Speak with a licensed sales agent: 1-800-637-7602 TTY User 711 / Mon-Fri 8:00a - 8:00p
Looking for a plan? Enter your zip code to shop online.
Looking for a plan?
Enter your zip code to shop online.
Home / Resources / Can I Switch from Medicare Advantage to Medigap?

Can I Switch from Medicare Advantage to Medigap?

By Donna Frederick

After retiring from a career as an executive travel counselor in 2006, Donna Frederick embarked on a second career as a licensed insurance agent. During that first year, many clients told Donna how ov ...erwhelmed they felt by Medicare, but that her assistance helped them finally understand the Medicare program. That experience inspired Donna to focus her efforts on educating her clients to ensure they fully understand their Medicare options. Today, Donna takes pride in providing outstanding customer service and going the extra mile to make sure each client knows all of their options and has a sound understanding of their Medicare plan, from costs to coverage and all points in between.Read more

Jan 08, 2021

If you’re enrolled in a Medicare Advantage (MA) plan but changed your mind and would rather have a Medicare Supplement (Medigap) insurance plan with Original Medicare, that’s ok. You’re able to switch from Medicare Advantage to Medigap during certain times of the year or with specific qualifying circumstances.

Both Medicare Advantage and Medigap are forms of health insurance you can have other than Original Medicare. Each plan offers different types of coverage and costs, and you may find it comforting to know you can switch between the two if you need to. Here’s information about when you can switch coverage and how to do it.

Changing from Medicare Advantage to Medigap

You cannot enroll in both Medicare Advantage and Medigap. If you’d like to switch from an MA plan to a Medigap plan alongside Original Medicare, you must meet certain requirements or do so during a specific time of the year.

First, you’d drop your MA plan coverage and return to Original Medicare (Part A and Part B), then you’d apply for a Medigap insurance plan. Or, you can apply for the Medigap plan first, and once you are approved, drop your MA coverage.

You can change from Medicare Advantage to Medigap coverage if:

  • You move outside your plan’s service area
  • Your MA plan leaves your area (in which case you’d automatically get returned to Original Medicare)
  • Your MA plan ends its contract with Medicare (in which case you’d automatically get returned to Original Medicare)
  • You move into a nursing facility or other institution, or move from a nursing facility back home
  • You joined a Medicare Advantage plan when you were first eligible for Part A, and within the first 12 months of joining, decide you want to switch back to Original Medicare (after which you could apply for a Medigap policy)

Otherwise, you’re able to change plans during a designated enrollment period.

Keep in mind if you switch from an MA plan to Medigap, you’ll likely be losing your Part D prescription drug coverage (typically built into MA plan coverage). If this is the case, you’ll want to be sure to enroll in a stand-alone drug plan as well.

When Can I Switch from Medicare Advantage to Medigap?

There are a few times per year when you can leave a Medicare Advantage plan:

  • Within the first 12 months of enrollment

If you enroll in an MA plan when you first become eligible, you’re able to switch back to Original Medicare and Medigap within the first 12 months of the plan. This is so you can find the policy that’s right for you, your budget, and your coverage needs.

  • Open Enrollment Period (January 1 through March 31).  You can:
    • Drop your MA plan and return to Original Medicare, where you can then apply for a Medigap plan
    • Switch from one MA plan to another
    • Add a stand-alone prescription drug plan (asl long as you don’t already have traditional Medicare)
  • Annual Election/Enrollment Period (AEP) (October 15 through December 7). You can:
    • Drop your MA plan and return to Original Medicare, where you can then apply for a Medigap plan
    • Enroll in a Medicare Advantage plan
    • Switch to a different MA plan
    • Add a stand-alone prescription drug plan

How to Switch from Medicare Advantage to Medigap

Here are the steps you’d take to switch from an MA plan to Original Medicare with a Medigap policy during a qualifying circumstance or enrollment period:

  • To disenroll from an MA plan, you can:
    • Contact the plan directly and request a disenrollment form
    • Contact Medicare and ask for disenrollment from your plan
    • Visit your local Social Security office
  • If you had Medigap coverage before joining a MA plan and have had your MA plan for less than one year, you can return to your previous Medigap policy.

What Are Guaranteed-Issue Rights?

In most cases, if you switch to Original Medicare from an MA plan, you lose your guaranteed-issue rights for Medigap. These rights ensure you can purchase any plan sold in your state/area, and you can’t be charged higher premiums based on your health status.

You typically only have these rights for six months when you are 65 and older and enrolled in Part B. Without these rights, your insurance company may require medical underwriting before selling you a plan. During this time, they look at your past medical history and current health status, and can refuse to sell you coverage based on your health risk. Or, they can charge you higher premiums.

Without guaranteed-issue rights, purchasing a Medigap plan can be expensive. However, there are a few times where you have time-limited guaranteed-issue rights. This typically lasts for 63 days from the date you leave your MA plan.

  • You purchased a MA plan when you first became eligible, but switched back to Original Medicare within the first 12 months.
  • You lost your MA coverage because you moved outside of the plan’s service area, or the plan no longer operates in your state.

What Is Medicare Advantage?

Medicare Advantage plans (Part C) are offered by private insurance companies contracted through Medicare. They offer the same hospital and medical coverage that Original Medicare does (through Part A and Part B), but they also offer additional coverage such as vision, dental, hearing aids, travel, wellness/gym memberships, and more. Most MA plans also include Part D prescription drug coverage.

While MA plans offer additional benefits, more personalized coverage, and coordinated care often at a lower cost, there are some disadvantages including select providers, service area limitations, complex coverage, and necessary prior authorizations or referrals.

In order to be eligible to enroll in a MA plan, you must:

  • Already be enrolled in Medicare Part A and Part B.
  • Reside within the plan’s service area.

What Is Medigap?

Medicare Supplement, or Medigap, is a supplemental insurance that helps fill “gaps” in Original Medicare coverage. While Medicare pays for much of the hospital and medical costs you may need, it doesn’t cover everything, which is why some people choose to purchase a Medigap policy.

These policies are offered by private insurance companies and help pay some costs such as copayments, coinsurance, and deductibles.

In order to be eligible for a Medigap policy, you must:

  • Have Medicare Part A and Part B.
  • Pay the insurance company the policy’s monthly premium in addition to the monthly Part B premium you pay Medicare.
  • Buy a Medigap policy from an insurance company licensed in your state to sell them.

The downside to Medigap policies is they do not cover everything, and may lack coverage for things such as prescription drugs, vision or dental, hearing aids, eyeglasses, and more.

Why Change from MA to Medigap

Other than the qualifying scenarios listed previously, there are a few other reasons you may want to change from MA coverage to a Medigap plan.

  • You’re looking for a larger provider network. Medigap covers the same network as Original Medicare, while MA plans typically have a smaller list of covered providers.
  • You want assistance with deductibles, copays or coinsurance. While some MA plans offer $0 premiums and lower out-of-pocket costs, some Medigap plans cover all deductibles and most out-of-pocket costs, which could result in greater cost savings.
  • You don’t use the extra MA coverage. One of the primary benefits to a MA plan is the extra benefits offered, such as hearing, vision and dental. If you don’t use those benefits, you may not need MA coverage.
  • You don’t want to have to get a referral. Often with MA plans, you need a referral or prior authorization to see a specialist or for certain services/procedures. Medigap plans do not require this.

When to Apply for Medicare

In general, Medicare is available to those who are age 65 or older, have a qualifying disability, or have End-Stage Renal Disease. If you are already getting benefits from Social Security or RRB, you’ll be automatically enrolled in Original Medicare Part A and Part B starting the first day of the month you turn 65. You’ll also be automatically enrolled if you have a qualifying disability.

You are eligible to enroll in premium-free Part A at any time after you are first eligible for coverage. Otherwise, there are a few times per year when you can sign up for Medicare.

Initial Enrollment Period

If you’re eligible for Medicare when you turn 65, you are able to sign up during your Initial Enrollment Period. This is a 7-month period surrounding your birthday, including the three months before the month you turn 65, the month you turn 65, and the three months after the month you turn 65.

If you do not pay a premium for Part A, it’s mandatory to enroll unless you also give up your Social Security or Railroad Retirement Board (RRB) benefits. You should sign up for Part A and Part B when you’re first eligible to avoid a delay in coverage.

Special Enrollment Period (SEP)

If you don’t enroll in Part A or B during your Initial Enrollment Period, you may have an opportunity to enroll during a Special Enrollment Period. However, you must meet certain requirements to be eligible, such as if you’re covered under a group health plan based on current employment and you lose that coverage.

General Enrollment Period (GEP)

If you don’t enroll in Medicare when you’re first eligible, and you don’t qualify for an SEP, you can still enroll in Part A and Part B during the Medicare General Enrollment Period, from January 1 through March 31.

You can also drop your MA plan and return to Original Medicare, switch from one MA plan to another, or add a stand-alone prescription drug plan (as long as you don’t already have Original Medicare).

Annual Enrollment Period (AEP)

From October 15 to December 7, you can:

  • Enroll in a Medicare Advantage plan
  • Drop your MA plan and return to Original Medicare
  • Switch to a different MA plan
  • Add a stand-alone prescription drug plan

Related Articles

Originally posted on Jan 19, 2021 11:01:24

Find a Plan Today!

Call a licensed sales agent

1-800-637-7602

TTY User 711

Mon-Fri 8:00a - 8:00p

The MedicareUSA website is operated by HealthPlanOne, LLC a licensed health insurance agency based in Connecticut; in California d/b/a HPOne Insurance Agency, license #OF30784. HealthPlanOne, is a licensed and certified representative of Medicare Advantage HMO, PPO and PFFS organizations and stand-alone prescription drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal.

For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

PLEASE NOTE: Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease.

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.

Medicare supplement plans are not connected with or endorsed by the U.S. Government or the federal Medicare program.

The Centers for Medicare and Medicaid Services (CMS) does not review or approve Medicare Supplement plan information.

MULTIPLAN_GHHJTCFENV2_2021_A

Last Updated 01/13/2021