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) insurance 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 insurance plans, and when and how you can switch between the two.
What is the difference between Medicare Advantage and Medicare Supplement insurance plans?
Medicare Advantage plans and Medicare Supplement insurance 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 insurance 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 insurance plan, unless you are planning to switch to Original Medicare.
When can I switch from Medicare Advantage to Medigap?
To switch from Medicare Advantage is a multi-step process. First, you need to drop your Medicare Advantage plan and return to Original Medicare, Part A and Part B. Then, you can apply for a Medicare Supplement insurance plan.
In most cases, you can only leave a Medicare Advantage plan during certain times of the year, such as:
- The Medicare Advantage Open Enrollment Period (OEP) between January 1 and March 31.
- The Annual Election Period (AEP), between October 15 and December 7. This is also called the Open Enrollment Period for Medicare Advantage and Medicare Prescription drug coverage.
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 lose your Medicare Advantage plan if it leaves your area or ends its contract with Medicare. You’ll get returned to Original 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 insurance 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 guaranteed-issue 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 expensive to buy a Medicare Supplement insurance 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 insurance 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 insurance plan.
Keep in mind, however, that these special situations may limit your choice of Medicare Supplement insurance 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 insurance plan, just enter your zip code on this page.
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