You can switch from Medicare Advantage to Medigap, but timing is critical. During your first 12 months in Medicare Advantage, trial rights allow you to return to Original Medicare and buy Medigap without medical underwriting. After that window closes, most states allow insurers to screen your health history, which can result in denial or higher premiums.
October 30, 2024 – Los Angeles, CA – Millions of American seniors with Medicare Advantage coverage are scurrying to find new coverage for 2025.
According to the American Association for Medicare Supplement Insurance, the total number of Medicare Advantage plans declined by 7% from 3,959 to 3,699. This indicates that a significant number of plans are being terminated or not offered for the upcoming year.
Impacted individuals can search for new Medicare Advantage plan coverage. Or, they may benefit from special circumstances that permit them to apply for Medigap coverage without having to meet health qualifications. This is referred to as “guaranteed-issue”.
Without guaranteed-issue rights, the insurance company may require medical underwriting before it offers you a plan. The insurer will examine your past medical history and current health status. If the company determines the risk of covering you is too high, it can refuse to offer you the plan you want, or it may charge you much higher premiums for the coverage.
From Medicare Advantage to Medigap
Getting guaranteed-issue Medigap coverage if your Medicare Advantage plan has been cancelled may be possible.
But, everything must be done correctly and within a very short permitted number of days. For that reason, we strongly suggest working with an experienced local Medicare insurance agent. Simply explained, if you switch to Original Medicare (you can do this during Medicare’s AEP that ends December 7th), you have short-term guaranteed-issue rights for a Medicare Supplement (Medigap) insurance plan.
However, this special situation may limit your choice of Medicare Supplement (Medigap) insurance plans. Although there are 10 standardized plans available in most states, some states only allow you to buy certain ones with guaranteed-issue rights outside your Initial Enrollment Period. And, the window to do all of this can be extremely short – basically 63 days.
Pros Of Switching To Medigap
There are a number of reasons to consider switching to a Medigap plan, especially if you can qualify for guaranteed-issue coverage. You are not limited to specified provider networks.
Medigap can cover up to 100% of most out-of-pocket expenses. Referrals not required to see specialists. And, few to no approvals are needed for services and supplies
Frequently asked questions:
Can I switch from Medicare Advantage to Medigap?
Yes, but timing and health status matter significantly. If you switch during your first year in Medicare Advantage, you have trial rights that allow you to return to Original Medicare and buy certain Medigap plans without medical underwriting. Outside that window, most states allow insurers to review your health history, which could result in denial or higher premiums.
What is the 63-day window for switching to Medigap?
When your Medicare Advantage plan is cancelled or you disenroll for qualifying reasons, you typically have 63 days of guaranteed-issue rights to purchase a Medigap plan without medical underwriting. Missing this window means you may be subject to health screening, and some conditions could result in being denied coverage or charged higher premiums.
Do I need to enroll in Part D when switching from Medicare Advantage to Medigap?
Yes. Medicare Advantage plans typically include drug coverage, but Medigap policies do not cover prescriptions. When you switch back to Original Medicare and add Medigap, you must also enroll in a standalone Medicare Part D prescription drug plan. Failing to enroll when first eligible can result in a permanent late enrollment penalty.
Will my doctor still be covered if I switch from Medicare Advantage to Medigap?
In most cases, yes. With Original Medicare and a Medigap policy, you can see any doctor or specialist who accepts Medicare nationwide, with no network restrictions. This is one of the primary reasons many seniors switch from Medicare Advantage, which requires using in-network providers in most plan types.
When is the best time to switch from Medicare Advantage to Medigap?
The best time is during your first 12 months in Medicare Advantage when trial rights apply, or when a qualifying event such as plan cancellation triggers guaranteed-issue rights. Switching during Medicare’s Annual Enrollment Period (October 15 to December 7) allows you to return to Original Medicare effective January 1, at which point you can apply for Medigap.
