How to Switch from Medicare Advantage to Medigap?

Over 26 million people are enrolled in Medicare Advantage plans. While many are happy with their Medicare Advantage coverage, others decide they want to switch to original Medicare and a Medigap supplement plan instead.

If you’re considering making the change from Medicare Advantage to Medigap, this guide will walk you through the process and key factors to keep in mind. We’ll cover when you can switch plans, how to apply for Medigap, and what happens to your existing coverage so you can evaluate if switching makes sense for your situation.

What is Medigap and How Does It Differ from Medicare Advantage?

Medigap, also known as Medicare Supplement Insurance, is private health insurance that helps pay for medical costs not covered by Original Medicare like copayments, coinsurance, and deductibles. Medigap Plans are standardized so each lettered plan (Plan A, Plan B, etc.) offers the same benefits nationwide.

In contrast, Medicare Advantage Plans are an alternative way to receive your Medicare Part A and Part B benefits. Medicare Advantage Plans are offered by private insurers who contract with Medicare. Many include prescription drug coverage and extra benefits not provided by original Medicare.

The key distinction is that original Medicare + Medigap will give you unrestricted access to any healthcare provider that accepts Medicare nationwide. Medicare Advantage Plans have networks and generally require you to see in-network providers.

When Can You Switch from Medicare Advantage to Medigap?

You have the right to switch from Medicare Advantage to Original Medicare only during certain times of year:

• Medicare Advantage Open Enrollment Period - This window from January 1 to March 31 allows you to disenroll from any Medicare Advantage Plan and return to Original Medicare.

• Medigap Open Enrollment Period - For the 6 months beginning when you're 65 and enrolled in Medicare Part B, you can buy any Medigap policy in your state regardless of health conditions.

Outside of these enrollment periods, insurers can deny your Medigap application or charge more based on your health status, a process known as medical underwriting. Your ability to switch plans is limited if you want to avoid underwriting.

How Do I Switch from Medicare Advantage to Medigap?

Follow this step-by-step process to disenroll from your Medicare Advantage Plan and enroll in a Medigap plan:

1. Compare Medigap Plans - Review costs, benefits, and insurer ratings to pick a Medigap policy that fits your needs. Plan F and Plan G tend to be most popular.

2. Drop your Medicare Advantage Plan - Contact your plan to disenroll. This will automatically put you back in Original Medicare.

3. Apply for Medigap - Once back in Original Medicare, submit your Medigap application to the insurer during an open enrollment period.

4. Send proof you left Medicare Advantage - Your new Medigap insurer will ask for a notice showing your Medicare Advantage disenrollment date.

5. Pick prescription drug coverage - Medigap doesn't cover prescriptions so you'll need to enroll in a stand-alone Medicare Part D drug plan.

Following this process will ensure you have continuous health coverage. Be aware you can't be enrolled in Medicare Advantage and Medigap at the same time.

What Do I Need to Know About Switching to Medigap?

Here are some key facts and considerations about making the change from Medicare Advantage to Medigap:

• Pre-existing conditions don't matter during open enrollment but can affect coverage and cost outside these periods.

• Shop around with different insurers as Medigap plan prices can vary significantly between companies.

• Your Medicare Advantage Plan may offer additional benefits besides basic Medicare coverage. Be sure to compare this with Medigap.

• You'll need to enroll in Part D prescription drug coverage as Medigap doesn't cover pharmacy costs.

• It can take a few weeks to a few months to process your Medigap and Medicare Advantage enrollment changes. Be patient!

• If over 65 and leaving an employer plan, you have a Medigap open enrollment period--use this because it saves you from underwriting.

By understanding the ins and outs of switching from Medicare Advantage to Medigap, you can decide if moving to original Medicare and supplemental coverage is your optimal path forward. Consult with a Medicare insurance broker if you need assistance navigating your options.

What Are the Pros of Switching to Medigap?

There are good reasons someone enrolled in a Medicare Advantage Plan may want to switch to Original Medicare with Medigap supplemental coverage:

Freedom to choose providers - Medigap allows you to see any doctor or hospital that accepts Medicare nationwide. Medicare Advantage networks are typically restricted.

Lower out-of-pocket costs - With Medigap covering copays, the 20% coinsurance, and more, most medical care is 100% covered up to Medicare-approved amounts.

Travel benefits - Your Medigap insurance applies anywhere in the U.S. versus Medicare Advantage limiting coverage to network regions.

Plan stability - Unlike Medicare Advantage, Medigap Plans don't unexpectedly drop providers or terminate coverage (outside of fraud).

No referrals needed - You can see any specialist you want without pre-approval from a primary care doctor as required by some Medicare Advantage HMOs.

For those who want maximum provider choice, lowest cost-sharing, and freedom to travel, switching to Medigap can be advantageous.

What Are the Cons of Switching to Medigap?

However, there are also some potential disadvantages to switching from Medicare Advantage to Medigap that are important to consider:

Higher premiums - Medigap premiums tend to be significantly higher than many Medicare Advantage Plans with $0 premiums. The average Medigap premium is over $150/month.

Separate drug plan enrollment - You'll need to join a standalone Part D prescription drug plan as Medigap doesn't cover pharmacy costs.

No extra benefits - Many Medicare Advantage Plans include dental, vision, hearing, gym memberships and other perks. Medigap only covers core Medicare benefits.

Pre-existing condition exclusions - Applying for Medigap outside of open enrollment means insurers can reject you or charge much higher premiums based on health history.

Plan differences by state - Each state regulates Medigap plans differently so benefits, options, and costs can vary based on your location.

If you have complex medical needs and take pricey drugs, the costs and hassle of switching from Medicare Advantage to Medigap may outweigh the benefits.

Is Switching Right for You? Key Questions to Ask

Deciding whether changing from Medicare Advantage to Original Medicare with a Medigap plan makes sense comes down to a few key considerations:

• How restrictive is your Medicare Advantage provider network? Do your preferred doctors participate?

• Do you need regular specialist care? Medicare Advantage may require referrals.

• Will your prescription drug needs be covered affordably on a separate Part D plan?

• Are your out-of-pocket costs higher under your Medicare Advantage coverage?

• Do you want national access to providers for travel purposes?

• Is your Medigap open enrollment period still active? This is the best time to avoid underwriting.

• Can you afford higher premiums? Medigap Plans cost $1000s more per year than many Medicare Advantage Plans.

Take time to weigh your specific healthcare needs and budget to determine if a switch to Medigap would benefit you personally. An independent broker can provide guidance.

There are compelling reasons to go with either Medicare Advantage or Medigap depending on your priorities around providers, prescription drugs, travel, and costs. Consider your options carefully. While you have an annual opportunity to make changes, switching back and forth too frequently can result in gaps in coverage.

Key Takeaways About Switching from Medicare Advantage to Medigap

Switching from Medicare Advantage to Original Medicare and purchasing a Medigap Supplemental Plan is a major decision. Keep these tips in mind:

• Use Medicare Advantage open enrollment or your Medigap open enrollment period to avoid medical underwriting

• Dropping your Medicare Advantage Plan will automatically put you back in Original Medicare

• Shop around between insurers for the best Medigap policy in terms of price and benefits

• Make sure to also join a Medicare Part D drug plan since Medigap doesn't cover prescriptions

• Be aware Medigap Plans have higher premiums but lower out-of-pocket costs for medical services

• Consider any healthcare needs unique to you that may impact whether Medicare Advantage or Medigap is a better fit

Consult with a broker and do your research to choose the right Medicare coverage for your health profile and finances. Evaluate both Medicare Advantage and Medigap to make an informed enrollment decision.

We’re Here to Help

You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at Lane Financial Strategies a Call at (804) 897-2170. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help

FAQs

Can I change from Medicare Advantage to Medigap?

Yes, you can change from a Medicare Advantage Plan to a Medigap plan. However, there are certain conditions and enrollment periods to be aware of.

What is a Medicare Advantage Plan?

A Medicare Advantage Plan is an alternative to Original Medicare, offered by private insurance companies approved by Medicare. These plans provide all the benefits of Original Medicare, and often include additional coverage such as prescription drugs, dental, and vision.

What is a Medigap plan?

A Medigap plan, also known as a Medicare Supplement Plan, is a private insurance policy that helps cover the out-of-pocket costs not covered by Original Medicare, such as deductibles, coinsurance, and copayments.

Can I switch back to Original Medicare from a Medicare Advantage plan?

Yes, you have the option to switch back to Original Medicare from a Medicare Advantage Plan. However, there are certain enrollment periods and rules to follow.

Can I drop my Medigap policy and switch to a Medicare Advantage Plan?

Yes, you can drop your Medigap policy and switch to a Medicare Advantage Plan. However, it's important to carefully consider and compare the benefits and coverage provided by both types of plans.

Can I switch from a Medicare Advantage Plan to a Medicare Supplement Plan (Medigap) without medical underwriting?

Yes, you may be able to switch from a Medicare Advantage Plan to a Medicare Supplement Plan (Medigap) without medical underwriting during certain enrollment periods, such as the Medicare Advantage Disenrollment Period or the Medigap Open Enrollment Period.

What are the cons of switching from Medicare Advantage to Medigap?

Some potential cons of switching from Medicare Advantage to Medigap include potentially higher premiums for Medigap Plans, the need to purchase prescription drug coverage separately, and the need to go through medical underwriting if switching outside of the Medigap Open Enrollment Period.

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 the different plans and prices available to find the one that best fits your needs.

What is the Medigap Open Enrollment Period?

The Medigap Open Enrollment Period is a six-month period that starts when you are both 65 years old or older and enrolled in Medicare Part B. During this period, you have guaranteed issue rights which means that insurance companies cannot deny you coverage or charge you higher premiums based on your health condition.

Can I change from Medicare Advantage to Medigap?

Yes, you can switch from a Medicare Advantage Plan to a Medigap Plan. However, there are some important things to consider before making the switch.

What is a Medicare Advantage Plan?

A Medicare Advantage Plan is a private insurance plan that provides all the benefits of Original Medicare (Part A and Part B) and often includes prescription drug coverage as well.

What is a Medigap Plan?

A Medigap Plan, also known as a Medicare Supplement Plan, is a private insurance plan that helps cover some of the costs that Original Medicare doesn’t cover, such as deductibles, co-payments, and coinsurance.

Can I switch from Medicare Advantage to Medigap without a penalty?

In most cases, you can switch from Medicare Advantage to Medigap without a penalty during certain enrollment periods. One key enrollment period is the 6-month Medigap Open Enrollment Period, which starts when you are first eligible for Medicare.

What are the pros of switching from Medicare Advantage to Medigap?

Some of the pros of switching from Medicare Advantage to Medigap include having the freedom to choose any doctor or hospital that accepts Medicare, having coverage for any Medicare-approved service or treatment, and not being restricted to a specific network of providers.

What are the cons of switching from Medicare Advantage to Medigap?

Some of the cons of switching from Medicare Advantage to Medigap include potentially higher monthly premiums, the need to also enroll in a standalone Part D prescription drug plan, and the possibility of being subjected to underwriting and medical approval when applying for a Medigap Plan.

When can I switch from Medicare Advantage to Medigap?

You can switch from Medicare Advantage to Medigap during certain enrollment periods, such as the Medicare Open Enrollment Period (October 15 to December 7) and the Medigap Open Enrollment Period (6-month period starting when you are first eligible for Medicare).

Do I need to buy a Medigap policy before dropping my Medicare Advantage Plan?

You do not need to buy a Medigap policy before dropping your Medicare Advantage Plan. However, it is important to have coverage in place before dropping any existing coverage to avoid being without health insurance.

Can I switch from Medicare Advantage to Original Medicare?

Yes, you can switch from Medicare Advantage to Original Medicare. However, it is recommended to also consider enrolling in a Medigap policy to help cover the out-of-pocket costs associated with Original Medicare.

What happens if I want to switch back to Medicare Advantage after joining a Medigap Plan?

If you decide to switch back to Medicare Advantage after joining a Medigap Plan, you may not be guaranteed the same Medigap Plan or pricing. It is important to carefully consider your options and compare the benefits and costs of each plan before making any changes

Yes, you can join a Medicare Advantage Plan if you already have a Medigap policy. However, you would need to drop your Medigap coverage if you decide to make the switch.