Making the Switch: Can I Switch from medicare Advantage to Medigap
As your health needs change over time, your Medicare coverage should adapt as well. If you enrolled in a Medicare Advantage Plan but now want the flexibility of Original Medicare plus a Medigap policy, switching is an option in many cases. This guide covers everything you need to know about making the change from Medicare Advantage to Medigap.
Medicare Advantage vs. Medigap at a Glance
First, let’s quickly summarize the key differences between Medicare Advantage and Medigap:
- Medicare Advantage – Also called Medicare Part C, these plans are offered by private insurers as an alternative to Original Medicare. They bundle Parts A, B, and usually D.
- Medigap – Also called Medicare Supplement Insurance, these polices help pay Original Medicare out-of-pocket costs like coinsurance and deductibles.
- Costs – Medigap Plans have higher premiums, while many Medicare Advantage Plans have $0 premiums. However, Medigap caps your out-of-pocket costs.
- Coverage – Medicare Advantage Plans restrict you to network providers. Medigap allows you to see any provider accepting Medicare nationwide.
Understanding these key differences allows you to make an informed choice between the two options.
Why Switch from Medicare Advantage to Medigap?
There are a few common reasons people want to drop their Medicare Advantage Plan and switch to a Medigap policy:
- Gaining access to more healthcare providers and hospitals nationwide
- Avoiding referral requirements and pre-approvals with Original Medicare
- Securing coverage when traveling anywhere in the U.S.
- Capping out-of-pocket spending which is unlimited under Medicare Advantage
- Escaping network restrictions that limit specialist choices
- Enrolling in stand-alone Part D Plans with more affordable prescription options
For these reasons, some Medicare Advantage enrollees become eager to change to Original Medicare plus Medigap for more choice and flexibility.
When Can You Make the Switch?
Switching from Medicare Advantage to Medigap is only allowed at certain times, except in special circumstances:
- Eligible for Medicare? Medicare Advantage Open Enrollment Period – From January 1 to March 31, you can leave your Medicare Advantage Plan and switch to Original Medicare plus a Medigap policy.
- Medicare Annual Enrollment Period – During this fall open enrollment from October 15 to December 7, you can choose to drop your Medicare Advantage Plan and move to Original Medicare and Medigap.
- Special Enrollment Periods – In limited situations like moving out of your plan’s service area, you may qualify to immediately return to Original Medicare Plan and apply for Medigap.
Make sure you change your coverage during these designated windows. Otherwise, you may need to wait until the next open enrollment period.
How Do You Make the Switch?
Follow this step-by-step process to smoothly transition from Medicare Advantage to a Medigap Plan:
- Research Medigap policies and prescription drug plans available in your area to prepare for your new coverage. Look for a plan that fits your budget and needs.
- Contact your Medicare Advantage insurer and inform them you want to disenroll and switch back to Original Medicare.
- Enroll in Original Medicare by contacting the Social Security Administration and filling out the proper forms.
- Select and apply for your Medigap policy within 63 days to secure guaranteed issue rights in most states.
- Sign up for a stand-alone Medicare Part D prescription drug plan.
- Once your Medigap coverage begins, you can cancel your Medicare Advantage policy.
Following this checklist helps avoid mistakes and coverage gaps when switching to Original Medicare and Medigap.
Maintaining Open Enrollment Guaranteed Issue Rights
To secure affordable Medigap coverage, maintaining your open enrollment guaranteed issue rights is key. When you first enroll in Medicare at 65, you have a 6-month Medigap open enrollment period where you cannot be denied a policy or charged more due to health conditions.
If you join a Medicare Advantage Plan when first eligible and want to switch to Medigap shortly after, you can do so while retaining these guaranteed issue protections in many states during your trial period. This allows you to obtain affordable Medigap coverage even with pre-existing conditions.
Check with your State Health Insurance Assistance Program (SHIP) to confirm your guaranteed issue rights when switching from Medicare Advantage back to Original Medicare and Medigap. Taking advantage of this open enrollment window saves you money on premiums.
Cost Comparison of Medicare Advantage vs. Medigap
How do costs compare when you move from Medicare Advantage to Original Medicare plus a Medigap Plan? Here are the key differences:
- Premiums – Medigap premiums range from around $100 to over $200 monthly depending on the plan’s coverage. Many Medicare Advantage Plans have $0 premiums.
- Out-of-pocket spending – With Medigap, 100% of Medicare out-of-pocket costs are covered. Medicare Advantage has a yearly limit around $8,300 for Parts A and B.
- Prescription drugs – You’ll need to enroll in a stand-alone Part D Plan with Medigap. Medicare Advantage typically includes drugs.
- Deductibles – Medigap covers Medicare deductibles while Medicare Advantage usually has no deductibles.
Overall, your total costs may rise when you switch to Original Medicare and buy a Medigap policy. But your financial exposure is also capped compared to Medicare Advantage.
Should You Make the Switch?
Is moving from Medicare Advantage to Original Medicare and a Medigap Plan the right choice? Consider the pros and cons:
Benefits of Switching
- Choose any healthcare provider nationally who accepts Medicare
- No need for referrals to see specialists
- Use any hospital including top-ranked facilities
- Medigap covers deductibles, copays and coinsurance
- Get needed care without pre-approvals
- Smooth Medigap claims process with no billing surprises
Downsides of Switching
- Higher overall premium costs
- Must enroll in separate Part D prescription plan
- Doesn’t include dental, vision and hearing benefits
- Pre-existing conditions may limit Medigap choices
- Can only switch plans at certain times of year
Evaluate your specific health needs and coverage priorities when deciding if the tradeoffs are worthwhile to gain more healthcare freedom.
Key Steps to Switch from Medicare Advantage to Medigap
Making a smooth transition from Medicare Advantage to Original Medicare plus Medigap involves:
- Researching available Medigap and Part D Plans during Medicare open enrollment
- Notifying your Medicare Advantage insurer you want to disenroll
- Enrolling in Original Medicare Parts A and B
- Applying for the Medigap policy that best meets your needs
- Signing up for a stand-alone Part D prescription plan
- Canceling your Medicare Advantage coverage once Medigap takes effect
Follow each step carefully and seek guidance to avoid gaps in coverage. With proper planning, you can switch to Original Medicare and Medigap coverage that empowers healthcare choices.
- You can switch from Medicare Advantage to Medigap during Medicare open enrollment periods or special enrollment windows.
- Notify your Medicare Advantage Plan you want to disenroll and enroll in Original Medicare Parts A and B.
- Apply for a Medigap policy within 63 days and a Part D prescription plan.
- Make changes carefully to prevent coverage gaps when transitioning from Medicare Advantage to Original Medicare and Medigap.
- Weigh the pros and cons to decide if a Medigap policy is right for your healthcare needs and budget.
The freedom and predictability of Original Medicare combined with supplemental Medigap coverage appeals to many Medicare Advantage enrollees. Know your options, choose the right windows, and execute the steps to successfully transition from Medicare Advantage to Medigap.
We’re Here to Help
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Can I switch from Medicare Advantage to Medigap?
Yes, you can switch from Medicare Advantage to Medigap, but there are certain restrictions and considerations to keep in mind.
What is a Medicare Advantage Plan?
A Medicare Advantage Plan, also known as Medicare Part C, is an alternative to Original Medicare that is provided by private insurance companies approved by Medicare.
What is a Medigap Plan?
A Medigap Plan, also known as a Medicare Supplement Plan, is a policy sold by private insurance companies to help pay for some of the out-of-pocket costs that Original Medicare doesn’t cover.
Can I switch back from Medigap to Medicare Advantage?
Yes, you can switch back from Medigap to Medicare Advantage if you meet certain requirements, such as being in your Medigap open enrollment period or having a qualifying special circumstance.
Can I drop my Medigap policy and switch to Original Medicare?
Yes, you can drop your Medigap policy and switch to Original Medicare at any time, but it’s important to carefully consider the potential impact on your coverage and costs.
Can I switch from Medicare Advantage to Medicare Supplement Plan without undergoing medical underwriting?
What are the cons of switching from Medicare Advantage to Medigap?
Some potential cons of switching from Medicare Advantage to Medigap include higher premiums, the need to enroll in a separate prescription drug plan, and the potential for limited network coverage.
How do I buy a Medigap policy?
You can buy a Medigap policy from private insurance companies that are licensed to sell them in your state. It’s important to compare plans and costs to find the one that best meets your needs.
Can I switch to a different Medigap Plan?
Yes, you can switch to a different Medigap Plan if you meet certain requirements, such as being within your Medigap open enrollment period or having a qualifying special circumstance.
Can I switch from a Medicare Advantage Plan to Medicare?
Yes, you can switch from a Medicare Advantage Plan to Original Medicare, but it’s important to understand the differences in coverage and costs between the two options.
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