Loss of Employer Coverage
If you had employer-based health coverage and it ends, you may qualify for a SEP to enroll in a Medicare Advantage plan or some Medicare supplement plans. Your choices will depend on your state laws.
Dual Eligibility
If you become eligible for both Medicare and Medicaid, you can typically switch or enroll in a Medicare Advantage plan at any time.
Other Special Circumstances
There are additional circumstances, such as qualifying for Extra Help with prescription drug costs, that may grant you a SEP to make changes to your Medicare Advantage plan.
Can I go back to my Medigap Plan if I don’t like Medicare Advantage?
If you dropped a Medicare supplement for a Medicare Advantage Plan, you may be able to get your supplement back.
Let’s say, you dropped a Medigap policy to join a Medicare Advantage Plan for the first time, and you’ve been in the plan less than a year.
If this is the case, you have the right to re-enroll in the Medicare Supplement policy (only with the previous insurance company) you had before you joined the Medicare Advantage Plan or Medicare SELECT policy, if available.
Can My Application for a Medicare Supplement be Denied?
If you do not qualify for a guarantee issue or Special enrollment period, and you do not live in either New York, Connecticut, Maine or Massachusetts’s, your application for a Medicare supplement plan can be denied.
Guaranteed Issue Rights
During Special Enrollment Periods, you may have guaranteed issue rights for some specific Medicare Supplement plans. This means that insurance companies cannot deny you coverage or charge higher premiums based on your health condition.
Medical Underwriting (health questions)
If you apply for a Medicare Supplement plan outside of a guaranteed issue period, insurance companies may require medical underwriting. What is medical underwriting? There is no physical as is the case with life insurance policies. It simply means the insurer can review your medical history and health status to determine whether to accept your application, charge higher premiums, or exclude coverage for pre-existing conditions.
We can review this with you if you have concerns.
In most cases, the insurance company is looking for ongoing health issues that lead to high costs. Not manageable health issues like high blood pressure or cholesterol.
Pre Existing Conditions
A pre-existing condition refers to a health issue that exists before the
start date of a new insurance policy. According to Medicare.gov, In certain cases, a Medigap insurance company may choose not to cover your out-of-pocket costs for these pre-existing health problems for up to 6 months. This is referred to as a “pre-existing condition waiting period.” However, after this 6-month period, the Medigap policy will cover the pre-existing condition.
With a supplement, this can only occur if there is a gap in coverage prior to applying for the supplement plan. If you had continuous coverage from an Advantage plan or another supplement, there can be no pre-existing condition clause application.
Note that coverage for a pre-existing condition can only be excluded if the condition was treated or diagnosed within 6 months prior to the start of your Medigap policy coverage. This period is known as the “look-back period.” Keep in mind that for services covered by Medicare, Original Medicare will still provide coverage for the condition, even if the Medigap policy doesn’t cover it.
State Laws
Each state can have its own regulations regarding Medigap plans, including additional consumer protections and eligibility rules. It’s important to understand the specific rules and requirements in your state when applying for a Medicare supplement plan.
We will review your specific state laws with you when helping you find the right coverage.
Ready to return to original Medicare? If you’d like to switch from Medicare Advantage to a Medigap plan, contact our award-winning team for a free and friendly consultation!
Have questions about Medigap coverage or other Medicare plans? Not enrolled in Medicare yet? Speak to one of our expert Medicare Advisors. Get help from a licensed insurance agent. Our services are free to the consumer.
Matthew Claassen
Matthew Claassen, CMT and CEO of Medigap Seminars Insurance Agency. Medigap Seminars is an award winning premier national Medicare Insurance Brokerage, ranked among the top in the U.S.A. Matthew is considered a leading national expert on Medicare and Social Security. Mr. Claassen is a distinguished member of the Forbes Business council, an invitation only organization of business leaders and entrepreneurs. He and his team have received awards from many of the countries largest insurance companies including Mutual of Omaha, Aetna, Humana, Cigna, United American, United Healthcare and others. His videos have become the most popular Medicare educational videos on YouTube with millions of views. As a financial analyst Matthew lead a team of researchers to win the 2009 Best Equity Research & Strategy Award from The Technical analysis magazine.
