Can I Change From Medicare Advantage to a Supplement Plan?

Medicare provides various options for healthcare coverage, primarily through Original Medicare (Parts A and B) and Medicare Advantage (Part C) plans. While Original Medicare offers fundamental hospital and medical insurance, Medicare Advantage plans, offered by private companies, bundle these benefits and often include additional coverage like prescription drugs, dental, vision, and hearing services. Individuals may find themselves weighing the benefits of these different structures, prompting questions about transitioning between a Medicare Advantage plan and a Medicare Supplement (Medigap) plan. This article explores the specific conditions and processes involved in making such a change.

Key Periods for Changing Plans

Switching from a Medicare Advantage plan to a Medicare Supplement plan is not always straightforward and is largely governed by specific enrollment periods and guaranteed issue rights. These defined windows determine when you can make such a change without facing medical underwriting, which assesses your health status.

The Medicare Advantage Trial Period offers a significant opportunity. If you enrolled in a Medicare Advantage plan when first eligible for Medicare Part A and Part B, you have a 12-month window to try the plan. During this period, you have a guaranteed right to switch back to Original Medicare and enroll in any Medigap policy available in your area without medical underwriting. This also applies if you dropped a Medigap policy to join a Medicare Advantage plan for the first time and then switch back within 12 months, allowing you to repurchase your previous Medigap policy or another one if the original is unavailable.

Beyond the trial period, guaranteed issue rights allow you to purchase a Medigap policy without medical underwriting in specific situations. These rights mean an insurance company cannot deny coverage or charge higher premiums due to pre-existing health conditions. Common scenarios include your Medicare Advantage plan leaving your service area, stopping coverage, not following its rules, misleading you, or if you move out of its service area.

Most guaranteed issue periods last for 63 days. This window usually begins after your existing coverage ends, though it can start up to 60 days before the end of your Medicare Advantage plan coverage. For instance, if your employer-sponsored group health plan ends, you generally have 63 days from the termination date to secure a Medigap plan.

The Annual Enrollment Period (AEP), from October 15 to December 7, allows for changes between Medicare Advantage plans or a return to Original Medicare. While you can use AEP to disenroll from your Medicare Advantage plan and return to Original Medicare, it does not automatically grant a guaranteed issue right to purchase a Medigap policy without medical underwriting. You would only have guaranteed issue for a Medigap policy during AEP if another specific guaranteed issue situation applies.

The Medicare Advantage Open Enrollment Period (MA OEP), from January 1 to March 31, allows individuals enrolled in a Medicare Advantage plan to switch to a different Medicare Advantage plan or disenroll and return to Original Medicare. Similar to AEP, MA OEP does not provide guaranteed issue rights for Medigap unless another qualifying event or trial right is present.

Special Enrollment Periods (SEPs) are triggered by various life events. While many SEPs facilitate enrollment or disenrollment from Medicare Advantage or Part D plans, some specific SEPs, particularly those related to involuntary loss of coverage or the trial period, can grant guaranteed issue rights for Medigap. For example, losing employer-sponsored insurance can trigger an SEP that provides a guaranteed issue right for a Medigap policy.

Preparing for a Medicare Supplement Plan Application

Medigap policies, also known as Medicare Supplement plans, are standardized private insurance plans designed to cover some of the “gaps” in Original Medicare, such as deductibles, copayments, and coinsurance. These plans are identified by letters (A, B, C, D, F, G, K, L, M, N). The benefits for each lettered plan are standardized across most states, meaning a Plan G from one insurer offers the same benefits as a Plan G from another.

Premiums for the same standardized plan can vary significantly among different insurance companies. Researching and comparing premiums for the specific lettered plan you are considering is important. Cost can differ based on factors such as the insurance company, your location, and the pricing method used. Plans F and G also offer high-deductible options in some states, which involve meeting a substantial deductible before the plan begins to pay.

Gathering necessary personal and Medicare-related information is important. You will need your Medicare ID number, located on your Medicare card, along with the effective dates for your Medicare Part A and Part B coverage. Your current address, contact information, and potentially information about any existing insurance coverage will also be required.

Understanding medical underwriting is important, especially if you do not qualify for a guaranteed issue right. Medical underwriting is a process where insurance companies evaluate your health status and medical history to determine whether to accept your application and what premium to charge. This assessment may involve answering detailed health questions, providing access to medical records, or undergoing a health exam.

If you apply outside of a guaranteed issue period, an insurer can deny coverage or charge more based on your health conditions. Underwriting questions often inquire about diagnoses, treatments for specific conditions like cancer, heart conditions, or diabetes, and recent hospitalizations. They may also ask about your weight, blood pressure, and current medications, as these can indicate underlying health concerns.

The Process of Changing Coverage

Once you have determined your eligibility and selected a Medicare Supplement plan, the process involves application and disenrollment. Applying for a Medicare Supplement plan can generally be done directly with an insurance company, through a licensed insurance agent, or sometimes online or by mail. Many insurance providers offer online portals or downloadable forms, and agents can provide guidance and assist with submission.

When applying, you will complete the application form, providing all necessary personal and Medicare information. If you are applying during a guaranteed issue period, you may need to submit documentation that proves your eligibility for this right, such as a notice of termination from your previous plan.

Disenrolling from your Medicare Advantage plan is an important step in the transition. In some instances, enrolling in a new Medicare Supplement plan and returning to Original Medicare will automatically disenroll you from your Medicare Advantage plan. However, confirm this with your new Medigap insurer or Medicare directly. If automatic disenrollment does not occur, you may need to contact your Medicare Advantage plan provider or call 1-800-MEDICARE to explicitly request disenrollment.

Careful timing and coordination of effective dates are important to prevent gaps in your healthcare coverage. You should aim to have your new Medicare Supplement policy become effective on the same day your Medicare Advantage plan coverage ends. This coordination ensures continuous coverage for your medical expenses. For example, if using a guaranteed issue right that requires application within a 63-day window after your Medicare Advantage plan ends, ensure your Medigap application is submitted promptly so new coverage can start immediately.

After applying for your Medigap plan and initiating disenrollment from your Medicare Advantage plan, expect to receive confirmation letters from both your new Medigap insurer and potentially from your former Medicare Advantage plan. Your new Medigap insurer will send new ID cards and information regarding premium billing.