Switching from Medicare Advantage to Medigap is entirely possible, but the process requires careful consideration and knowledge of the rules. It is not an instantaneous action but a step that needs careful thought.
The main motivation for many is the desire for greater freedom in choosing doctors and for more predictable costs. This choice means giving up the additional services available in Medicare Advantage in favor of a wider network of medical facilities.
Understanding the Difference Between Medicare Advantage and Medigap
Can you switch from Medicare Advantage to Medigap? Yes, but before doing so, you need to learn about all the benefits and differences between the plans.
| Aspect | Medicare | Medigap |
|---|---|---|
| Coverage structure | Combines Original Medicare (Part A and Part B) and often includes additional options such as dental, vision, and prescription drugs. | Supplements Original Medicare by covering costs not included in standard Parts A and B (e.g., deductibles, copayments, coinsurance). |
| Provider access | Usually limits the choice of doctors and clinics to a network established by the insurance company. | Allows you to see any doctor or facility that accepts Medicare, without network restrictions |
| Costs | Lower monthly premiums, but costs depend on service usage and plan rules | Higher premiums, but predictable expenses and fewer unexpected payments |
| Flexibility | Includes additional benefits (fitness programs, transportation, preventive services), but requires adherence to plan rules | No additional services, but provides stability and freedom of choice |
Decide what suits you best – a package deal or supplementary insurance.
Can You Switch from Medicare Advantage to Medigap?
Switching medicare plans requires careful attention to timing. This is not a case where you can change plans at any convenient time. The rules strictly define the periods when such a move is possible. If you miss it, you will have to wait until the following year or face a mandatory medical examination, which can complicate the process of obtaining a policy.
Eligibility Requirements for Switching
When switching from Medicare Advantage to Medigap, it is important to ensure in advance that the policy you choose meets your medical and financial needs. Sometimes standard coverage may not be enough; in that case, it is worth considering additional options.
If your prescription drug costs were covered under Medicare Advantage, you will need to enroll in a separate Medicare Part D program when you switch to Medigap. This is the only way to maintain access to prescription drugs and avoid unexpected costs.
The Role of Guaranteed Issue Rights
How to move on from Medicare advantage to original Medicare? Just have a guaranteed right to purchase a policy. It eliminates risks and allows you to obtain insurance even if you have pre-existing conditions, making the process more predictable and secure.
This option is relevant in a certain case:
- moving to another state or region where your current Medicare Advantage plan does not operate;
- the insurance company ceasing operations or the plan leaving the Medicare program;
- a situation where an agent or company misled you during the sale;
- using the trial period when, after turning 65, you chose Medicare Advantage but decided to return to Medigap within the first year.
Each of these options opens a special 63-day window during which you can enroll in Medigap without being denied and without undergoing medical screening.
When Can You Make the Switch?
The first question is: when can you change Medicare Advantage plans? Switching from Medicare Advantage to Medigap is only possible within strictly defined time frames. Usually, such changes are allowed during the open registration period, which lasts from January 1 to March 31, and during the annual election period, from October 15 to December 7.
Step-by-Step Guide to Switch from Medicare Advantage to Medigap
Although the Medicare Advantage program continues to expand rapidly, some participants are taking a step back and returning to Medigap. In 2021, only about 1.2% of people switched from Medicare Advantage to traditional coverage with Medigap, but this small percentage reflects a deliberate choice in favor of greater independence and flexibility. For many seniors, this decision is driven by a desire to control costs and have greater access to doctors. Below, we take a closer look at the steps involved in making this transition.
Step 1 – Drop your Medicare Advantage plan
The first step toward Medigap is to leave the Medicare Advantage program. This can only be done within a specified time frame. Consider the entire timeline and prepare your application correctly so that the transition goes smoothly and without unnecessary complications.
Step 2 – Re-enroll in Original Medicare (Part A and Part B)
To switch to Medigap, you must re-enroll in Original Medicare. It is hospital insurance (Part A) and medical insurance (Part B). You can apply through the Social Security Administration or directly at Medicare.gov. Again, it is critical to be mindful of enrollment deadlines.
Step 3 – Apply for a Medigap plan
Once you have selected a Medigap plan that meets your needs, the next step is to apply. If you do not have guaranteed eligibility for a policy, the insurance company will conduct underwriting, which means it will carefully review your medical history to determine your eligibility and premium amount.
There are several important things to keep in mind during this process:
- checking health status and past diagnoses;
- assessing the level of risk for the insurer;
- calculating the premium based on the data obtained.
You can proceed only after you receive an official letter confirming the policy start date. This document serves as confirmation that your insurance has been activated and is ready to provide coverage.
Step 4 – Enroll in a separate Part D drug plan if needed
If you need coverage for prescription drugs, you must enroll in Part D separately. In contrast to Medicare Advantage, Medigap does not cover prescription drugs.
How to Choose the Right Medigap Plan for Your Needs
When switching from Medicare Advantage to Medigap, your insurance coverage changes. Instead of a single comprehensive package, you create a system of two separate elements: Medigap, which covers gaps in Original Medicare, and Part D, which covers prescription drugs. This approach offers more flexibility, but requires careful attention to detail and an understanding of underwriting rules.
For new Medicare participants, the choice usually comes down to two options:
- Medigap G is the most popular option because it covers almost all costs, leaving only the annual Part B deductible.
- Medigap N is an alternative with a more affordable premium, but it requires small copayments for doctor visits and emergency room visits.
Plan F, previously considered the most comprehensive, is no longer available to those who became eligible after January 1, 2020.
Common Mistakes to Avoid When Switching Plans
If you don’t fully understand how to go back to Medicare from an Advantage plan, you may make mistakes. For example, the HMO system operates on a limited network principle. You can only use the services of doctors and clinics on the approved list. Therefore, before signing up, it is important to confirm that your usual specialists are available in this healthcare format.