Can I switch From Medicare Advantage to Medigap?
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Can I switch From Medicare Advantage to Medigap?

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By Daniel Petkevich

Sep 14, 2022

Things You Need to Know Before Switching Plans

We all know the feeling of buyer’s remorse. This feeling is not unique to shopping for clothes; it could relate to your choice of Medicare.

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Regarding health insurance, you might find that your current plan isn't the right fit.

Luckily, Medicare has an exchange policy — letting you switch your Medicare Advantage plan to a Medigap plan.

But before you make the switch, let's consider what you need to know and how you can start the process.

Medicare Advantage Vs. Medigap

Medicare Advantage plans and Medigap plans (Medicare Supplement Insurance) are both provided by private insurance companies. They each help cover the costs of Medicare in different ways.

Here's a chart that compares the two:

Medigap Plan Vs. Medicare Advantage Plan

A Medicare Advantage plan replaces Original Medicare. Medicare Advantage typically has lower premiums and additional benefits, such as dental and vision services.

Medigap plans supplement Original Medicare by covering deductibles and coinsurance costs. That's why you'll often see Medigap referred to as Medicare Supplement Plans. They don't have network restrictions and don't need prior approval.

Can I Switch From a Medicare Advantage Plan to Medigap?

Yes, you can change your Medicare Advantage (MA) Plan to a Medigap Plan.

Medicare Advantage plans usually offer more benefits. But, you might want to switch to a Medigap plan if:

  • Your doctor drops from the network.

  • You're not satisfied with the benefits.

  • Getting prior approval is a burden.

  • You're moving out of your plan's service area.

  • Your plan provider moves from your area.

  • You want more flexibility to see doctors outside the network.

  • Your out-of-pocket expenses grow more than you expected.

While making the switch can be simple, you don't want to cancel your MA plan and later find out that you're not eligible for the Medigap plan of your choice.

Also, make sure you switch plans during one of the specified periods (detailed below).

When Can I Switch From Medicare Advantage to Medigap?

‎You can change to Medigap while still enrolled in a Medicare Advantage plan. However, you'll almost always have to switch during one of these specified periods:

  • Open Enrollment Period: January 1st – March 31st

  • Annual Election Period: October 15th – December 7th

Here's the catch: If you enroll during one of these periods, you must undergo medical underwriting. Then, if you qualify, you can enroll in the Medigap Plan of your choice. (Health requirements and qualifications differ from one insurance company to another).

Switching plans during any other time of the year is only possible if:

  • You've moved out of your plan's service area.

  • Your insurance provider ends its contract with Medicare.

  • You enrolled in a Medicare Advantage plan during your initial enrollment period (when you turned 65), and you want to switch back to your Original Medicare within the first 12 months.

  • You had a Medigap plan before enrolling in the Medicare Advantage plan, and you want to switch back within the first 12 months.

Can Medigap Be Denied?

Short answer: Yes, your Medigap application could be denied.

When you apply for a Medigap plan, you'll have to answer health questions and undergo medical underwriting. Your insurance provider will accept or reject your application based on your medical history.

So, there's no guarantee that you'll be approved for Medigapunless you have "Guaranteed Issue Rights" or "trial rights."

Guaranteed Issue Rights protect you in the following ways:

  • You won't go through medical underwriting.

  • Insurance companies can't reject your application or charge you more due to medical reasons, including pre-existing conditions.

You have Guaranteed Issue Rights if any of the following apply:

  • You move out of your plan's service area.

  • Your old insurance plan stops providing service.

  • You return to Original Medicare within 12 months of joining a Medicare Advantage Plan (at age 65).

  • You had a Medigap plan before enrolling in the Medicare Advantage plan, and you want to switch back within the first 12 months.

How to Switch From a Medicare Advantage Plan to Medigap

First, make sure a Medigap plan will cover all your needs. In some cases, you may need to get additional coverage.

For example, if your current Medicare Advantage Plan covers prescription drugs, you'll have to add Medicare Part D with your Medigap plan to get drug coverage.

To avoid any hurdles while switching plans, follow these steps in order:

  1. Apply for a Medigap Plan

  2. Wait for approval

  3. Get Approved

  4. Unenroll from your Medicare Advantage Plan

  5. Enroll in Part D

Order for Switching From Medicare Advantage to Medigap Plan

Due to the medical underwriting requirement, approval for Medigap coverage takes time. Make sure to apply early during the Annual Election period so you will have plenty of time to enroll in Part D before the period ends.

Takeaway

Medicare lets you switch health insurance plans if you're dissatisfied with your current one.

Both Medicare Advantage and Medigap have their pros and cons. Understand the benefits and drawbacks of each before choosing which plan works best for you.

If you decide to switch, follow the correct procedures to avoid losing health insurance coverage. And if you have a pre-existing condition, make sure you understand the health requirements of each Medigap Plan before applying.

If you're unsure where to begin, talk to our insurance advisors at (888) 376-2028. They know the ins and outs of each plan and will gladly guide you through the process.

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