Table of Contents
| Section | Jump to Section |
|---|---|
| Medicare Basics | Go to Medicare Basics |
| Understanding Medicare Advantage | Go to Medicare Advantage |
| What is a Medicare Supplement (Medigap) Plan? | Go to Medigap |
| Steps to Switch from Medicare Advantage to Medigap | Go to Steps to Switch |
| Medical Underwriting and Special Enrollment Periods | Go to Medical Underwriting |
| Pros and Cons of Switching | Go to Pros and Cons |
| FAQs | Go to FAQs |
Medicare Basics
Medicare is a federal health insurance program for individuals aged 65 and older, as well as certain younger people with disabilities. It consists of multiple parts:
- Medicare Part A covers hospital stays and inpatient care.
- Medicare Part B covers doctor visits, outpatient care, and medical services.
- Medicare Part C (Medicare Advantage) is a private insurance alternative to Original Medicare.
- Medicare Part D provides prescription drug coverage.
Many beneficiaries choose between Original Medicare and Medicare Advantage based on their healthcare needs and budget.
Get Your Free Medicare Supplement Quote
Find the best plan at the lowest price. Get your personalized quote today!
Get My QuoteUnderstanding Medicare Advantage
Medicare Advantage (Medicare Part C) is a plan offered by private insurance companies that provides benefits covered by Original Medicare (Parts A and B). These plans often include Medicare prescription drug coverage, vision, dental, and wellness benefits.
Key Features of Medicare Advantage Plans:
- Lower monthly premiums but with higher out-of-pocket costs.
- Limited provider networks, meaning you must use doctors and hospitals within the plan’s network.
- Many plans include prescription drug coverage.
- Plans may require preauthorization for certain services.
Compare Medicare Advantage Plans Near You!
Schedule a CallWhat is a Medicare Supplement (Medigap) Plan?
A Medicare Supplement (Medigap) plan helps cover out-of-pocket costs that Original Medicare doesn’t cover, such as:
- Deductibles
- Copayments
- Coinsurance
Unlike Medicare Advantage plans, Medigap policies do not include prescription drug coverage, so you would need a separate Medicare Part D plan.
Key Features of Medigap Plans:
- Higher monthly premiums but lower out-of-pocket costs.
- You can see any doctor that accepts Medicare (no network restrictions).
- Medigap only works with Original Medicare, not Medicare Advantage.
Steps to Switch from Medicare Advantage to Medigap
If you want to switch from a Medicare Advantage plan to a Medigap plan, follow these steps:
1. Switch to Original Medicare
You must first leave your Medicare Advantage plan and return to Original Medicare (Parts A and B). This can be done during:
- Medicare Advantage Open Enrollment Period (January 1 – March 31)
- Annual Election Period (AEP) (October 15 – December 7)
- Special Enrollment Period (SEP) (if you qualify)
2. Buy a Medigap Policy
Once enrolled in Original Medicare, you can apply for a Medigap plan. If you are outside your Medigap Open Enrollment Period, you may be subject to medical underwriting.
3. Enroll in a Medicare Part D Plan (if needed)
Since Medigap plans do not include prescription drug coverage, you’ll need to enroll in a Medicare Part D plan.
Medical Underwriting and Special Enrollment Periods
6-Month Medigap Open Enrollment Period
Your best time to buy a Medigap policy is during your 6-month Medigap Open Enrollment Period, which starts when you first enroll in Medicare Part B.
Medical Underwriting
If you apply for a Medigap plan outside of this period, insurance companies can use medical underwriting to determine your eligibility and premium rates.
Special Enrollment Periods
Some qualifying events allow you to switch from Medicare Advantage to Medigap outside of standard enrollment periods:
- Moving out of your Medicare Advantage plan’s service area.
- Your Medicare Advantage plan leaves the market.
- Losing other health coverage.
Find a Medicare Supplement that fits your budget today!
Explore PlansPros and Cons of Switching
Pros of Switching to Medigap
✔ Freedom to choose any doctor that accepts Medicare.
✔ Lower out-of-pocket costs for medical services.
✔ No network restrictions.
Cons of Switching to Medigap
✖ Higher monthly premiums compared to Medicare Advantage.
✖ Medical underwriting may apply if switching outside the open enrollment period.
✖ No additional benefits (e.g., vision, dental, or wellness programs).
Frequently Asked Questions
Can I switch from Medicare Advantage to Medigap anytime?
No. You can only switch during Medicare’s open enrollment periods or if you qualify for a Special Enrollment Period.
Do I need a separate prescription drug plan if I switch to Medigap?
Yes, Medigap does not include prescription drug coverage. You will need a Medicare Part D plan.
What happens if I miss my 6-month Medigap Open Enrollment Period?
If you apply for Medigap outside of this period, insurance companies may require medical underwriting, which could result in higher premiums or denial of coverage.
Can I switch back to Medicare Advantage if I don’t like Medigap?
Yes, you can switch back during the Medicare Advantage Open Enrollment Period (January 1 – March 31) or the Annual Election Period (October 15 – December 7).
Does every insurance company offer Medigap plans?
No. Medigap plans are standardized, but availability varies by state and insurer. Always check with your insurance agent or state insurance department.
Conclusion
Switching from Medicare Advantage to a Medigap policy requires careful planning, especially regarding enrollment periods and medical underwriting. Understanding the difference between Medicare Advantage and Medigap can help you choose the best Medicare insurance based on your needs.
If you’re unsure, consult an insurance agent or contact your state insurance department for guidance.
