Guide to Switching From Advantage to Medigap
If you have selected a Medicare Advantage (MA) Plan, know that it is not a decision for life. If your current plan is not meeting your needs, you have a window of time every year to change plans or switch back to Part A and Part B. Switching from an MA Plan, also referred to as Part C, to Medigap (a Supplement Plan) can be a bit more limited, but there are some exceptions.
This guide will help you to better understand the process of switching from Medicare Advantage to Medigap.
Advantage Plans vs Supplement Plans
Many people get confused between MA Plans and Medigap Plans. But when you look closely, you will see that they are two very different things. Medigap is a supplemental insurance that you purchase through private companies. It covers costs that your Part A and Part B doesn’t pay for, like copayments, coinsurance and deductibles.
Unlike Medigap, Part C replaces Part A and Part B, providing you with all of the benefits. MA Plans can also include additional drug coverage, vision, dental and/or hearing.
Many people choose to purchase an MA Plan from a private insurance company because it can cost less for equal or more benefits. However, you do get a more limited choice of doctors.
Switching from Part C to Medigap
At some point in your life, you may want to switch from MA to Part A and B with Medigap. Anyone with an Advantage plan can disenroll and switch back during the Medicare Advantage Disenrollment Period. This period occurs each year from January 1st to February 14th. Click here to learn about this period for switching plans.
Adding Medigap to your Part A and Part B may not be as straightforward. If you have had an MA Plan for a year or longer, federal law doesn’t typically allow you to buy a Medigap Plan. However, there are some exceptions.
Your state might give you certain rights to buy Medigap after having an Advantage Plan. Make sure to check with your State Health Insurance Assistance Program (SHIP) to understand your rights in your state. You may also have some guaranteed issue or trial rights, which allow you to buy an MS Plan. You can learn more about these rights below.
Right to Switch Plans from MA to MS
Along with the different state rights that we briefly mentioned above, there are some general rights to buying Medigap policies that cover all eligible American citizens. We will list a few of the most relevant rights from Medicare.gov here.
- When switching back, you can buy a Medigap policy if your MA Plan is leaving Medicare, stops providing care in your area, or if you move out of the area that your plan services. Your new Medigap coverage can’t start until your previous coverage ends.
- If you chose an MA Plan when you were first eligible (age 65) and decide you want to switch to original within the first year of joining, you can still buy a Medigap policy.
- If you switched from Medigap to MA for the first time within the past year, you can change back to Medigap.
- You are also allowed to buy a Medigap policy if your MA insurance company misled you or hasn’t followed the rules.