How to Switch From Medicare Advantage to Medigap

November 8, 2019

• General
• Medicare
• Medicare Advantage
• Medigap

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 Medicare Advantage?

Medicare Advantage, also called Medicare Part C, is a type of private Medicare plan. When you first enroll in Medicare, you’ll start with Medicare Part A (the part that covers hospital care), and then most people will enroll in Medicare Part B (the part that covers doctor’s appointments). 

Medicare parts A and B are limited, so adding Part C can give you additional benefits like:

• Long-term care
• Specialized care
• Dental
• Vision
• Hearing
• Physical fitness
• Prescription drugs

No two Medicare Advantage plans are the same. In fact, there are several different types. You’ll have to look at what you’re eligible for and decide which benefits you need most and how much you’re willing to spend.

Medicare Part C doesn’t always mean spending more money, though. Some plans might even have $0 premiums!*

*Even with a $0 Medicare Advantage premium, you’d have to continue paying your Part B premium.

What is a Medigap plan?

Medicare Advantage plans sound fantastic, but some people will find that Medigap plans work best for them. Medigap coverage is what can “fill the gap” between what Medicare covers and what you owe out of pocket. These plans are also called “Medicare Supplement” plans because they supplement your existing Medicare Part A and Medicare Part B coverage.

Some Medigap plans may provide a few extra “perks,” but generally speaking, they do not provide additional health benefits in the same way that Medicare Advantage plans do. Instead, supplemental insurance covers your Medicare Part A and Medicare Part B deductibles, copayments, coinsurance, etc.

You’re probably thinking, “great!” I’ll just go ahead and get Medigap and Medicare Advantage. However, you can’t have both. That decision can be tough, but it all comes down to how much you’re able to spend each month and whether or not you can afford a medical emergency. For example, Medigap premiums tend to be a bit higher than Medicare Advantage, but if you’re in the hospital all the time, it might pay off. 

Can I switch from Medicare Advantage to Medigap?

If you enroll in a Medicare Advantage plan and decide that a Medigap plan might be better, you can switch – but there are a few things you’ll need to keep in mind.

Mainly, Medigap plans come with medical underwriting. In other words, you can be denied for pre-existing conditions. Meanwhile, you will never be denied or charged more for a Medicare Advantage plan based on your preexisting conditions. There are two times when your preexisting conditions won’t affect your Medigap enrollment: when you’re enrolling in Medicare for the first time, and if you are forced out of your current plan and need to find a new one quickly. That rule is called “guaranteed issue rights.”

You’ll also have to keep in mind that if you had a Medicare Advantage plan with prescription drug coverage and you want to switch to Medigap, you will lose your prescription drug coverage. The only way to have a prescription benefit with Medicare Supplements is to also invest in a Part D (prescription drug) plan. 

One of the many benefits to Medicare Advantage is that most of your benefits will be rolled into one plan, whereas if you have Medigap, you may have to seek alternative plans for your prescription drugs, dental, vision, etc. 

Can I switch from a Medigap plan to an Advantage plan?

Just like switching from Medicare Advantage to Medigap, switching from Medigap to Medicare Advantage is possible, but there are some things to be aware of. 

One of the first things you’ll notice when you switch plans from Medigap to Medicare Advantage is that your copayments might rise. This will all depend on what plans you have. For example, if you had Medigap Plan G (which covers Part B copayments), and then you switched to a Medicare Advantage PPO plan that had a $20 copayment for doctor visits, you might feel like your costs are rising. However, your Medicare Advantage plan might have a lower premium than your Medigap plan did, making your overall costs lower.

Confused? Your insurance agent can walk through these numbers with you before you switch plans to help you decide which type of plan is truly best for you. 

Is it better to have Medicare Advantage or Medigap?

The question should read, “Is it better for ME to have Medicare Advantage or Medigap?” That may not be the answer you were looking for, but it is different for every person. What you may see as disadvantages of Medicare Advantage might be great for someone else. Common Medicare Advantage disenrollment reasons, like trouble finding a doctor in-network or the lack of one very specific benefit, may not apply to you. 

While Medicare Advantage usually provides more covered benefits, Medigap can result in lower hospital bills and lower overall out-of-pocket costs.

Your decision should be based on your health history, your budget, and the quality of plans available in your area. Try sitting down and writing a pros/cons list for Medicare Advantage vs. Medigap, like this: 

Medicare Advantage: 

Pros: Prescription drug coverage can be included

Cons: Stricter network

Medicare Supplements:

Pros: Copayments can be covered

Cons: Higher premiums

Add in any items specific to you, like a specific benefit that you need or a specific cost that you are worried about. Then, circle the items that are most important to you. Whichever column has the most circled items is likely the best option for you. 

Why should I switch Medicare plans?

There are plenty of reasons to switch Medicare plans. Everything from network size to costs and benefits can be a factor. 

You may want to switch Medicare plans if:

• Your plan doesn’t cover all of your healthcare needs.
• The premiums are too high.
• Your favorite doctors are not in-network.
• The costs are not worth the benefits you’re receiving.
• A better plan becomes available in your area.
• You become eligible for a cheaper or more specialized plan.

When can I switch from Medicare Advantage to Medicare Supplement?

Unfortunately, switching Medicare plans is not always easy. If you have a Medigap plan, you can switch to another Medigap plan at any time. However, if you already have Medicare Advantage and want a new Medicare Advantage plan, or if you have Medigap but want to switch to Medicare Advantage, you’ll have to wait for one of three* Medicare Advantage enrollment periods:

• Annual Enrollment Period: October 15 – December 7 of every year, applies to all Medicare beneficiaries, any change is allowed
• Special Enrollment Period: Applies only to those with specific circumstances, such as a special medical or financial need, and allows enrollments at specific times outside of AEP and OEP
• Open Enrollment Period: January 1 – March 31 of every year, allows those with Medicare Advantage to make one switch to a different Medicare Advantage plan or drop coverage

*The fourth Medicare Advantage enrollment period is when you first become eligible for Medicare and is called the Initial Enrollment Period. This is when you would enroll in Medicare Part A and Part B for the first time and can choose to also enroll in Medicare Advantage (or Medicare Supplements and Part D). 

When can I switch from Medicare Advantage to Medigap without losing guaranteed issue rights?

The guaranteed-issue rights for Medigap state that you cannot be denied coverage based on a preexisting condition if you enroll:

1. When you first become eligible for Medicare, or
2. When you lose your current coverage for reasons beyond your control

Additionally, Medicare.gov identifies a few specific circumstances that can grant you guaranteed issue rights, including:

1. Your Medicare Advantage plan leaves your service area, or you move out of the plan’s service area.
2. You have Part A and Part B, and now your employer coverage is ending.
3. You joined either a Medicare Advantage plan of PACE (Programs of All-Inclusive Care for the Elderly) upon turning 65 and decided to switch within the first year.
4. You switched from Medigap to Medicare Advantage and want to switch back within less than one year.
5. Your policy’s company mislead you or broke a rule.

When You Can Change Medicare Advantage Plans

If you don’t want to switch between Medigap and Medicare Advantage and you simply want to disenroll from a Medicare Advantage plan or switch to another, you can do that during one of the Medicare Advantage enrollment periods. 

CMS added the Medicare Advantage disenrollment period in 2020 to give beneficiaries another chance to switch without having to wait a full calendar year. This Medicare disenrollment period is actually the “Open Enrollment Period” lasting from January 1 through March 31. You are only eligible if you already have Medicare Advantage.

If you’d prefer to switch from Medigap to Medicare Advantage or make any other types of changes, you can do that during the annual election period in the fall, which is sometimes referred to as “Medicare open enrollment,” though it should not be confused with the Open Enrollment Period. 

If you qualify for a Special Enrollment Period (SEP), you can make changes outside of the traditional enrollment periods. Common reasons that you might qualify are if you moved to a new plan service area (or your plan leaves your service area, you move into or out of a long-term care facility, you are also eligible for Medicaid, or you have a medical condition that qualifies you for a Special Needs Plan.

Can I Change my Medicare Advantage Plan If I Move?

You can (and may have to) change your Medicare Advantage plan if you move. Medicare Advantage plans are confined to specific service areas. Some are confined to specific counties or zip codes, while others are state-wide. If you leave that service area, you will need to change plans. 

Additionally, moving to a new service area grants you a Special Enrollment Period. That means that from the date that you are officially living in the new area, you will have 60 days to switch Medicare Advantage plans. If you wait too long, you will have to wait until the Annual Enrollment Period rolls around again. 

Switching Medicare Advantage Plans with Pre-existing Conditions

If you have preexisting conditions and want to switch into a new Medicare Advantage plan, you do not have to worry about medical underwriting. Medicare Supplement (Medigap) plans are the only type of Medicare plan that may require medical underwriting. Original Medicare (parts A and B), Prescription Drug Plans (Part D), and Medicare Advantage plans (Part C) all cannot deny you coverage based on your health history. 

How to Switch Medicare Plans: Step by Step

When you think you’re ready to switch Medicare plans, follow these steps to ensure a successful switch: 

1. Review your current benefits and make notes about what you like and what you don’t like about your current plan.
2. Find out if you qualify for Medicaid, Social Security Disability Income, Medicare Savings Programs, or Low-Income Subsidies (all things that can help you save money on your Medicare coverage).
3. Use this Medicare plan finder tool to find out what plans are available in your area that meet what you’re looking for.
4. Meet with an insurance agent who can help you fill out your application correctly and answer all your questions (for no additional fees).

Tips for choosing a Medicare plan

Choosing a Medicare plan is a very personal process. Your Medicare coverage goes beyond copayments and deductibles. It can determine how prepared you are for emergencies, it can affect the quality of care you receive, and it can alter your lifestyle based on the benefits included.

Some people might find that traditional Medicare (parts A and B alone) is all they need, but most people will likely want to look for a prescription drug plan or some other benefits as well. No two health plans are the same. Some are very simple, covering basic needs and prevention, and others are complex, offering unique benefits like gym memberships and meal delivery. 

When choosing your Medicare coverage, keep the following tips in mind:

1. What works for your spouse or friend may not work for you.
2. Always make sure your favorite doctors are in the plan network before you enroll.
3. Before selecting a prescription drug plan, verify that the prescriptions you need are covered.
4. Remember to look at all costs: premiums, copayments, deductibles, and coinsurance. It’s easy to get excited when you see one low number, but everything together can add up.
5. It doesn’t cost you anything to meet with an insurance agent who already understands the plans. They might even be able to help you save money.

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.