One common misconception about Medicare Advantage is that you can never switch from Medicare Advantage to Medigap. Many people wrongly believe that once you enroll in Medicare Advantage, there is no going back. There can be some truth to that, but it’s not the whole picture.

If you are considering switching from Medicare Advantage to Medigap, it’s wise to understand your rights and how the process works. We’re going to give you all those details today.

Why You Might Switch from Medicare Advantage to Medigap

We understand the strong appeal of Medicare Advantage plans. They offer low monthly premiums and lots of extra benefits. They’re a great fit for many people, but not everyone. There are a few reasons someone may end up wanting to switch from Medicare Advantage back to Original Medicare with a Medigap plan. 

One complaint we hear is that Medicare Advantage plans require too many referrals and prior authorizations. It’s true that this is different from Original Medicare and Medigap. Medigap plans follow the same rules as Original Medicare. Original Medicare does not require any referrals to specialists, as some Medicare Advantage plans do. This is convenient, as you’ll have fewer doctor visits and, therefore, fewer copays.

Medicare Advantage plans try to control their costs by requiring prior authorizations. A prior authorization ensures that you and your healthcare provider have tried other, less invasive, less costly options before more invasive, more expensive treatment. The thought behind this is good, but your insurance carrier is not your doctor. Prior authorizations mean paperwork, delayed treatment, and sometimes, denied treatment.

Another problem people can run into is the provider networks. Most Medicare Advantage plans require you to see providers that are contracted with them. Going outside of the network will cost you more in most cases. Some Medicare Advantage plans, like Health Maintenance Organizations (HMOs), do not offer any coverage outside of the network except in emergencies. If your doctors aren’t in the network or suddenly leave the network, you may have to look for new providers. This is frustrating for many people who wish to see the doctors they’ve been seeing for years.

Lastly, while the low monthly premiums are appealing, Medicare Advantage plans have more out-of-pocket costs than Medigap plans. We like to think of them as a “pay-as-you-go” option. You pay for services as you need them. If you have health problems or chronic conditions, those bills can quickly add up.

How to Switch from Medicare Advantage to Medigap

Whatever your reason, it’s important that you take great care when switching from Medicare Advantage to Medigap. You’ll need to know what rights you have to switch and when you’re allowed to do so.

Let’s discuss election periods first. Medicare Advantage plans require an annual commitment and renew in January of each year. However, it is possible to leave the plan before the end of the year.

The Annual Election Period (October 15 – December 7) allows you to review your current Medicare Advantage plan and either choose another or switch back to Original Medicare. Whatever you decide to do, the new plan will go into effect on January 1. You can also apply for a Medigap plan during this time, but we’ll talk more about that in a minute.

The Medicare Advantage Open Enrollment Period (January 1 – March 31) offers you another time to change your plan. During this enrollment period, anyone who is already enrolled in Medicare Advantage can make a one-time change. This could be a switch to another Medicare Advantage plan or a move back to Original Medicare. And again, you can also apply for a Medigap plan.

Another option some beneficiaries have is to use their Trial Right Period. If you are still within your first 12 months of having a Medicare Advantage plan for the first time, you can choose to leave your plan and go back to Original Medicare during any of those 12 months. Once that first year has passed, you won’t have those same rights.

You may be able to switch to Original Medicare outside of an enrollment period for a couple of other reasons. If you want to make a change, it’s best to chat with your Medicare advisor to find out what options you have.

All of these options allow you to switch back to Original Medicare. Original Medicare does not require any medical underwriting, and you won’t be denied coverage because of your current or past health history. The same is not true of Medigap plans. Let’s talk about that next.

About the only time you’ll have guaranteed issue rights to a Medigap plan (after having been enrolled in Medicare Advantage) is if you’re within the 12-month trial right period we mentioned earlier. If you decide to switch back to Original Medicare during those 12 months, you can also re-enroll in your Medigap plan with no questions.

Outside of that situation, in most cases, you’ll need to apply for a Medigap plan and answer health questions. Your answers to those questions are what the insurance carrier will do to decide if they want to issue a policy to you. Your enrollment is not guaranteed.

This is an important consideration, as you do not want to leave your current plan prior to getting approval for a Medigap plan. Having Original Medicare alone can lead to extensive out-of-pocket costs and is not typically recommended.

Get Help from Your Local Medicare Specialists

Working with an insurance agent who specializes in Medicare is the best way to make sure you’re making wise decisions about your healthcare coverage. Our advisors will inform you about any upcoming enrollment deadlines and fill you in on the process of switching from Medicare Advantage to Medigap. Give us a call today to speak to a Medicare advisor near you!