Some people enroll in a Medicare Advantage plan and later decide they would rather have Original Medicare with a Medicare Supplement plan, also called Medigap. This can be a reasonable choice for people who want broader doctor access or more predictable out-of-pocket costs.
But switching is not always as simple as choosing a new plan. You may need to leave your Medicare Advantage plan, return to Original Medicare, enroll in a Part D prescription drug plan, and apply for a Medicare Supplement plan. The timing matters because you may not always have a guaranteed right to buy Medigap coverage.
Can you switch from Medicare Advantage to Medigap?
Yes, you can generally leave Medicare Advantage and return to Original Medicare during certain enrollment periods. Once you are back in Original Medicare, you can apply for a Medicare Supplement policy.
However, applying for Medigap and being approved are not always the same thing. Outside certain protected situations, insurance companies in many states may ask health questions before they accept your application. This process is called medical underwriting.
A carrier may approve your application, offer coverage at a different rate where allowed, or decline it based on its underwriting rules. Rules can vary by carrier and state.
When can you leave a Medicare Advantage plan?
Most people have two common opportunities each year to leave Medicare Advantage.
- Annual Enrollment Period: This runs from October 15 through December 7 each year. You can leave Medicare Advantage, return to Original Medicare, and add a stand-alone Part D drug plan. Changes generally take effect January 1.
- Medicare Advantage Open Enrollment Period: This runs from January 1 through March 31. If you are already enrolled in a Medicare Advantage plan, you can switch to another Medicare Advantage plan or return to Original Medicare. If you return to Original Medicare, you can also enroll in a Part D plan. Changes generally take effect on the first day of the month after your request is received.
You may also qualify for a Special Enrollment Period if you move outside your plan’s service area, lose certain coverage, qualify for Medicaid or Extra Help, or experience another qualifying event.
Leaving a Medicare Advantage plan does not automatically mean you have a Medicare Supplement plan in place. That is an important detail to plan carefully.
Should you apply for Medigap before leaving Medicare Advantage?
In many cases, it can be wise to apply for a Medicare Supplement plan before you finalize your Medicare Advantage disenrollment. This may help you avoid ending up with Original Medicare alone if your Medigap application is not approved.
Medicare Supplement plans are designed to help pay some of the deductibles, copayments, and coinsurance left by Original Medicare. Without a supplement, you are generally responsible for Original Medicare’s cost-sharing amounts, and there is no annual out-of-pocket maximum under Original Medicare alone.
An agent can help you coordinate effective dates. You generally should not cancel coverage or make plan changes until you understand your enrollment options and have reviewed the new policy details.
Will you have to answer health questions for Medigap?
Often, yes. If you are beyond your one-time Medigap Open Enrollment Period and do not have a guaranteed-issue right, a Medigap carrier may use medical underwriting.
Your personal Medigap Open Enrollment Period begins when you are both age 65 or older and enrolled in Medicare Part B. It lasts six months. During that time, you can generally buy any Medigap plan sold in your state without health underwriting.
After that window, you may still be able to apply, but acceptance is not guaranteed in most states. Some states have additional consumer protections or separate enrollment rules, so it is worth checking the rules where you live.
What is a Medicare Advantage trial right?
In limited situations, you may have a trial right. A trial right can give you the opportunity to buy certain Medigap plans without medical underwriting after you leave Medicare Advantage.
For example, you may have a trial right if you joined a Medicare Advantage plan when you first became eligible for Medicare at age 65 and decide to leave it within the first 12 months. You may also have a trial right if you dropped a Medigap policy to join Medicare Advantage for the first time and leave that Medicare Advantage plan within 12 months.
Trial-right rules are specific, including deadlines and the Medigap plans available to you. Do not assume you qualify simply because you have had Medicare Advantage for less than a year. Confirm your situation before making a change.
Do you need a Part D drug plan after you switch?
Usually, yes. Original Medicare and Medicare Supplement plans generally do not include outpatient prescription drug coverage. When you leave Medicare Advantage and return to Original Medicare, you may want to enroll in a stand-alone Medicare Part D plan.
Be careful if your Medicare Advantage plan includes drug coverage, as many plans do. Once you leave that plan, your drug coverage usually ends too. Going without creditable drug coverage for too long may lead to a late enrollment penalty later, unless you qualify for an exception.
Why do people consider switching to Medigap?
There is no single best Medicare choice for everyone. Medicare Advantage plans can offer lower monthly plan premiums, added benefits, and an annual limit on covered in-network medical costs. They may also use provider networks and plan rules such as referrals or prior authorization, depending on the plan.
Original Medicare with a Medicare Supplement policy can offer different advantages. Many people value the ability to see any doctor or hospital that accepts Medicare nationwide, without a plan network. A Medigap policy may also make medical expenses easier to predict, depending on the plan you choose.
Medigap policies have a separate monthly premium, and you generally need a separate Part D drug plan. Benefits, premiums, availability, and underwriting rules can vary by plan, carrier, and state.
A few steps to take before you switch
- Review whether your doctors, hospitals, and specialists accept Original Medicare.
- List your prescriptions and compare available Part D drug plans.
- Find out whether you have a guaranteed-issue right or may need medical underwriting.
- Compare Medigap benefits and premiums from available carriers in your state.
- Coordinate effective dates so you do not create an unwanted gap in coverage.
- Keep records of notices, plan documents, and any proof of a guaranteed-issue right.
Switching from Medicare Advantage to Medigap may be a good fit if you want the flexibility of Original Medicare and help with its out-of-pocket costs. The right path depends on your health needs, budget, travel habits, and enrollment rights. If you would like free, no-pressure help reviewing Medicare Supplement options in your area, you can reach out to Eric for guidance.