A person can switch from Medicare Advantage to Medicare with a Medigap policy. However, the Centers for Medicare & Medicaid Services designate certain periods to do so.
That said, some people can also switch at other designated 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. Find out more about it here.
Traditional Medicare is available in several parts that cover in-hospital treatments, medical care, and prescription drugs. However, these can come with several out-of-pocket costs, such as deductibles and coinsurances.
Medigap plans, or Medicare supplement plans, are available to help people fund these extra costs. People enroll in them alongside traditional Medicare.
This article explains when a person can switch from Medicare Advantage to Medicare with Medigap. It also outlines some factors that they may wish to consider before making the change.
A person cannot enroll in both Medicare Advantage and Medigap.
People can only enroll in a Medigap plan alongside traditional Medicare, though they only need to buy a Medigap plan if they feel it is suitable. It is not compulsory and serves as a supplemental policy to reduce out-of-pocket costs.
A person may sign up for Medicare Advantage but then find that they could spend less money or have more inclusive benefits on an original Medicare plan with a Medigap supplement.
Also, not all regions offer Medicare Advantage policies. A person may move out of an area that offers these and need to find different coverage. Under these circumstances, a person may choose to sign up for traditional Medicare with a Medigap supplement.
When a person qualifies for Medicare at the age of 65 and enrolls in Medicare Part B, they have a 6-month Medigap Open Enrollment Period.
During this time, an insurance company cannot deny a person Medigap coverage based on their age or any preexisting health conditions. After this period ends, however, an insurance company does not have to sell a person a Medigap policy, and they are entitled to charge more.
For this reason, a person may find that they can save money if they sign up for Medigap within the first 6 months of their Medicare benefits starting.
There are different circumstances under which a person can switch from Medicare Advantage to Medigap. The sections below cover these in more detail.
In the 3 months of Medicare enrollment
If a person enrolls in Medicare Advantage when they first become eligible for Medicare, they can switch to traditional Medicare and Medigap within the first 3 months of their plan.
This benefit is available to protect individuals 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. An insurance company cannot deny an individual their Medigap policy during this time.
During the Open Enrollment Period for drug coverage
Two Open Enrollment Periods apply to Medicare Advantage plans. These are also the times when a person can drop their Medicare Advantage program and go back to traditional Medicare.
The first is October 15 to December 7. This is the Open Enrollment Period for all Medicare plans, including Medicare Advantage and Medicare prescription drug coverage.
During this time, a person can change back to traditional Medicare. If a person had prescription drug coverage through Medicare Advantage, they will need to enroll in Medicare Part B for similar benefits, as this accounts for prescription drug cover.
They can then start the process of searching for Medigap policies, if they wish.
During the Medicare Advantage Open Enrollment Period
From January 1 to March 31, a person can switch from one Medicare Advantage plan to another or drop their Medicare Advantage plan for traditional Medicare. During this time, a person can also join a prescription drug plan and Medigap.
Although this period sounds similar to the Open Enrollment Period from October to December, it works in a slightly different way. A person cannot switch from original Medicare to a Medicare Advantage plan during this time.
A person also cannot enroll in new prescription drug coverage or switch prescription drug coverage if they already have traditional Medicare.
During Special Enrollment Periods
Special Enrollment Periods (SEPs) are periods during which a person can usually make changes to their Medicare plans without incurring a financial penalty.
Examples of some SEPs 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
Other situations can qualify a person to switch during an SEP. A person can contact Medicare if they are unsure whether or not they meet the criteria.
A person can take the following steps to switch from Medicare Advantage to original Medicare and 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 call Medicare at 1-800-MEDICARE and ask for disenrollment from their plan, or they can visit their local Social Security Office.
- Those who had Medigap coverage before joining Medicare Advantage and have had Medicare Advantage for under a year have the right to return to their previous Medigap policy, as long as the insurer still sells it. If not, they can enroll in a new plan that the insurance company offers. People have to switch within 63 days of leaving their Medicare Advantage plan.
- Those who have never had Medigap 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.
- People can then choose the policy that best meets their healthcare and financial needs.
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.
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 Open Enrollment Period, 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 and 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 health 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 receive the best-value premiums, a person should ideally enroll in Medigap within 6 months of signing up for Medicare.
If a person finds that Medicare Advantage does not meet their needs, switching to traditional Medicare may enable them to sign up for a new Medigap policy.
Outside of certain enrollment periods and special circumstances, an insurance company does not have to offer Medigap policies.
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