Can You Switch from Medicare Advantage to Original Medicare and Buy a Supplement?

Can You Switch from Medicare Advantage to Original Medicare and Buy a Supplement?

Switching from Medicare Advantage (MA) to Original Medicare can be confusing, especially if you're considering adding a Medigap policy afterward. This guide will break down what you need to know about making this switch, including when you can make the change and how to get a Medigap plan.

When Can You Switch?

Medicare has specific times when you can switch from Medicare Advantage back to Original Medicare. These are called "enrollment periods." The most common time is during your Annual Election Period (AEP), which runs from January 1 through March 31 each year. If you make this change by the end of February, your new coverage will start on April 1.

Another key period is when you have a “qualifying event.” A qualifying event could be moving out of your current Medicare Advantage plan’s service area or losing your job if it was tied to your employer’s group health coverage. In these cases, you can switch back to Original Medicare at any time during the year.

If you’re new to Medicare and are currently in a Medicare Advantage plan, there's also an Initial Coverage Election Period (ICEP) when you first become eligible for Medicare Parts A and B. During this 7-month window, which starts three months before your Part B start date, you can choose Original Medicare instead of staying with your current MA plan.

What Happens When You Switch?

When you switch from a Medicare Advantage plan to Original Medicare, there are several things that change:

1. Coverage: With Original Medicare, you get coverage through Parts A and B. Part A covers hospital stays, while Part B pays for outpatient care like doctor visits and some preventive services.

2. Deductibles and Co-pays: You may have to pay deductibles and co-pays under Original Medicare that weren’t present in your Medicare Advantage plan. For example, you’ll need to cover the Part A deductible if you’re hospitalized.

3. Prescription Drugs: Your prescription drug coverage will end when you leave a Medicare Advantage plan. If your MA plan included prescription drug coverage (Part D), you'll need to sign up for a standalone Part D prescription drug plan or enroll in an Original Medicare + Medigap policy that includes drug coverage.

Adding a Medigap Plan

After switching back to Original Medicare, many people choose to add a Medigap (Medicare Supplement) plan. A Medigap plan can help cover some of the costs that aren't paid by Original Medicare, like deductibles and co-pays.

You have a six-month window to buy a Medigap policy when you first enroll in Medicare Part B if you're still in your Initial Coverage Election Period (ICEP). If you switch from a Medicare Advantage plan later on, this special enrollment period no longer applies. In that case, you may face medical underwriting and be asked about pre-existing conditions to qualify for coverage.

If you're healthy and don't have any existing health issues, getting a Medigap policy should go smoothly. However, if you do have significant health problems, insurers might deny your application or charge higher premiums based on the medical underwriting process.

What If You’re Not in Your ICEP?

Even if you missed your Initial Coverage Election Period (ICEP), you can still shop for a Medigap plan during open enrollment periods. Open enrollment typically occurs from January 1 to March 31 each year, and any changes take effect on April 1.

If you have a qualifying event like moving out of your Medicare Advantage plan’s service area or losing employer coverage, you may be able to buy a Medigap policy without medical underwriting at those times. However, this depends on the state where you live as some states provide guaranteed-issue rights in these situations.

Summary

Switching from Medicare Advantage back to Original Medicare is possible during specific enrollment periods and qualifying events. After making that switch, you can consider adding a Medigap plan to help cover additional costs not covered by Original Medicare. If you're still within your Initial Coverage Election Period (ICEP), the process for getting a Medigap policy should be straightforward. For those outside of this period, it's important to shop around and consider open enrollment periods or qualifying events that might offer better chances at coverage.

Not affiliated with or endorsed by the federal Medicare program or any government agency.