Can I Switch From Medigap to Medicare Advantage?

Medicare beneficiaries often weigh their coverage options, including Medigap policies and Medicare Advantage Plans. Medigap policies supplement Original Medicare by covering certain out-of-pocket costs. Medicare Advantage Plans are an alternative to Original Medicare, often bundling Part A and Part B benefits with additional coverage like prescription drugs. Understanding the process and implications of switching from a Medigap policy to a Medicare Advantage Plan is important.

Key Enrollment Periods for Medicare Advantage

Enrollment in a Medicare Advantage Plan is generally restricted to specific times of the year. The Annual Enrollment Period (AEP) runs annually from October 15 through December 7. During the AEP, individuals can switch from Original Medicare, with or without a Medigap policy, to a Medicare Advantage Plan. Any changes made during this period become effective on January 1 of the following year.

The Medicare Advantage Open Enrollment Period (MA OEP) runs from January 1 to March 31 each year. This period is for individuals already enrolled in a Medicare Advantage Plan. During the MA OEP, a person can switch to a different Medicare Advantage Plan or disenroll to return to Original Medicare. If returning to Original Medicare, they can also enroll in a separate Medicare Part D prescription drug plan.

Special Enrollment Periods (SEPs) allow for changes outside standard enrollment windows due to specific life events. These events include moving to a new service area, losing other creditable coverage, or becoming eligible for Extra Help (a Medicare program that helps with prescription drug costs). The duration of an SEP can vary, but many last for 2 months.

Steps to Enroll in Medicare Advantage

Enrolling in a Medicare Advantage Plan involves several steps once an eligible enrollment period is identified. Begin by researching and comparing available plans in your service area. Medicare.gov provides a plan finder tool to compare options, including estimated costs for medications and out-of-pocket expenses. Check if preferred doctors and pharmacies are within the plan’s network before making a selection.

Once a suitable plan is identified, enrollment can be completed through various methods. You can enroll directly online via Medicare.gov, by calling the plan provider, or by mailing an application form. Working with a licensed insurance agent or broker is another option, as they can assist with plan comparisons and the application process. When applying, you generally need to provide your Medicare number and the effective dates for your Medicare Part A and Part B coverage. This information is typically found on your Medicare card.

After submitting an application, expect to receive enrollment confirmation directly from the plan. This confirmation often includes plan materials, such as a member ID card and coverage details. Coverage generally begins on the first day of the month after the plan receives the enrollment request, assuming all eligibility criteria are met.

Managing Your Medigap Policy

When transitioning from Original Medicare with a Medigap policy to a Medicare Advantage Plan, consider the status of your existing Medigap coverage. You generally cannot have both a Medigap policy and a Medicare Advantage Plan simultaneously. Medicare Advantage Plans replace Original Medicare, and Medigap policies are designed to work with Original Medicare to cover its out-of-pocket costs.

If you switch to a Medicare Advantage Plan, you typically need to cancel your Medigap policy. Contact the Medigap insurance company directly to initiate the cancellation process. Provide written notification to ensure a clear record of the cancellation request and its effective date. Canceling the Medigap policy will cease monthly premiums and eliminate its supplemental coverage.

While generally not permissible to hold both types of plans, rare circumstances, such as specific employer-sponsored plans, may allow some coordination. For most beneficiaries, enrolling in Medicare Advantage means discontinuing Medigap coverage.

Rejoining a Medigap Policy

Returning to a Medigap policy after enrolling in a Medicare Advantage Plan is possible under specific circumstances, often involving “guaranteed issue rights” or “trial rights.” For example, if you enroll in a Medicare Advantage Plan for the first time upon becoming Medicare eligible, and then switch back to Original Medicare within 12 months, you have a guaranteed right to purchase certain Medigap policies without medical underwriting. This means insurers cannot deny coverage or charge higher premiums due to health conditions.

A similar trial right applies if you drop a Medigap policy to join a Medicare Advantage Plan for the first time. If you disenroll from the Medicare Advantage Plan within 12 months to return to Original Medicare, you generally have a guaranteed right to get your old Medigap policy back if the company still sells it. If the previous policy is unavailable, you may purchase a similar Medigap policy offered by any company in your state.

Other situations that may trigger guaranteed issue rights include losing employer-sponsored coverage, a Medicare Advantage Plan leaving the service area, or a plan stopping its Medicare contract. When exercising a guaranteed issue right, you typically have a limited timeframe, often 63 days from the qualifying event, to apply for a Medigap policy. Outside of these specific situations, returning to a Medigap policy usually involves medical underwriting, where insurers can consider health status and potentially deny coverage or charge higher premiums.