Medicare Advantage and Medigap are similar in some ways but very different in others. If you’ve enrolled in a Medicare Advantage plan and you don’t like it, you may think switching Medicare plans and enrolling in Medigap is a great idea. It’s important to understand the differences between the two so you can make the best choice.
What is a Medigap plan?
Before you disenroll from your Medicare Advantage plan and enroll in a Medigap plan, you should know what a Medigap plan is. Medigap (Medicare Supplement) plans are private health insurance plans that can “fill in the gaps” Original Medicare may create.
They help pay for financial items such as Original Medicare copays and coinsurance. They’re very different from Medicare Advantage plans because they cover financial gaps instead of additional medical benefits.
Medicare Supplement plans have eight different coverage levels, and each one is assigned a letter. Each “letter” is the same in every state (except for Wisconsin, Minnesota, and Massachusetts, which all operate slightly differently).
Can I switch from Medicare Advantage to Medigap?
Have you already enrolled in a Medicare Advantage plan but decided that it isn’t right for you and your health care needs? You can switch from Medicare Advantage to Medigap, but it’s important to know what might happen if you switch.
Why should I switch Medicare plans?
Medigap gives you access to any doctor that accepts Medicare. Instead of paying for additional health benefits, your Medigap plan may cover things like your Original Medicare copayments.
Some people can save more money with a Medicare Supplement plan than Medicare Advantage because some Medigap plans will cover coinsurance and copays entirely.
However, that can mean higher premiums. Monthly premiums for both Medicare Advantage and Medigap plans differ by location. For example, the average Medigap Plan G premium in Los Angeles, California is $152 a month in 2019.
Plus, if you want prescription drug coverage, you must purchase a Medicare Part D plan as well, which could mean that you have yet another monthly premium. The average Part D premium nationwide is $33.19 in 2019.
Medicare Advantage (MA) may offer lower premiums and can include Part D (prescription drug) coverage. MA plans sometimes include extra benefits, like prescription drugs, routine eye exams, and fitness memberships, all for one monthly premium. The average MA premium in 2019 is $26.87 nationwide, but some plans have $0 premiums.
Note: you may have to continue paying your Part B premium in addition to your Medigap or Medicare Advantage premium except for in limited circumstances.
*A Medicare Advantage HMO, or Health Maintenance Organization, typically has a very limited provider network.
When can I switch from Medicare Advantage to Medicare Supplement?
Once you’ve decided to switch, you have four separate time periods during which you can disenroll from your MA plan. Once you successfully disenroll from MA, you can enroll in a Medicare Supplement at any time during the year.
If you enroll in a Medicare Advantage plan when you first become eligible for Medicare, you can drop MA during the first 12 months of coverage with your current plan.
You can also drop MA coverage during the Annual Enrollment Period (from October 15 through December 7), during the Open Enrollment Period (January 1 through March 31), and during a Special Enrollment Period (if you have one).
When can I switch from Medicare Advantage to Medigap without losing guaranteed issue rights?
Guaranteed issue rights are protections that you have as a consumer. If you have guaranteed issue rights, it means that an insurance carrier cannot deny you a Medigap policy.
There are certain situations where you have temporary guaranteed-issue rights (usually 63 days from the date you leave your Medicare Advantage plan) outside your Initial Enrollment Period (IEP), which is the time period during which you’re allowed to enroll in Medicare.
If you’ve aged into the Medicare program, your IEP is the three months before your 65th birthday, your birthday month, and the three months after your birthday. If you qualify for Medicare due to ALS, receiving SSDI for at least 25 months, or ESRD, the IEP is 30 days after you first become eligible.
You can switch from Medicare Advantage to a Medicare Supplement without losing guaranteed issue rights if you:
- Bought a Medicare Advantage plan during your IEP, but decided within the first 12 months that you weren’t happy with it. In this case, you may be able to switch back to Original Medicare with short-term guaranteed-issue rights to enroll in a Medicare Supplement insurance plan.
- You lost your Medicare Advantage plan because you moved outside the plan’s service area, or the plan was no longer available in your zip code. If you switch to Original Medicare, you may have temporary guaranteed issue rights to buy a Medigap plan.
When You Can Change Medicare Advantage Plans
If you don’t like your Medicare Advantage plan, but you still want the additional benefits MA can offer, you may be able to enroll in a different MA plan. You can still enroll in a new plan during AEP.
If you have a MA plan already, you can change Medicare Advantage plans during the Medicare Advantage Open Enrollment Period (MA OEP), which is from January 1 to March 31. Your new coverage will take effect the month following your enrollment. For example, if you enroll in a new MA plan on January 20, your new coverage will go into effect on February 1.
Special Enrollment Periods (SEP) work differently depending on your reason for having one. Many people who qualify for SEPs do so because they have Special Needs Plans (SNP) If you have a Chronic Special Needs Plan (CSNP) (for chronic conditions) or Institutionalized Special Needs Plan (ISNP) (if you’ve lived in an institution such as a nursing home for longer than 90 days), your SEP allows you to make changes to your coverage as your medical needs change.
If you have a Dual Special Needs Plan (DSNP), which is for beneficiaries who qualify for both Medicare and Medicaid, you can make one change per quarter from January to September. You can make changes during the fourth quarter, but you can only do so during AEP. Your new coverage won’t take effect until January 1 of the following year.
If you have a SNP, switching back to Original Medicare and adding a Medicare Supplement plan may mean that you lose the health benefits your SNP helped you gain like prescription drugs and/or care coordination. Talk to your agent about your budget and medical needs so you can make an informed decision.
We Can Help You Decide Which Coverage You Need
Changing your Medicare plan from Medicare Advantage to a Medicare Supplement is a big decision. Our licensed agents are highly trained, and they can help you find the plans available in your area. Your agent can discuss the pros and cons of MA and Medigap and help you make the decision that best fits your needs. To set up a no-cost, no-obligation meeting with an agent, call 1-844-431-1832 or contact us here today.
This post was originally published on October 23, 2018, by Anastasia Iliou, and updated on November 8, 2019, by Troy Frink.