Can I Switch From Medicare Advantage to Medicare Supplement?

This article clarifies the process of transitioning from a Medicare Advantage (Part C) plan to a Medicare Supplement (Medigap) plan. Medicare Advantage plans are offered by private companies approved by Medicare, providing an alternative way to receive Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) benefits, often bundling prescription drug coverage and additional benefits.

Medicare Supplement plans work alongside Original Medicare (Parts A and B) to help cover out-of-pocket costs such as deductibles, copayments, and coinsurance. Switching between these plan types is possible, but involves specific rules and considerations.

Understanding Eligibility to Switch

Switching from a Medicare Advantage plan to a Medicare Supplement plan often depends on specific situations that grant “guaranteed issue rights.” These rights allow an individual to purchase a Medigap policy without medical underwriting, meaning an insurance company cannot deny coverage or charge higher premiums due to health conditions.

One common scenario triggering guaranteed issue rights is the “trial period” for Medicare Advantage plans. If an individual enrolls in a Medicare Advantage plan when first eligible for Medicare Part A at age 65, they have a 12-month period to try out the plan. If they decide the plan does not meet their needs within this first year, they can switch back to Original Medicare and purchase a Medigap policy without medical underwriting. This also applies if an individual drops a Medigap policy to join a Medicare Advantage plan for the first time and then decides to return to Original Medicare within 12 months.

Other situations that grant guaranteed issue rights include losing coverage through no fault of your own, such as when your Medicare Advantage plan leaves your service area or Medicare. This also applies if your Medicare Advantage plan violates its terms or you were misled when joining. In these instances, individuals generally have a specific timeframe, often 60 days before and up to 63 days after their Medicare Advantage plan coverage ends, to apply for a Medigap policy.

When guaranteed issue rights do not apply, individuals seeking a Medigap policy will likely undergo medical underwriting. This process involves the insurance company reviewing an applicant’s health history, including pre-existing conditions, through health questions and medical record review. Based on this assessment, the insurer can deny coverage or charge higher premiums.

Some states may offer additional protections or guaranteed issue rights beyond federal requirements, providing more opportunities to obtain Medigap coverage without medical underwriting. It is advisable to understand specific state regulations, as these can vary and offer important safeguards for beneficiaries.

Key Enrollment Periods for Switching

Specific enrollment periods dictate when changes can be made and can influence whether medical underwriting is required for a Medigap policy.

The Annual Enrollment Period (AEP), from October 15 to December 7 each year, is a primary window for many Medicare beneficiaries to make coverage changes. During this time, individuals can disenroll from their Medicare Advantage plan and return to Original Medicare. This return to Original Medicare is a necessary prerequisite for enrolling in a Medicare Supplement plan, as Medigap policies only work with Original Medicare. Any changes made during the AEP become effective on January 1 of the following year.

The Medicare Advantage Open Enrollment Period (MA OEP) occurs annually from January 1 to March 31. This period allows individuals already enrolled in a Medicare Advantage plan to make a one-time election to switch to a different Medicare Advantage plan or disenroll to return to Original Medicare. If an individual uses the MA OEP to return to Original Medicare, they can then apply for a Medicare Supplement policy. However, unless specific guaranteed issue rights apply, purchasing a Medigap policy during this period typically involves medical underwriting.

Special Enrollment Periods (SEPs) may also provide opportunities to switch from Medicare Advantage to Original Medicare, which can then lead to Medigap enrollment. SEPs are triggered by various life events, such as moving to a new address outside the plan’s service area, losing other creditable coverage, or if the Medicare Advantage plan changes its contract with Medicare. Many SEPs can also trigger guaranteed issue rights for Medigap, allowing enrollment without medical underwriting.

Steps to Switch from Medicare Advantage to Medicare Supplement

Switching from a Medicare Advantage plan to a Medicare Supplement plan involves several steps.

First, disenroll from your current Medicare Advantage plan. This can be done by contacting your Medicare Advantage plan directly, calling Medicare at 1-800-MEDICARE, or visiting a local Social Security office. Disenrollment must align with an appropriate enrollment period, such as the Annual Enrollment Period or the Medicare Advantage Open Enrollment Period, unless a Special Enrollment Period applies.

Next, confirm you are enrolled in Original Medicare (Parts A and B). Medigap policies supplement Original Medicare and cannot be used if you are still enrolled in a Medicare Advantage plan. If you disenroll from Medicare Advantage, you will automatically revert to Original Medicare.

After ensuring enrollment in Original Medicare, apply for a Medicare Supplement (Medigap) policy. Research different Medigap plans and contact insurance companies directly or work with an insurance broker or agent to compare options and submit an application. Approval depends on whether you qualify for guaranteed issue rights or pass medical underwriting.

Finally, since most Medicare Advantage plans include prescription drug coverage (Part D), individuals switching to Original Medicare and a Medigap plan will need to apply for a standalone Medicare Part D prescription drug plan. Enrolling in a Part D plan is important to avoid a late enrollment penalty, which can be incurred if there is a gap of 63 continuous days or more without creditable prescription drug coverage. This penalty is typically calculated as 1% of the national base beneficiary premium for each uncovered month and is added to your monthly Part D premium for as long as you have Part D coverage.

Comparing Medicare Advantage and Medicare Supplement

Understanding the differences between Medicare Advantage and Medicare Supplement plans is important for making an informed decision about your healthcare coverage.

Medicare Advantage plans, also known as Medicare Part C, are “all-in-one” alternatives to Original Medicare, offered by private insurance companies. These plans bundle Part A and Part B benefits and often include prescription drug coverage (Part D), along with additional benefits not covered by Original Medicare, such as routine dental, vision, and hearing services. Medicare Advantage plans typically have their own network of doctors, hospitals, and other providers, meaning you may need to use providers within the plan’s network, except in emergencies. Some plans may also require referrals to see specialists.

In contrast, Medicare Supplement (Medigap) plans pay for some of the out-of-pocket costs that Original Medicare (Parts A and B) does not cover, such as deductibles, copayments, and coinsurance. Medigap plans do not provide standalone health coverage; they enhance Original Medicare. With Original Medicare and a Medigap plan, you generally have the freedom to see any doctor or hospital nationwide that accepts Medicare, without network restrictions or the need for referrals. Medigap plans do not include prescription drug coverage, so a separate standalone Part D plan is necessary.

Regarding costs, Medicare Advantage plans often feature lower monthly premiums, with some plans even having a $0 premium. However, enrollees typically pay copayments and coinsurance for services as they receive care. These plans have an annual out-of-pocket maximum, which limits how much you pay for covered services in a year. Once this maximum is reached, the plan covers 100% of covered costs for the remainder of the year.

Medigap plans typically have higher monthly premiums compared to Medicare Advantage plans. In exchange for these higher premiums, a Medigap policy significantly reduces or eliminates the out-of-pocket costs associated with Original Medicare, making healthcare expenses more predictable. There is no out-of-pocket maximum with Original Medicare and a Medigap plan, as the Medigap policy covers a large portion of those costs. While some Medicare Advantage plans offer limited emergency coverage for international travel, Medigap plans, depending on the specific plan letter, may offer more extensive foreign travel emergency coverage. Medicare Advantage plans also frequently offer additional benefits like gym memberships, which are not covered by Original Medicare or Medigap.