Medicare Advantage, or Medicare Part C, often offers additional benefits and sometimes savings on out-of-pocket costs. However, Medigap can also help you save on your costs and pay less for coinsurance, copayments, and deductibles.
It’s important to know the difference between Medicare Advantage and Medigap, along with the pros and cons of each. After that, you may be wondering, “Can I switch from Medicare Advantage to Medigap?” This article will help you understand if you can, and when it’s possible.
Medicare Advantage, or Medicare Part C, is an all-inclusive alternative to Original Medicare. It generally encompasses Medicare Parts A, B, and D. However, because your coverage is provided by a private insurer and not the government, there are limitations on your provider network. You can also expect different — and sometimes lower — copayments, deductibles, and coinsurance.
People choose Medicare Advantage because they enjoy getting additional benefits, such as low-cost health club memberships, vision and dental coverage, and more. They also prefer the predictable out-of-pocket costs rather than a percentage coinsurance.
Medigap is an add-on to Original Medicare and helps you pay for healthcare costs like your deductible, copayments, and coinsurance. There are several plans, lettered from A to N. However, some are not available to beneficiaries after a certain date. Medigap is sold by private insurers, and the only difference between providers offering the same letter is cost — every Plan A will be the same as every other Plan A.
Medicare beneficiaries choose Medigap because it lowers or eliminates a lot of out-of-pocket costs. Medigap has to pay its share when Medicare covers its part. You can see any doctor in the U.S. that accepts Medicare, and you don’t need referrals for specialist appointments.
In general, no one can sell you a Medigap plan if you have Medicare Advantage. In order to get Medigap, you have to disenroll from Medicare Advantage and return to Original Medicare.
People have a lot of questions about switching from Medicare Advantage to Medigap. This section will answer some of the most frequently asked questions.
If you choose Medigap with Original Medicare during your initial enrollment period around your 65th birthday, you were guaranteed acceptance even if you had known health conditions. After that initial period, if you want to join a Medigap plan, they generally use underwriting to review your health risk before they decide to accept you.
If you want to avoid this underwriting, you’ll need a special enrollment period that has guaranteed issue rights. For instance, if you decide to switch out of a Medicare Advantage plan within the first 12 months, you can get Medigap without underwriting.
Other times you can get Medigap without underwriting include:
In order to switch to Medigap, you need to disenroll in Medicare Advantage and go back to Original Medicare. You can do this during two enrollment periods.
The first is Open Enrollment, which occurs from October 15th-December 7th each year. During this time you can make any changes you’d like, including returning to Original Medicare and getting Medigap.
You might wonder about Medicare Advantage’s Annual Enrollment period, from January 1-March 31 each year. While you can leave your Medicare Advantage plan during that time and return to Original Medicare, you won’t be able to sign up for Medigap until the next Open Enrollment period.
Understanding your rights under Medicare can be challenging. It’s often easier when you speak to a licensed insurance agent about your situation. If you’d like to discuss your options and see whether Medicare Advantage or Medigap is better for you, we’re here to help. Contact us today!