Switching From Medicare Advantage to Medigap

Switching from Medicare Advantage to a Medigap plan can be a wise choice in some cases. However, it won’t be perfect if a person leaves Medicare Advantage to find out they don’t have approval for the Medigap plan. Discover critical factors for smoothly switching from Medicare Advantage to Medigap, including eligibility, timing, and process. Ideal for informed healthcare plan decisions.

Why Is the Medicare Advantage Plan Good?

Healthcare beneficiaries prefer taking Advantage Plan, which provides medical services at lower premiums than Medigap. Also, the Advantage plans come with a Part D, strictly for drug prescription, so you don’t need any additional card. Moreover, the advantage plan covers extra benefits in routine checkups, gym memberships, dental, and other visionary services.

Guessing Why Would You Want to Switch:

Now, there might be two reasons: 

The Doctor:

Perhaps the most common reason to switch is that your doctor is no longer a part of the network you’re paying for. People often trust a doctor more than others, so it’s hard for them to start afresh with a new doctor every time the network changes. However, this is normal and happens occasionally, as the doctor’s contracts are renewed. 

The Referrals:

Another reason you would opt to switch might be the frustration of referrals. Not everyone enjoys being so bound that they have to get a referral before seeing a specialist or going for a screening or other things like operations. Some people might want to give up some savings in exchange for freedom from referrals. 

Ground Rules for Switching:

Annual Election Period:

The suggested time is between October 15th to December 7th. This period is known as the Annual Election Period. Since all the Medicare Advantage plans are for the whole year, the beneficiaries can switch to a different Advantage plan or return to their Medicare Basic plan.

You can switch by enrolling in another part D plan to cancel your current plan and return to the basic plan. 

Open Enrollment Period:

Another way is to use the Open Enrollment Period (OEP) to ensure the beneficiaries make a change once a year. The two options provided under OEP are;

• Switch from one Medicare Advantage plan to another
• Disenroll from the Medicare Advantage plan and enroll in the Medicare Basic plan/ Medigap plan

Other Election Periods:

In addition to the above-said periods, one can switch to other special election periods, offering beneficiary plan changes.

Do You Have the Approval?

It takes you back to Basic Medicare by quitting a Medicare Advantage package. Just Basic Medicare places you at greater risk for catastrophic medical expenses if you have a severe condition. There is no limit on the out-of-pocket payments for Medicare. 

For instance, with no limit on the expenditure, someone with cancer would pay 20 percent for their chemotherapy.

For this reason, most individuals returning to Medicare Advantage will choose to apply to replace their plan with a Medigap plan. However, you do not automatically qualify for Medigap unless you are involuntarily dismissed from the Medicare Advantage package.

A portion of health questions requires a Medigap plan application. To be eligible for coverage in most states, you must respond to any of these issues. A medical underwriter will check your application. 

A chronic condition such as congestive heart failure or COPD would disqualify you from virtually every Medicare supplement insurance carrier.

So, ensure you are confident you will be eligible for Medigap coverage before quitting your current coverage.

Preplan It:

Leaving your Medicare Advantage plan typically means you will need new coverage for the first month after the disenrollment. However, if you are adjusting the Annual Election Cycle, the effective date on any new insurance needs to be January 1st. Usually, quitting Medicare Benefit means you will miss the built-in Part D drug coverage.

This method can be significantly streamlined by consulting an insurance broker specializing in Medicare Advantage policies. Every year, our department performs thousands of Medicare Advantage plan switches. Our team is aware of all the right election periods to use. We will help you prepare for each move so you don’t miss anything important.

Reach out Today at NewMedicare.