Can I switch from Medicare Advantage to Medicare Supplement?
Switching from a Medicare Advantage plan back to Original Medicare can be challenging due to specific enrollment periods and potential underwriting requirements.
One of the biggest risks when leaving a Medicare Advantage plan is finding out afterward that you don’t qualify for a Medigap plan. To avoid this, it’s crucial to work with a knowledgeable broker who can guide you through the process in the correct sequence and ensure you’re using the appropriate election periods. A broker can also help you determine your eligibility for alternative coverage options before making any changes.
Many people initially choose Medicare Advantage plans because they often have lower premiums compared to Medigap. Additionally, beneficiaries are drawn to the extra perks these plans offer, such as vision exams, eyeglasses, and gym memberships.
So, why would someone on a Medicare Advantage plan want to switch back to Original Medicare? There are several common reasons that we often see in our agency.
Common Reasons for Switching from Medicare Advantage to Medigap
A primary reason is when an important doctor leaves the Medicare Advantage network. Since these plans typically require members to use a specific network of providers, losing a trusted doctor can prompt a switch back to Original Medicare, which offers broader access to healthcare providers.
Another common issue is the frustration with the requirements for specialist referrals. Medicare Advantage plans often require prior authorizations for surgeries or diagnostic tests, which can be cumbersome. Some beneficiaries find that the lower premiums of Medicare Advantage plans are not worth the trade-off in access and flexibility.
Important Considerations When Switching to Original Medicare
Switching from a Medicare Advantage plan requires an eligible election period. Medicare Advantage plans generally require a commitment for the entire calendar year, and leaving the plan necessitates using an approved election period.
The Annual Election Period (AEP) from October 15th to December 7th is the most straightforward option for making a switch. During AEP, you can move from a Medicare Advantage plan to another Advantage plan or return to Original Medicare. Enrolling in a standalone Part D drug plan during this period will automatically disenroll you from your current Medicare Advantage plan and return you to Original Medicare.
There’s also the Medicare Open Enrollment Period (OEP), which allows one-time changes from January 1st to March 31st. During this period, you can switch from one Medicare Advantage plan to another or disenroll from Medicare Advantage and return to Original Medicare, with or without a Part D plan.
Beyond these periods, there are special election periods for specific circumstances, such as moving out of your current plan’s service area or qualifying for a Low-Income Subsidy. Your broker can help you determine if you qualify for any special election periods to make a mid-year change.
Medigap Approval Isn’t Guaranteed
Switching from Medicare Advantage to Original Medicare doesn’t automatically qualify you for a Medigap plan. Without supplemental coverage like Medigap, you could face significant out-of-pocket costs, as Original Medicare doesn’t cap your expenses. For instance, you could be responsible for 20% of the costs of chemotherapy without any limit.
To qualify for a Medigap plan, you typically need to pass medical underwriting, meaning you must answer health questions as part of your application. Serious health conditions, such as congestive heart failure or COPD, can result in denial from most insurance carriers.
Before leaving your Medicare Advantage plan, confirm that you’re likely to be approved for Medigap coverage. You don’t want to be left without supplemental insurance, which could expose you to high medical expenses.
Planning Your Effective Dates
When leaving a Medicare Advantage plan, your new coverage typically starts on the first day of the month following your disenrollment. If you’re making the change during the Annual Election Period, your new coverage will take effect on January 1st.
Since leaving Medicare Advantage usually means losing your Part D drug plan, it’s important to research and choose a suitable standalone drug plan before returning to Original Medicare. Drug formularies vary between plans, and setting up new services like mail-order prescriptions can take time. Be sure to refill your medications before your current coverage ends.
Working with a broker who specializes in Medicare Advantage can simplify the transition process. Our agency handles numerous plan changes each year and understands the importance of timing and details. We can help ensure a smooth transition, so you don’t overlook anything crucial.
If you need assistance with switching plans, feel free to reach out. Our services are free!
Key Points to Remember
In most states, switching to a Medigap plan requires answering health questions.
Changing plans requires a valid election period, such as the Annual Election Period.
Common reasons for switching include losing a preferred doctor from your network or dissatisfaction with prior authorization requirements.