NEW YORK, May 10, 2021 (Newswire.com) - When you're choosing healthcare, the choice between Medicare Advantage and Original Medicare is essential. If you've opted for Medicare Advantage and are thinking about switching to Original Medicare, you may be wondering if you can still qualify for Medicare supplement plans, also known as Medigap.
The good news is that it is possible to switch from Medicare Advantage to Medicare supplement, but it can only be done at certain times.
Understanding Medicare Advantage vs Medicare supplement plans
Medicare Advantage, also known as Medicare Part C, is a private insurance alternative to Original Medicare. Like other private insurances, it has a network of providers it works with — however, it also needs to meet coverage standards set by the federal government for Medicare beneficiaries.
Original Medicare is the federal insurance program available to any US citizens or permanent residents over the age of 65, or younger people who meet certain criteria. Original Medicare covers 80% of all Medicare-approved health expenses, but the coverage has some essential "gaps." That's where Medicare supplement plans, aka Medigap, come in.
Medigap is a supplemental insurance offering that you can buy in addition to Original Medicare. Medigap comes in standardized plans and has an additional monthly premium on top of the Original Medicare Plan B premium. The benefits of Medigap plans can include lower copayments, coinsurance, health coverage while abroad and out-of-pocket maximums for annual health spending.
How to switch from Medicare Advantage to a Medicare supplement plan
If you've joined a Medicare Advantage plan for the first time and have had the plan for less than a year, you can return to Original Medicare and buy a Medigap plan due to your "trial right." If you had a previous Medigap policy, you may be able to get the same policy. If you joined a Medicare Advantage plan before buying any Medigap policy, you can buy any available Medigap policy.
To switch from Medicare Advantage to a Medicare supplement plan outside of the first year of your Medicare Advantage plan is more complicated. First, you should find the Medigap policy you want. Then find the appropriate time to switch your plan. During that time, apply for the Medigap policy — but be aware you may need to meet certain medical underwriting requirements to qualify. If you're approved for the Medigap policy you want, disenroll from your Medicare Advantage plan and buy the Medigap policy immediately.
When can you switch from Medicare Advantage to Medicare supplement?
It's possible to switch from Medicare Advantage to Original Medicare at several regular intervals, as well as due to life changes.
Within your first year of your Medicare Advantage plan: You can change back to Original Medicare at any time during your first year of having Medicare Advantage. If you had a Medigap plan before, you may be able to return to the same plan. If you never bought Medigap, you can purchase any Medigap plan of your choice.
During open enrollment: Every year, there is an open enrollment period for Original Medicare from October 15 through December 7, and an open enrollment period for Medicare Advantage from January 1 through March 31. It's easy to disenroll from Medicare Advantage during both open enrollment periods, either by going to your Social Security Office, calling 1-800-MEDICARE, or contacting your Medicare Advantage insurer.
Special circumstances: There are special circumstances that allow you to switch from Medicare Advantage to Original Medicare. These include moving away from your Medicare Advantage plan's service area, being admitted to long-term care, or changes to your Medicaid eligibility. There are also other, less common special circumstances involving other insurance coverage or a technical error that you should contact your Social Security Office about if you believe it may apply to you.
Source: iQuanti, Inc.