Over 26 million Americans are enrolled in a Medicare Advantage Plan as of 2023. But what if you want to transition to Original Medicare and a Medigap Supplement Plan? Making the switch is possible, but timing is crucial. This comprehensive guide explains how and when you can change from Medicare Advantage to Medigap.
Medicare Advantage vs. Medigap Basics
First, let’s summarize some key differences between Medicare Advantage and Medigap:
- Medicare Advantage Plans bundle Parts A, B, and usually D and restrict you to in-network providers. These are offered by private insurers.
- Medigap pays a portion of Original Medicare out-of-pocket costs and allows you to see any provider accepting Medicare nationwide.
- Costs – Medigap policies have higher premiums, while many Medicare Advantage Plans have $0 premiums. But Medigap caps your expenses.
- Prescriptions – Most Medicare Advantage Plans include Part D drug coverage. With Medigap, you need a separate Part D Plan.
Now let’s look at the details of changing from Medicare Advantage to Medigap.
Reasons to Switch from Medicare Advantage to Medigap
There are a few common reasons someone may want to transition from a Medicare Advantage Plan to Original Medicare plus a Medigap policy:
- Gaining the freedom to see any healthcare provider nationwide who accepts Medicare
- Avoiding the need for referrals and pre-approvals required by many Medicare Advantage Plans
- Capping out-of-pocket spending which is unlimited under Medicare Advantage
- Securing reliable coverage when traveling anywhere in the U.S.
- Escaping Medicare Advantage drug formulary restrictions by enrolling in stand-alone Part D Plans
- Accessing top specialty hospitals and cancer centers often excluded from Medicare Advantage networks
For these reasons, some Medicare Advantage enrollees look to switch to Original Medicare paired with a Medigap Plan for more flexibility and predictability.
When Can You Make the Switch?
You can only transition from Medicare Advantage to Medigap at certain times of year without penalty:
- Medicare Advantage Open Enrollment Period – From January 1 to March 31, you can switch to Original Medicare and get a Medigap Plan.
- Annual Enrollment Period – During this fall enrollment from October 15 to December 7, you can move from Medicare Advantage to Original Medicare plus Medigap.
- Special Enrollment Period – Qualifying life events like moving out of your plan’s service area also allow switching immediately to Original Medicare and applying for Medigap.
Carefully follow the designated windows to avoid delays or gaps in coverage when transitioning from Medicare Advantage to Medigap.
Maintaining Open Enrollment Medigap Rights
To obtain affordable Medigap coverage, maintaining your open enrollment rights is essential. When first enrolling in Medicare at 65, you have a 6-month Medigap open enrollment period with guaranteed issue protections.
If you join a Medicare Advantage Plan initially but want to switch soon after, you can return to Original Medicare and get Medigap coverage while retaining these open enrollment rights in many states. This allows you to secure Medigap insurance without medical underwriting or higher premiums.
Check on your state’s regulations for maintaining open enrollment Medigap protections when leaving Medicare Advantage Plans. Taking advantage of this window saves you money.
Step-by-Step Process for Switching
Follow this checklist to smoothly drop your Medicare Advantage Plan to Original Medicare plus Medigap:
- Research Medigap policies and prescription drug plans in your area to prepare for the change Medicare. Look for options meeting your needs within your budget.
- Notify your Medicare Advantage insurer that you want to disenroll and return to Original Medicare Parts A and Medicare Part B.
- Enroll in Original Medicare by contacting Medicare directly or working with a broker.
- Apply for the Medigap Plan you want within 63 days of leaving Medicare Advantage to maintain open enrollment rights.
- Sign up for a stand-alone Part D prescription drug plan.
- Once your Medigap coverage kicks in, cancel your Medicare Advantage policy.
Carefully completing each step prevents gaps in healthcare coverage when moving from Medicare Advantage to Original Medicare and Medigap.
Cost Comparison of Medicare Advantage vs. Medigap
How do costs compare when switching from Medicare Advantage to Original Medicare plus Medigap? Here are the key differences:
- Premiums – Medigap premiums range from $100 – $250 per month. Many Medicare Advantage Plans have $0 premiums.
- Deductibles – Medigap covers Medicare deductibles. Most Medicare Advantage Plans don’t have deductibles.
- Coinsurance – Medigap pays 20% Medicare coinsurance. Medicare Advantage Plans have 10-50% coinsurance for services.
- Out-of-pocket spending – Medigap allows you to cap costs. Medicare Advantage limits spending to around $8,300 per year.
- Drugs – Medigap doesn’t cover prescriptions. Medicare Advantage includes integrated Part D drug coverage.
While your overall costs may rise with Original Medicare and Medigap, your financial exposure is also capped compared to Medicare Advantage.
Should You Make the Switch?
Is changing from Medicare Advantage to Original Medicare and Medigap right for you? Consider the tradeoffs:
Benefits of Switching
- See any healthcare provider nationwide who accepts Medicare
- Use top-ranked specialty hospitals and cancer centers
- Smooth claims process without fighting for coverage
- Get needed care without pre-approvals
- Reliable coverage when traveling
Downsides of Switching
- Higher overall premium costs
- Must enroll in separate Part D prescription plan
- Doesn’t include dental, vision, hearing benefits
- Pre-existing conditions may limit Medigap choices
- Can only change plans at certain times of year
Assess your healthcare priorities and needs to decide if the flexibility of Original Medicare plus Medigap is worth the tradeoffs.
Key Steps for Switching from Medicare Advantage
To smoothly transition from Medicare Advantage to Original Medicare and a Medigap policy:
- Research Medigap and Part D options during fall open enrollment
- Notify Medicare Advantage Plan you want to disenroll
- Enroll in Original Medicare Parts A and B
- Apply for your chosen Medigap policy within 63 days
- Sign up for stand-alone Part D prescription coverage
- Cancel Medicare Advantage after new coverage starts
With proper planning, you can change to Original Medicare and Medigap for the freedom and predictability many Medicare Advantage enrollees desire.
Takeaways for Switching from Medicare Advantage to Medigap
- Use Medicare open enrollment periods like the Medicare Advantage OEP to make the change.
- Notify your Medicare Advantage insurer you want to disenroll.
- Enroll in Original Medicare and apply for a Medigap Plan within 63 days.
- Get stand-alone Part D prescription coverage.
- Weigh the pros and cons to decide if Medigap meets your needs.
- Carefully follow each step to avoid gaps when you transition from Medicare Advantage to Medigap.
The flexibility of Original Medicare combined with Medigap appeals to many Medicare Advantage enrollees. Know the rules for changing plans and consult a Medicare expert to successfully switch from Medicare Advantage to Medigap.
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 Scott Sims at Sims Insurance Medicare Plans a Call at (541) 915-0939. 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.
Is it hard to switch from a Medicare Advantage Plan to an Original Medicare Plan?
The process of switching from a Medicare Advantage Plan to Original Medicare is generally straightforward. However, it is recommended to carefully review your options and consider certain factors such as your health needs, budget, and prescription drug coverage before making the switch. Consulting with a Medicare advisor or using online resources can help guide you through the decision-making process.
What is a Medicare Advantage Plan?
Medicare Advantage Plans, also known as Medicare Part C, are private health insurance plans that provide an alternative way to receive your Medicare benefits. These plans are offered by private insurance companies approved by Medicare and often include additional benefits beyond what Original Medicare offers, such as prescription drug coverage, dental, vision, and hearing services.
When is the Medicare open enrollment period?
The Medicare open enrollment period, also known as the Annual Enrollment Period (AEP), typically runs from October 15th to December 7th each year. During this time, Medicare beneficiaries can make changes to their existing coverage, switch Medicare Advantage Plans, join a Medicare prescription drug plan, or return to Original Medicare.
Can I switch from Original Medicare to a Medicare Advantage Plan?
Yes, you can switch from Original Medicare to a Medicare Advantage Plan during specific enrollment periods. The Medicare Advantage Open Enrollment Period, which occurs from January 1st to March 31st each year, allows individuals already enrolled in a Medicare Advantage Plan to switch to another Medicare Advantage Plan or return to Original Medicare.
Can I switch back to Original Medicare if I currently have a Medicare Advantage Plan?
Yes, you have the option to switch back to Original Medicare from a Medicare Advantage Plan. The Medicare Advantage Disenrollment Period, which runs from January 1st to February 14th each year, allows individuals enrolled in a Medicare Advantage Plan to drop their plan and return to Original Medicare.
How can I switch to a different Medicare Advantage Plan?
To switch to Medicare Advantage Plan, you can use the Medicare Plan Finder tool on the official Medicare website to compare different available plans in your area. Once you have selected a new plan, you can enroll in it online, over the phone, or by completing a paper application provided by the insurance company offering the plan.
Can I switch Medicare Advantage Plans at any time?
No, you can only switch Medicare Advantage Plans during specific enrollment periods. The Annual Enrollment Period (AEP) from October 15th to December 7th is the main period for switching plans. However, there are other enrollment periods such as the Medicare Advantage Open Enrollment Period and Special Enrollment Periods that may allow for plan changes under certain circumstances.
What happens if I miss the Medicare open enrollment period?
If you miss the Medicare open enrollment period, you may have to wait until the next open enrollment period to make changes to your Medicare coverage. However, there may be other enrollment periods throughout the year that you may qualify for based on specific circumstances, such as the Special Enrollment Periods.
Can I switch from a Medicare Advantage Plan to a Medicare Supplement insurance plan?
Yes, you have the option to switch from a Medicare Advantage Plan to a Medicare Supplement insurance plan (also known as Medigap). However, it is important to note that you may have to go through medical underwriting, and the availability of Medigap Plans may vary depending on your state and eligibility criteria.
Can I switch plans if I am not satisfied with my Medicare coverage?
Yes, if you are not satisfied with your current Medicare coverage, you have the opportunity to change your Medicare Plan during the designated enrollment periods. It is important to carefully review and compare your options to ensure that the new plan meets your specific healthcare needs and preferences.