How to Change from Medicare Advantage to Medigap

Are you thinking about changing from Medicare Advantage to Medigap? You might have been told it’s impossible. It’s not, though not everyone can do it.

Medicare Advantage plans have become increasingly popular in the last few years because they offer lower premiums than Medigap plans. Plus, they also offer extra benefits that you won’t find in Original Medicare or a Medigap plan. Of course, those “advantages” do come with some drawbacks, too.

Some people find these drawbacks to be too much of a disadvantage and want to know if they can switch back to Original Medicare with a Medigap plan. It is possible, and there are a few things you should know about the process. We’ll uncover those today.

The Difference Between Medigap and Medicare Advantage

First, let’s talk a little more about why you’d want to change from Medicare Advantage back to Original Medicare with a Medigap plan. As you may know by now, Medicare Advantage plans work quite differently than Original Medicare. Some of those changes are good, and some are less convenient.

Medicare Advantage plans require you to use provider networks. Going outside your plan's network will result in either higher copays or no coverage at all. Some people don’t mind this limitation, but if you live in rural areas or travel frequently, it can be difficult to find contracted providers.

Another disadvantage is Medicare Advantage plans have more rules about how you receive care. They frequently require prior authorizations on services, which results in lots of paperwork and delays your treatment. It could also mean that coverage gets denied altogether. 

These are the two biggest drawbacks to Medicare Advantage plans, and they aren’t small considerations. Many people want more freedom to choose providers and don’t want to have to jump through any hoops to get care. If you fall into either of those categories, Medicare Advantage might not be the right choice for you.

Instead, Original Medicare (Parts A and B) offers more flexibility. You can see any provider that accepts Medicare, which nearly all of them do. In addition, Original Medicare does not require as many prior authorizations as Medicare Advantage plans. Since Medigap plans are a secondary insurance, they follow all the same rules as Original Medicare. If Medicare approves a provider or service, your Medigap plan will also pay. 

Switching from Medicare Advantage to Medigap

We’ve had clients tell us that they want to switch back to a Medigap plan but have been told it’s impossible. That can be true in some cases, but it’s not true for everyone. Let’s talk about your options.

Medicare Advantage Trial Right

Everyone has a trial right period the first time they try a Medicare Advantage plan. This is true whether you enroll as soon as you’re eligible or if you switched from a Medigap plan you had for a decade.

Within the first 12 months of having a Medicare Advantage plan, you can use the Medicare Advantage Trial Right to get back to your original plan. This trial right means you can reinstate your old Medigap plan with no questions asked.

The caveat here is that you can only go back to the same plan you had under the same carrier. If you had Plan G with Company X, you must go back to Plan G with Company X. You cannot try to change your Medigap plan or the company you were enrolled with.

Medical Underwriting

If your trial right has passed, there is another option. You can go through medical underwriting.

If you no longer have guaranteed rights to a Medigap plan, you’ll have to pass medical underwriting to get one. This does not mean you have to have a medical examination. However, you will be asked a series of health questions, and the insurance company will likely audit your health records. Unhealthy individuals or those who pose too much of a risk will not be able to get a Medigap plan.

Every insurance carrier has different underwriting rules. Some are more strict than others. If you fail one carrier’s underwriting requirements, you might be able to find another carrier that is willing to take you on. Your advisor at Local Medicare Specialists will be able to tell you which companies are a possibility in your situation.

Individuals who cannot pass underwriting should keep their Medicare Advantage plan. Of course, you can drop the Medicare Advantage plan and have Original Medicare only, but we almost never recommend that option. The risk of significant medical bills is too great.

If you are enrolled in Medicare Advantage and want to explore Medigap plans, call your local insurance agent. Local Medicare Specialists has agents near you who are happy to discuss your situation and present personalized options.