As your budget, healthcare needs, and benefits change, you may be considering switching up your Medicare coverage. If you’re enrolled in a Medicare Advantage plan and have been considering a switch to a Medicare Supplement (Medigap) plan, you’re not alone. Let’s dive into some crucial questions to help you make an informed decision.
Can I switch from Medicare Advantage to Medicare Supplement?
Yes, you can absolutely switch from Medicare Advantage to a Medicare Supplement plan. However, there are a few key things to keep in mind:
- Timing: The best time to make this switch is during the Medicare Annual Enrollment Period (AEP), which runs from October 15th to December 7th each year. Any changes you make during this period will take effect on January 1st of the following year.
- Underwriting: Unlike Medicare Advantage plans, Medicare Supplement plans require you to undergo medical underwriting unless you reach criteria for an exception. This means the insurance company will review your health history to determine your eligibility and premium rates. If you have pre-existing health conditions, you may face higher premiums or even be denied coverage for certain plans.
- Guaranteed Issue Rights: There are certain situations where you may have a guaranteed issue right to a Medigap plan, even if you have pre-existing conditions. This typically occurs when you lose your current coverage due to circumstances like your employer group health plan ending or you moving out of your Medicare Advantage plan’s service area.
What is the advantage of switching from MA to Medigap?
Medicare Supplement plans offer several advantages that appeal to many beneficiaries:
- More Predictable Costs: With a Medigap plan, you’ll typically have more predictable out-of-pocket costs. While premiums may be higher, you’ll have lower copays, coinsurance, and deductibles when you receive care. This can offer greater peace of mind, especially if you have significant healthcare needs. Medicare Supplement premiums are usually raised each year, but one of the key benefits over Medicare Advantage is that you won’t lose any benefits or coverage year-to-year.
- Greater Provider Choice: Original Medicare paired with a Medicare Supplement plan gives you the freedom to see any doctor or specialist who accepts Medicare, anywhere in the country. You’re not limited to a network like you are with many Medicare Advantage plans.
- No Referrals Needed: You won’t need referrals to see specialists with Original Medicare and a Medigap plan. This can simplify the process of getting the care you need.
Can I have both Medicare Advantage and Medicare Supplement?
No, you cannot have both a Medicare Advantage plan and a Medicare Supplement plan at the same time. You’ll need to choose one or the other.
Pros and Cons of Switching from Medicare Advantage to Medigap:
Pros:
- Predictable Costs
- Greater Provider Choice
- No Referrals Needed
- Coverage Nationwide
Cons:
- Higher Monthly Premiums
- Medical Underwriting
- May Need to Purchase a Separate Part D Drug Plan
Making the Decision on Switching Plans
The decision to switch from Medicare Advantage to Medicare Supplement is a personal one. Carefully weigh the pros and cons based on your individual health needs, financial situation, and preferences. It’s also a good idea to compare plans and get quotes from different insurance companies.
Remember: If you’re considering a switch, don’t wait until the last minute. Our licensed insurance agents can guide you through the pros and cons for your exact care needs.
