A person can switch from Medicare Advantage to Medicare with a Medigap policy. However, the Centers for Medicare and Medicaid Services designate certain periods to do so. That said, some people can also switch at certain other times without incurring a penalty.
Medicare Advantage, or Medicare Part C, is a bundled plan that private companies administer. The plans vary based on which medical services are available in a certain area, and people often need to receive treatment from an approved network of healthcare professionals. Learn more here.
Traditional Medicare is available in several parts that cover in-hospital treatments, medical care, and prescription drugs. However, out-of-pocket costs usually include deductibles and coinsurance.
Medigap plans, or Medicare supplement plans, are available to help people fund these extra costs. People can enroll in them alongside traditional Medicare.
However, a person cannot enroll in both Medicare Advantage and Medigap.
This article explains when a person can switch from Medicare Advantage to Medicare with Medigap. It also outlines some factors that people may wish to consider before making the switch.
There are several differences between Medicare Advantage and Medicare supplemental insurance, or Medigap.
For example, a person can only enroll in a Medigap plan alongside original Medicare (Part A and Part B). However, this is not compulsory and serves only as a supplemental policy to reduce out-of-pocket costs.
However, a person with a Medicare Advantage plan may find that they could spend less money or have more inclusive benefits if they enrolled with original Medicare with a Medigap supplement.
In addition, not all regions offer Medicare Advantage policies. If a person moves out of an area that offers Medicare Advantage plans, they may need to find different coverage and may choose to enroll in original Medicare with a Medigap plan.
When a person qualifies for Medicare at the age of 65 years and enrolls in Medicare Part B, they have a 6-month Medigap open enrollment period (OEP). During this time, an insurance company cannot deny a person Medigap coverage based on their age or any preexisting health conditions they have.
However, after this enrollment period ends, an insurance company does not have to sell a person a Medigap policy, and they may also charge more for a policy. For this reason, people may find that they can save money if they sign up for Medigap within the first 6 months of their Medicare benefits starting.
A person can take the following steps to switch from Medicare Advantage to original Medicare plus Medigap during an enrollment period:
- It is possible to disenroll from a Medicare Advantage plan by contacting the insurance company directly and requesting a disenrollment form. People can also call Medicare at 800-633-4227 and ask for disenrollment from their plan, or they can visit their local Social Security office.
- A person who previously had Medigap coverage before joining Medicare Advantage and has been enrolled in Medicare Advantage for under a year has the right to return to their previous Medigap policy, as long as the insurer still offers it. If it is not available, the person can enroll in a new plan that the insurance company offers. People have to switch within 63 days of leaving their Medicare Advantage plan.
- If a person has never enrolled in a Medigap plan, they can find available Medigap policies by searching on Medicare.gov, contacting a State Health Insurance Assistance Program, or contacting an insurance agent or company to obtain a Medigap quote.
If, at any time, a person is not sure about their rights or enrollment periods, they can contact Medicare or visit their Social Security office.
There are different circumstances under which a person can switch from Medicare Advantage to Medicare with Medigap. The sections below cover these in more detail.
Within 3 months of Medicare enrollment
If a person enrolls in Medicare Advantage when they first become eligible for Medicare, they can switch to original Medicare and Medigap within the first 3 months of their plan.
This benefit is available to protect people who find that the policy they first chose does not work well for their healthcare needs. A person would still be within the Medigap enrollment window, and an insurance company cannot deny an individual a Medigap policy during this time.
During the OEP for drug coverage
Two OEPs apply to Medicare Advantage plans. These are also the times at which a person can drop their Medicare Advantage plan and return to original Medicare.
The first enrollment period runs from October 15 to December 7 each year. This is the OEP for all Medicare plans, including Medicare Advantage and Medicare prescription drug coverage.
During this time, a person can return to original Medicare. However, if they had prescription drug coverage through Medicare Advantage, they will need to enroll in Medicare Part B to maintain their prescription drug coverage.
During the Medicare Advantage OEP
From January 1 to March 31 each year, a person can switch from one Medicare Advantage plan to another or drop their Medicare Advantage plan altogether in favor of original Medicare. During this time, a person can also join a prescription drug plan and Medigap.
Although this period sounds similar to the OEP that runs from October to December, it works in a slightly different way; a person cannot switch from original Medicare to Medicare Advantage during this time. A person also cannot enroll in new prescription drug coverage or switch prescription drug coverage if they already have original Medicare.
During special enrollment periods
Special enrollment periods (SEPs) are periods during which a person can usually make changes to their Medicare plan without incurring a financial penalty. Examples of such changes include:
- moving to a new address
- moving back to the United States after living in another country
- moving into or out of a skilled nursing facility or long-term care hospital
- reaching the end of a jail sentence
A person can contact Medicare if they are unsure whether or not they meet the SEP criteria.
The information in the table below can help people work out whether or not they would benefit from switching to a Medigap plan.
|Fewer out-of-pocket costs: Having a Medigap policy can make healthcare expenses more predictable.||Costs: If a person is not within the first 6 months of their Medigap OEP, an insurance company does not have to sell them a policy. |
If an insurance company does sell them a Medigap policy, they may need to pay a higher monthly premium.
|Fewer provider limitations: Medicare Advantage policies usually require a person to use in-network providers for care. |
Having traditional Medicare with Medigap usually has fewer restrictions on the providers a person can visit.
|Coverage: Medigap plans do not provide additional benefits that Medicare Advantage may, such as dental or vision care.|
|Overseas treatment: Several Medigap plans offer some degree of coverage for healthcare costs in foreign countries. |
Medicare Advantage plans do not usually cover overseas treatment.
|Medical underwriting: If a person did not enroll in Medigap during their 6-month enrollment period, they may have to complete medical underwriting for an insurance company to cover them. |
People with preexisting medical conditions may not qualify.
To get the best value premiums, a person should enroll in Medigap within 6 months of signing up for Medicare. Outside of certain enrollment periods and special circumstances, an insurance company does not have to offer Medigap policies.
If a person finds that Medicare Advantage does not meet their needs, switching to original Medicare may enable them to sign up for a new Medigap policy.