A person can switch from a Medicare Advantage (Part C) plan to a Medicare plan with a Medigap policy. However, an individual can do so only during certain periods, with a few exceptions.
A Medicare Advantage (Part C) plan bundles coverage from Medicare Parts A and B (Original Medicare) and sometimes Part D.
Private companies administer Part C plans. These plans vary based on which medical services are available in a certain area, and people often must receive treatment from an approved network of healthcare professionals.
Medicare has several parts that cover in-hospital treatments, medical care, and prescription drugs. However, out-of-pocket costs usually include deductibles and coinsurance.
Medigap plans, or Medicare supplement plans can help people fund these extra costs. Individuals can enroll in these plans along with Original Medicare. However, a person cannot enroll in both Medicare Advantage and Medigap.
This article explains when a person can switch from a Medicare Advantage plan to a Medicare plan with Medigap and outlines some factors that people may wish to consider before making the switch.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Advantage and Medicare supplement insurance, also called Medigap, have several differences.
A person can enroll in a Medigap plan only if they have Original Medicare (parts A and B). However, enrolling in Medigap is not compulsory. It serves only as a supplemental policy to reduce out-of-pocket costs.
A person with a Medicare Advantage plan may find they could spend less money or have more inclusive benefits if enrolled with Original Medicare with a Medigap supplement.
Plus, not all regions offer Medicare Advantage policies. If a person moves out of an area that offers Medicare Advantage plans, they may need to find different coverage. They may choose to enroll in Original Medicare with a Medigap plan instead.
When a person qualifies for Medicare at age 65 and initially enrolls in Medicare Part B, they have a 6-month Medigap open enrollment period (OEP). During this time, an insurance company cannot denycoverage based on age or any preexisting health conditions.
However, after this OEP ends, an insurance company does not have to sell a person a Medigap policy, and companies may also charge more for a policy.
For this reason, people may find that they can save money if they sign up for Medigap within the first 6 months of when their Medicare benefits begin.
During an enrollment period, a person can take the following steps to switch from Medicare Advantage to Original Medicare plus Medigap.
It is possible to disenroll from a Medicare Advantage plan by contacting the insurance company directly and requesting a disenrollment form. People can also call Medicare at 800-633-4227 and ask for disenrollment from their plan, or they can visit their local Social Security office.
A person who previously had Medigap coverage before joining Medicare Advantage and has been enrolled in Medicare Advantage for under a year has the right to return to their previous Medigap policy as long as the insurer still offers it. If it is not available, the person can enroll in a new plan that the insurance company offers. People must switch back to Medigap within 63 days of leaving their Medicare Advantage plan.
Suppose a person has never enrolled in a Medigap plan. In that case, they can find available Medigap policies by searching Medicare.gov, contacting a State Health Insurance Assistance Program, or contacting an insurance agent or company to obtain a Medigap quote.
If a person is unsure about their rights or enrollment periods at any time, they can contact Medicare or visit their Social Security office.
A person can switch from Medicare Advantage to Medicare with Medigap at several different times.
Within 3 months of Medicare enrollment
If a person enrolls in Medicare Advantage when they first become eligible for Medicare, they can switch to Original Medicare and Medigap within the first 12 months of their plan.
This benefit protects people who find that the policy they first chose does not meet their healthcare needs. A person would still be within the Medigap enrollment window, and an insurance company cannot deny an individual a Medigap policy.
During the OEP for drug coverage
Two OEPs apply to Medicare Advantage plans. These are also when a person can drop their Medicare Advantage plan and return to Original Medicare.
The first enrollment period runs from October 15 to December 7 each year. This is the OEP for all Medicare plans, including Medicare Advantage and Medicare prescription drug coverage.
During this time, a person can return to Original Medicare. However, if they had prescription drug coverage through Medicare Advantage, they must enroll in Medicare Part D to maintain their prescription drug coverage.
During the Medicare Advantage OEP
From January 1 to March 31 each year, a person can switch from one Medicare Advantage plan to another or drop their Medicare Advantage plan altogether in favor of Original Medicare. During this time, a person can join a prescription drug plan and Medigap.
Although this period sounds similar to the OEP that runs from October to December, it works in a slightly different way. During this time, a person cannot switch from Original Medicare to Medicare Advantage. They can also not enroll in new prescription drug coverage or switch it if they already have Original Medicare.
During special enrollment periods
Special enrollment periods (SEPs) are periods during which a person can usually make changes to their Medicare plan without having a financial penalty. Examples of such changes include:
- changing addresses
- moving back to the United States after living out of the country
- living in or moving out of a nursing home or rehabilitation hospital
- being released from jail
- no longer being eligible for Medicaid
A person can contact Medicare if they are unsure whether or not they meet the SEP criteria.
The information in the table below can help people work out whether they would benefit from switching to a Medigap plan:
| Pros | Cons |
|---|---|
| Costs: If someone is not within the first 6 months of their Medigap OEP, an insurance company does not have to sell them a policy. If an insurance company does sell them a Medigap policy, they may need to pay a higher monthly premium. | Costs: If a person is not within the first 6 months of their Medigap OEP, an insurance company does not have to sell them a policy. If an insurance company does sell them a Medigap policy, they may need to pay a higher monthly premium. |
| Fewer out-of-pocket costs: A Medigap policy can make healthcare expenses more predictable. | Coverage: Medigap plans do not provide additional benefits that Medicare Advantage may offer, such as dental or vision care. |
| Overseas treatment: Several Medigap plans offer some degree of coverage for healthcare costs in foreign countries. Medicare Advantage plans do not usually cover overseas treatment. | Medical underwriting: If a person did not enroll in Medigap during their 6-month enrollment period, they may have to complete medical underwriting for an insurance company to cover them. People with preexisting medical conditions may not qualify. |
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
To get the best value premiums, a person should enroll in Medigap within 6 months of signing up for Medicare. Outside of certain enrollment periods and special circumstances, an insurance company cannot offer Medigap policies.
If a person finds that Medicare Advantage does not meet their needs, switching to Original Medicare may let them sign up for a new Medigap policy.
