Can I Switch From Medicare Advantage to Medigap?

Yes, most beneficiaries can switch from Medicare Advantage to a Medicare Supplement plan (Medigap), but only during these periods:

• AEP
  • Medicare Annual Enrollment Period – October 15th through December 7th each year.
  • *Medical underwriting may be required.
• OEP
  • Medicare Advantage Open Enrollment Period – January 1st through March 3st each year.
  • *Medical underwriting may be required.
• SEPs
  • Special Enrollment Periods – if you lose coverage due to certain life events.
  • Medical underwriting not required.

*Important to note: If you switch from Medicare Advantage to Medigap outside of a Special Enrollment Period, insurance providers may require medical underwriting to assess your medical history and current health. The insurer might deny you a plan or charge higher premiums depending on the risk.

Special Enrollment Periods

According to Medicare.gov, you can switch your Medicare Advantage coverage during Special Enrollment Periods (SEPs) triggered by specific life events.

Here are some scenarios that may qualify you for a SEP:

• Moving to an area not covered by your current plan
• Losing health insurance from your current employer
• Medicare discontinuing the plan’s contract

Additional situations may qualify you for an SEP, which are evaluated on a case-by-case basis.

How Do I Switch From Medicare Advantage to Medigap?

If you are eligible to switch from your Medicare Advantage plan to a Medicare Supplement plan, you can follow these steps:

1. Apply for Medigap: Before leaving your Medicare Advantage plan, you must apply for coverage through the Medigap provider you wish to enroll with. Applying for coverage beforehand ensures that you are approved and not left without insurance if you are denied during underwriting.

2. Disenroll from your Medicare Advantage plan: Once approved for a Medigap plan, you must drop your Medicare Advantage plan before the new Medigap coverage becomes active. You can also enroll in a standalone Part D plan to maintain prescription drug coverage.

• How Do I Disenroll?

  You can contact your Medicare Advantage plan provider directly, or you can choose to enroll in a prescription drug plan, which will disenroll you from Medicare Advantage.

Can I Have Medicare Advantage and Medigap at the Same Time?

No, you can’t have active Medicare Advantage and Medigap plans simultaneously because they’re both based on Original Medicare. Medicare Advantage replaces Original Medicare, while Medigap fills the coverage gaps. 

Also, an insurance company can’t legally sell you a Medigap plan if they know you’re enrolled in an Advantage plan (unless you prove in writing that you’re switching).

Medicare Advantage Overview

Medicare Advantage (Part C) is an all-in-one alternative to Original Medicare. Private insurers offer these plans, which cover everything Original Medicare covers, often including additional benefits such as vision, dental, and prescription drug coverage.

However, Medicare Advantage has its restrictions. Network limitations might affect your choice of healthcare providers, and you may face unexpected costs if you require services outside your plan’s coverage area.

Medigap Overview

Medicare Supplement (Medigap) plans are designed to work alongside Original Medicare (Part A and Part B). Medigap plans help to cover out-of-pocket costs, such as deductibles, coinsurance, and copayments. Medigap also allows you to visit any doctor that accepts Medicare nationwide.

With ten standardized Medigap plans labeled Plan A through N (with some plans discontinued but still available for beneficiaries who have them), there are many options to choose from. Each plan provides different levels of coverage, allowing you to select one that works best for your healthcare needs and budget.

Unlike Medicare Advantage plans, Medigap plans typically do not offer additional benefits such as vision, dental, or prescription drug coverage.

• Bonus tip:
  • If you currently have a Medigap policy and decide to switch to a Medicare Advantage plan for the first time but later find that you’re unsatisfied with your new plan, there is a trial right period of 12 months. 
  • You can switch back to your previous Medigap policy if the same insurance company still offers it during this trial period.

Bottom Line

Beneficiaries enrolled in Medicare Advantage plans can switch to Medigap, but there are certain restrictions to be aware of.

You must be eligible for a Special Enrollment Period to avoid medical underwriting. Underwriting may be required if you switch during the Medicare Annual Enrollment Period (AEP) or the Medicare Advantage Open Enrollment Period.

For more personalized advice on your plan options, contact one of our licensed insurance agents. We can guide you through the finer points of all plans, make recommendations tailored to your needs, and assist you with the transition process.

Sources: How Medigap Works |  How to Enroll |  AEP Info |  Medicare Advantage

FAQs

• Can you cancel Medicare Advantage at any time?

  No, you can only cancel your Medicare Advantage plan during an eligible enrollment period.

• Why do people choose Medigap over Medicare Advantage?

  Many people choose Medigap plans because they offer more comprehensive coverage than what is available from some Medicare Advantage plans. Additionally, Medigap policies don’t have network restrictions like Medicare Advantage plans.