The short answer? Yes. But there are important rules to be aware of. Before we examine when, why, and how you may switch from a Medicare Advantage plan to a Medigap plan, it’s important to explore the differences between the two options so that you’re informed before making a decision. Here’s everything you need to know.
Medicare Advantage vs Medigap
These two options offer completely different types of coverage. Let’s take a closer look:
- Medicare Advantage is a complete alternative to Original Medicare that is sold by Medicare approved private insurance companies. Sometimes called “Part C,” Medicare Advantage includes the Part A (hospital insurance), Part B (medical insurance) and Part D (prescription drug insurance) offered by Medicare. “Part C” can also sometimes offer additional benefits like regular hearing, dental and vision care. This is a completely separate option that takes the place of standard Medicare and offers lower out-of-pocket costs in exchange for a smaller pool of in-network doctors and benefits that Original Medicare does not offer.
- Medigap Plans can be purchased on top of your Original Medicare Part A and B plans. They are sold by private insurance companies to fill any “gaps” in your Medicare coverage. You must be enrolled in Medicare Part A and B to purchase a Medigap plan. Note that these plans don’t cover any prescription drug-associated costs under part D and cannot be used in tandem with a Medicare Advantage plan. It’s against the law for a private insurance company to sell you a Medigap plan if you have Medicare Advantage. You must be enrolled in Original Medicare.
You can think of Medicare Advantage as a completely separate package of coverage that you buy in its entirety through your private insurance company. Medigap plans, on the other hand, are supplemental policies that help to cover gaps in the public healthcare option known as Medicare.
Why Choose Medicare Advantage Over Medigap?
Medicare Advantage Plan recipients typically see prescription drug coverage and potential extra benefits like vision exams, eyeglasses or gym memberships. These benefits come at the expense of a smaller pool of in-network doctors.
Why Switch from Medicare Advantage to Medigap?
The most common reason for switching is the high out of pocket expenses associated with Medicare Advantage (up to $12,500) and out of network doctors or facilities. Doctors can come and go from this network annually with their contracts. Medigap plans, however, provide coverage for any doctor that’s in-network for Medicare—more than 800,000 providers nationwide. With a Medigap plan, you’re able to see any Medicare-covered specialist, with no primary doctor referral required. Your coverage is also guaranteed renewable, meaning it can never be canceled due to health conditions from the claims you file.
Medigap plans can also offer more benefits, such as foreign travel assistance, that Medicare Advantage plans do not. Medigap plans may also cover all deductible and out-of-pocket costs, depending on which option you choose.
What Medigap Plan is Right for Me?
There are currently 10 Medigap plans, which all offer different coverage levels and benefits. It may seem overwhelming at first, but we’re here to help. At Compare Medigap Insurance, we make it easy to compare Medigap plans and even premiums for your preferred plans. Just click the links below:
How Can I Switch from Medicare Advantage to Medigap?
To switch from Medicare Advantage to Medigap, you must first enroll in Original Medicare (Parts A and B) to be eligible for Medigap plan enrollment. Note that you can change to original Medicare, but this does not guarantee the ability to change to Medigap. You might have to be approved by the Medigap carrier depending on when and why you changed.
If approved, you have between 60 days before Medicare Advantage coverage ends to 63 days after coverage ends to enroll in Medigap in the following scenarios:
- Within your first year of enrollment in Medicare Advantage: Thanks to a loophole, you’re able to enroll in Medigap within the first year of your enrollment in Medicare Advantage—whether you’re enrolling for the first time or going back.
- During Special Enrollment Period: Special Enrollment Periods offer guaranteed issuance, meaning the policy price is standardized and not affected by your health status. You will have to qualify to make the switch. If you do qualify, you will not have to undergo medical underwriting to obtain a Medigap plan.
- During the Annual Election Period (Oct 7 – Dec 15): Also known as Open Enrollment, this window is the best time frame to leave Medicare Advantage and apply for Medigap with a January 1 start date.
- During the Medicare Advantage Disenrollment period (Jan 1 – Feb 14): During this time, you can leave your Medicare Advantage plan and return to Original Medicare, join a drug plan, and join a Medigap plan. It’s important to ensure you’re first approved by your Medigap plan before enrolling.
What’s Next?
Schedule an agent call to discuss your options, and visit our Medigap Plans Comparison to get a sense of what Medigap policy may make sense for you as you prepare to make your decision.
More Important Notes On Medigap
Medigap plans are government standardized. This means that regardless of where and from which private insurance company you buy your plan, you will get the same exact benefits. The premiums associated with Medigap plans, however, do vary across states and insurance companies. Insurance companies in your area. For this reason, it’s important to compare companies and premiums before purchasing your preferred plans.
Get A Free Price Report to compare insurance companies and premiums for Medigap plans in your area. We make it easy to find the best rate for your preferred plan through a quick and easy survey.