If you are new to Medicare and joined a Medicare Advantage plan, you have a 1-year trial right. During this period, you can switch back to Original Medicare and buy a Medigap policy. There’s a second situation that gives you the same right.
This article will explain the ins and outs of moving from Medicare Advantage to Medigap.
- New Medicare beneficiaries have a special trial right that allows them to try out a Medicare Advantage plan without losing their Medigap guaranteed issue right.
- You may also have a trial right if you cancel a Medigap policy to enroll in a Medicare Advantage plan for the first time and return within the first 12 months.
- Original Medicare, Medigap, and Medicare Advantage all have enrollment rules determining when a beneficiary can enroll and disenroll. They are all different.
- If you miss an enrollment period, you can get penalized or lock yourself into a particular type of coverage.
If you joined a Medicare Advantage plan, and are dissatisfied with your coverage, you can go back to Original Medicare during the right enrollment periods. And, if you meet specific requirements, you can buy a Medigap plan (Medicare Supplement) without going through medical underwriting.
In most cases, if you want to switch from Medicare Advantage coverage to Medigap, you will be required to answer underwriting health questions. For this reason, it is imperative that you understand which plan type works best for you before enrolling or making a switch from one to the other.
When Can I Switch from Medicare Advantage to Medigap?
Medicare has specific enrollment periods when you can disenroll from a Medicare Advantage plan and enroll in a Medicare Supplement plan. These include the Annual Enrollment Period and the Medicare Advantage Open Enrollment Period.
The Annual Enrollment Period occurs each fall and allows beneficiaries to leave their Medicare Advantage plan and return to Original Medicare. At the same time, you can apply for a Medicare Supplement plan. If you pass underwriting, your Part A, Part B, and Medicare Supplement coverage will begin on January 1 of the following year.
The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 each year. During this enrollment period, you can make a one-time change to your Medicare Advantage plan. This includes going back to Original Medicare and applying for Medigap coverage.
It’s important to understand that neither enrollment period allows you to get a Medigap policy without answering medical underwriting questions. As a result, an insurance carrier can turn down your application based on pre-existing health conditions.
IMPORTANT: Do not disenroll from your Medicare Advantage plan until you have been approved for your Medicare Supplement plan.
Medicare Advantage Trial Right
Medicare gives you a 1-year period to see if a Medicare Advantage plan is a good option for you. If you don’t like the plan, you can switch back to Original Medicare and buy a Medicare Supplement insurance plan, without medical underwriting. But you must do so within the 1-year period.
To get a special enrollment period to make this switch, you will need to call Medicare. They will grant your special enrollment period under two trial right conditions:
- You join a Medicare Advantage Plan when you first become eligible for Medicare at age 65 and want to switch back to Original Medicare within the first year.
- You cancel a Medigap policy to enroll in a Medicare Advantage plan for the first time, and within the first 12 months, you wish to go back to your original Medigap plan.
These two trial rights are commonly overlooked by Medicare beneficiaries they are unaware they exist. Now you know.
Advantages of Switching
Original Medicare and a Medigap policy have several advantages over Medicare Advantage plans. For starters, Medigap has fewer provider restrictions and limitations.
When you have Original Medicare and a Medicare Supplement, you have the option to use all healthcare providers that accept Medicare nationwide. As long as a provider accepts Medicare, and is taking new patients, you are free to make an appointment without a referral or prior approval.
This is not true with most Medicare Advantage plans. Many HMO plans, and some PPO plans, force you to use providers in a limited, restricted network of doctors and hospitals. Plus, Medicare Advantage plans do not provide emergency coverage when you travel outside of the USA.
Most Medigap plans provide emergency coverage when you travel internationally (up to $50,000). With a Medicare Advantage plan, you’ll have to buy additional coverage.
In addition to fewer restrictions and international coverage, with a Medicare Supplement plan, you’ll have fewer out-of-pocket expenses. With a Medicare Supplement Plan G policy, for example, you’ll have no out-of-pocket costs once you’ve paid the annual Part B deductible.
Here’s a full list of coverage benefits by plan:
Disadvantages of Switching
There are some situations where a Medicare Advantage plan is a better option. It all has to do with your health and where you live.
In some areas, many Medicare Advantage plans offer additional benefits compared to Original Medicare. Common extra benefits include routine dental, vision, hearing, and prescription drug coverage. Some of the less common extra benefits include free gym memberships, Medicare Part B premium reduction, and transportation to and from appointments.
By law, extra benefits can’t be offered in the 10 standardized Medicare Supplement plans available today. If you need dental, vision, and prescription coverage, you have to buy separate policies.
Medicare Advantage plans also offer low monthly premiums, but you are still required to pay your monthly Part B premium. It isn’t uncommon to see Medicare Advantage plans have a $0 monthly premium, making them very affordable.
However, it’s important to understand that nearly all plans with a low premium have higher out-of-pocket costs. As a result, these plans are best suited to individuals in excellent health, not those with chronic health conditions.
It’s also important to understand that Medicare Supplement plans have an additional premium. There are no free plans. In some areas, Florida for example, Medigap policies can be pretty expensive.
And, finally, let’s not forget that, unless you have a guaranteed issue right, you will go through medical underwriting. In many cases, individuals who want to switch plans won’t be able to due to their health history.
How to Get Help Switching
If you wish to switch from a Medicare Advantage to a Medicare Supplement plan, we can help. The first step is to get quotes in your area. We provide a free service.
To get started with your free plan evaluation today, call 1-855-728-0510 (TTY 711) or complete our online rate comparison form.