Seniors have three opportunities to switch from a Medicare Advantage Plan to a Medicare Supplement Plan. The first is if they select a Medicare Advantage Plan for their Initial Enrollment Period when they turned 65 years old, and then decide they want to switch to a Medicare Supplement within the first year of having the Advantage Plan.
The second way to switch is to wait until the Annual Enrollment Period – which runs from October 15 to December 7 every year, disenroll from their Advantage Plan, enroll in a separate Part D Prescription Plan (PDP), and then apply for a Medicare Supplement starting the first of the New Year after they have gone back on to Original Medicare.
The third way to change from a Medicare Advantage Plan to a Medigap Plan is if you move outside your Medicare Advantage Plan service area – it allows you a guaranteed issue opportunity to get a supplement (A, B, C, D, F, K, or L) with any company.
What if I made the wrong choice?
If you initially chose a Supplement Plan when you first enrolled in Medicare, then dropped your Supplement for a Medicare Advantage Plan and instantly missed having your supplement, you have one year to go back and get your old Supplement Plan without having to prove evidence of insurability (answer the health questions on the application). Or, if you get a Medicare Advantage Plan during your Initial Enrollment Period and decide you don’t like it, you have one year to trade it in for a Medicare Supplement instead.
This ability to get a Medicare Supplement without having to answer the health underwriting questions is called “trial right,” and you can only make this switch once. This gives seniors the option to try a Medicare Advantage Plan without worrying that they won’t be able to get their Medigap Plan back.
In addition to being able to switch from Medicare Advantage to Medigap, you also get a 30-day trial when switching from one Medigap Plan to another Medigap Plan with another company. If you switch to a new plan and don’t love it, you can get your old plan back within 30 days, guaranteed by Federal law.
Am I healthy enough to switch plans?
If you aren’t within a trial right or one of the special enrollment periods mentioned above, you will have to qualify for your new Medicare Supplement by answering the company’s underwriting health questions. Usually the application has between 10-15 questions, asking whether you’ve experienced or been treated for certain conditions in the past 2 to 5 years. Most health conditions, excluding the most severe diseases, will not get your application automatically declined – unless there are multiple health conditions, such as high blood pressure, smoking, AND diabetes.
If you have multiple health conditions and you’re looking to switch supplements because the monthly premium on your current supp is too high, then an insurance broker can be a valuable asset. With the ability to shop multiple companies and compare their coverage of your health conditions and prescriptions, brokers can help you find a company that offers the best coverage for less. Insurance brokers do this free of charge, as they are compensated by the insurance company whether you get your plan directly from the company or through an insurance broker.
Will I pay more for a Medigap plan than for Medicare Advantage plan?
Seniors switching from a Medicare Advantage Plan to a Medicare Supplement Plan could see a bump in the monthly premium they’re used to paying. Instead of paying $0 per month for an Advantage Plan, they could be spending $150 or more a month for their Supplement. Although their monthly premium is higher with a Medigap Plan, their out-of-pocket costs for medical care are capped, so they generally won’t encounter unexpected medical expenses throughout the year.
So instead of spending $0 per month for a Medicare Advantage Plan that leaves them open to potential out-of-pocket costs up to $4,000-$6,000 or more, they’re spending $150 a month, totaling $1,800 over the course of the year for a Medicare Supplement – while enjoying the freedom of not having to stay within a network.
Do both plans cover my prescriptions?
One benefit of Medicare Advantage Plans is that they (usually) offer prescription drug coverage – whereas seniors with Medicare Supplements have to get a separate Part D Drug Plan, sometimes from another insurer. Whether you have a drug plan through your Medicare Advantage Plan or a PDP in addition to your Supplement, you may have additional deductibles, copays and coinsurance you’re required to pay for your medications.
Part D Drug Plans range in monthly premium from about $20 to more than $100, depending which formulary tier your medications belong to. In other words, generic medications will be lower on the insurer’s formulary tier than brand-name pharmaceuticals, and therefore have less expensive copays. Drug plans may also have a deductible that needs to be satisfied first before they can pay for their drugs with smaller more manageable copays.
The best way to shop your Part D Prescription Drug Plan is to go to Medicare.gov, create a simple account, and enter all the medications you take. Be sure to note down the date, your zip code and reference number so you can easily recall your medication list and re-shop drug plans the following year. Another option is to contact your local insurance broker to shop your options with your medication list, and they can help you enroll over the phone once they find a plan that takes all your medications.
