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Can I switch from Medicare Advantage to Medigap?

You may have chosen Medicare Advantage and later decided that you’d rather have the protections of a Medicare Supplement (Medigap) plan that go along with Original Medicare. The good news is that you can switch from Medicare Advantage to Medigap, as long as you meet certain requirements. This article will help you understand the difference between Medicare Advantage and Medicare Supplement Plans, and when and how you can switch between the two.

What is the difference between Medicare Advantage and Medicare Supplement Plans?

Medicare Advantage plans and Medicare Supplement Plans are two entirely different types of coverage.

A Medicare Advantage plan is an alternate way to get your Original Medicare (Part A and Part B) benefits from a private insurance company. Medicare Advantage plans cover everything that Original Medicare covers, at a minimum, and some may even offer extra benefits for things like routine vision, dental, and hearing care. Most also include Part D coverage for prescription drugs.

Medicare Supplement Plans, on the other hand, cover some or all of your out-of-pocket expenses from Original Medicare, such as copayments, coinsurance and deductibles. They do not cover any costs associated with prescription drugs under Part D, and they can’t be used for out-of-pocket costs under Medicare Advantage. If you have a Medicare Advantage plan, it is against the law for a company to sell you a Medicare Supplement plan, unless you are planning to switch to Original Medicare.

When can I switch from Medicare Advantage to Medigap?

You can only leave a Medicare Advantage plan during certain times of the year, specifically between January 1 and February 14, during the Medicare Advantage Disenrollment Period, and during the Annual Election Period between October 15 and December 7. Outside these periods, you can only switch between Medicare Advantage and Original Medicare if you meet certain requirements like moving outside your plan’s service area. You may also be able to switch if your Medicare Advantage plan leaves your area or ends its contract with Medicare.

If you move from home into a nursing facility or other institution, or move back home from an institutional setting, you may also be able to switch from Medicare Advantage to Original Medicare.

Once you’ve left your Medicare Advantage plan and enrolled in Original Medicare, you are generally eligible to apply for a Medicare Supplement plan. Note, however, that in most cases, when you switch from Medicare Advantage to Original Medicare, you lose your “guaranteed issue” rights for Medigap. You generally have gauranteed issues rights for six months when you are both 65 or older and enrolled in Medicare Part B. Guaranteed issue rights ensure that you can buy any plan sold in your state, and that you won’t be charged higher premiums based on your health status.

Without guaranteed issue rights, your insurance company may require medical underwriting before it sells you a plan. During medical underwriting, the insurer looks at your past medical history and current health status. If the company determines the risk of covering you is too high, it can refuse to sell you the plan you want, or it may charge you much higher premiums for the coverage.

When can I switch from Medicare Advantage to Medigap without losing my guaranteed issue rights?

It can be very expensive to buy a Medicare Supplement plan without guaranteed issue rights. However, there are certain situations where you have time-limited guaranteed issue rights (generally 63 days from the date you leave your Medicare Advantage plan) outside your Initial Enrollment Period:

  • You bought a Medicare Advantage plan when you first became eligible for Medicare, but decided within the first 12 months that you weren’t happy with it. In this case, you can switch to Original Medicare with short-term guaranteed issue rights for a Medicare Supplement Plan.
  • You lost your Medicare Advantage plan because you moved outside the plan’s service area, or the plan stopped operating where you live. If you switch to Original Medicare, you have short-term guaranteed issue rights for a Medicare Supplement plan.

Keep in mind, however, that these special situations may limit your choice of Medicare Supplement Plans. Although there are 10 standardized plans available in most states, some states only allow you to buy certain ones with guaranteed issue rights outside your Initial Enrollment Period.

If you would like to begin searching for a Medicare Advantage or Medicare Supplement plan, just enter you zip code on this page.  

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