Medicare Advantage and Medigap are examples of different insurance types you can have — just not at the same time. If you currently have Medicare Advantage, you can switch to Medigap during certain enrollment windows. Here’s what you need to know to make it happen.
If you want to switch from Medicare Advantage to Medigap insurance, there are several steps to follow. We’ve laid them out for you here:
- Step 1: Research currently available Medigap plans in your area. It’s important to think ahead on what’s available to you and what may best suit your needs before you leave your current Medicare Advantage plan. Ways to research include visiting Medicare.gov and searching available Medigap plans, calling your State Health Insurance Assistance Program (SHIP) and asking for a Medigap comparison shopping guide, or calling an insurance company you may wish to secure your plan with to find out potential costs.
- Step 2: Leave your current Medicare Advantage plan and return to Original Medicare. You can usually only do this during key times of the year, so mark your calendar. These times include within the first 12 months of enrolling, if this is your first time having Medicare Advantage; during the Medicare Advantage open enrollment period — between Jan. 1 and March 31; or during the annual election period for Medicare Advantage — between Oct. 15 and Dec. 7. You may also be able to leave your plan if you’re moving and your Medicare Advantage plan is now outside your service area.
- Step 3: Apply for a Medicare supplement or Medigap insurance plan. Note that it’s usually important to do this as quickly as possible after your Medicare Advantage plan coverage ends. Some insurance companies have rules about how long you have to apply without having to evaluate your health status, also known as medically underwriting your plan. Insurance experts call this guaranteed issue rights. Otherwise, you may have to pay higher health premiums or an insurance company could refuse to cover you altogether.
Typically, when a person applies for Medigap insurance, they do so during their 6-month open enrollment period. This is usually after they turn 65 and after their Medicare Part B goes into effect.
After that time, they have about 6 months to apply for a Medicare supplement plan. This is when an insurance company can’t refuse a person or charge them higher premiums based on their health status.
After this time, insurance companies for the most part can charge more for Medigap insurance. That’s why Medicare urges people to make careful choices about Medicare Advantage versus Medicare supplement plans.
However, sometimes you can regain guaranteed issue rights where you’re afforded the same selection process as your original Medicare supplement open enrollment period.
This includes if you determine within the first 12 months that a Medicare Advantage plan isn’t for you, if the Medicare Advantage plan stopped operating where you live, or if you moved outside the service area of your Medicare Advantage plan.
Also known as Medicare Part C, Medicare Advantage is a type of private insurance option available through Medicare. These plans are a bundle of coverage that includes:
- Medicare Part A, or hospital or inpatient stay coverage
- Medicare Part B, or medical services and supplies coverage
- Medicare Part D, or prescription drug coverage
Some people find bundling these services into one monthly payment is easier to understand and sometimes more cost-effective. You can’t have both a Medicare Advantage and Medigap plan — you have to pick one or the other.
You can join Medicare Advantage after age 65 and after you’ve enrolled in Medicare Part A and B. If you have end-stage renal disease (ESRD), you can usually only join a special Medicare Advantage plan called a Special Needs Plan (SNP).
However, if you joined Medicare Advantage before you had ESRD, you can usually keep your plan.
Advantages of a Medicare Advantage Plan
- Medicare Advantage Plans may cover some services traditional Medicare doesn’t, such as vision, dental, or wellness programs.
- These plans may offer packages that are tailored to people with certain chronic medical conditions who need particular services.
- These plans include prescription drug coverage.
- Medicare Advantage Plans can be less costly if a person only needs to see the list of approved medical providers on a Medicare Advantage plan. This is why Medicare Advantage plans are commonly HMO, PPO, or Private-Fee-For-Service plans.
Disadvantages of a Medicare Advantage Plan
- Some plans may limit doctors you can see, which could result in out-of-pocket expenses if you see a doctor who isn’t in-network.
- Some people who are very sick may find Medicare Advantage is very expensive due to out-of-pocket costs and needing to see providers who aren’t eligible under a certain plan.
- Some plans may not be available based on a person’s geographic location.
Choice or the absence of it is usually the reason why a person likes or dislikes a Medicare Advantage plan.
Insurance companies usually limit the amount of providers as a cost savings. If a person finds they start needing to see a lot of specialists, Medicare Advantage may start to be a less-appealing option.
Medicare supplement insurance (Medigap) is an insurance policy from a private insurer that helps support some of the costs traditional Medicare doesn’t cover. Medigap coverage may include costs like coinsurance, deductibles, and copayments.
A Medigap policy is a supplement to Medicare Part A and Part B benefits. You’ll still pay your Medicare Part B premium as well as a Medigap premium.
Unless a person purchased their Medigap plan before 2006, the available plans don’t cover prescription drugs. You’ll need Medicare Part D as well if you want prescription drug coverage.
Medigap policies are standardized. This means you can pick from several policies that are essentially the same across the country. However, insurance companies can charge different prices for Medigap policies, which is why it pays to shop around.
You can buy a Medigap policy during the 6-month open enrollment period that occurs after you’ve turned age 65 and have enrolled in Medicare Part B. If you don’t enroll in this time, insurance companies may increase the monthly premiums.
Some states require insurance companies to sell at least one type of Medigap policy to those under age 65 who qualify for Medicare. Other states may not have Medigap plans available to those under age 65 who have Medicare.
Advantages of a Medigap plan
- Medigap plans are standardized, which means if you move, you can still keep your coverage. You don’t have to find a new plan, like you usually do with Medicare Advantage.
- The plans can help supplement healthcare costs that Medicare doesn’t pay, which reduces a person’s healthcare financial burden.
- While Medigap plans can often cost more on the front end than Medicare Advantage plans, if a person becomes very ill, they can usually reduce costs.
- Medigap plans are usually accepted at all facilities that take Medicare, usually making them less restrictive than Medicare Advantage plans.
Disadvantages of a Medigap plan
- Medigap plans require paying an additional insurance premium, which may be confusing for some people.
- Monthly premium is usually higher than Medicare Advantage.
- Plan F, one of the most popular Medigap plans, covers most out-of-pocket expenses. It’s going away in 2020 for new Medicare recipients. This may affect the popularity of Medigap plans.
- Use sites like Medicare.gov to compare pricing of plans.
- Call your state’s insurance department to find out if a plan you’re considering has had complaints against it.
- Talk to your friends who have Medicare Advantage or Medigap and find out what they like and dislike.
- Contact your preferred medical providers to find out if they take a Medicare Advantage plan you’re evaluating.
- Evaluate your budget to determine how much you can reasonably expect to pay on a monthly basis.
Medicare Advantage and Medigap plans are parts of Medicare that can potentially make health coverage less expensive.
While choosing one or the other typically requires some research and timing, each has the potential to save you money in healthcare costs should the need arise.
If you aren’t sure where to start, call 1-800-MEDICARE where government representatives can help you find the resources you need.