Whats Medigap And Whats The Big Deal About Losing Medigap
Medigap is like buying extended coverage for Original Medicare. Medigap helps you cover out-of-pocket costs of coinsurance, copays, and deductibles. There are several types of Medigap policies to choose from:
- Medigap Plan A
- Medigap Plan L
- Medigap Plan N
* Please note that Medigap Plans C and F are no longer available to new Medicare beneficiaries. If you already have either Medigap plan and you leave the plan, you will not be able to re-enroll.
When you first enroll in Medicare, you get a signup period called guaranteed issue rights. This means you can enroll in a Medigap plan without medical underwriting.
Medical underwriting is the process of figure out a persons health insurance premium. Its based on several factors, including their health. It also means that a healthcare insurer can deny coverage to people who dont meet health standards.
Outside of your initial enrollment period, youre not offered guaranteed issue rights. That means youd be subject to medical underwriting. For people with pre-existing conditions, this means more expensive monthly premiums. Even denial of coverage.
Luckily, when you decide to try Medicare Advantage for the first time, youre given trial rights. These give you time to decide if you like your new health insurance. If you dont like your plan, you can switch back to Original Medicare and keep your guaranteed coverage.
Lets explore that further.
The Medicare Annual Enrollment Period
The Medicare Annual Enrollment Period lasts from October 15 through December 7.
During Annual Enrollment, you may:
- Sign up for a Medicare Advantage plan
- Leave an Advantage plan to return to Original Medicare
- Leave one MA plan for another
- Join a standalone Medicare Part D plan
- Drop your Medicare prescription drug plan
Changes you make during Annual Enrollment take effect on January 1.
Reasons You May Want To Make A Change
There are just a few reasons why you might want to change plans::
- You didnt know you signed up for a Medicare Advantage plan.
- The medicines you take arent covered by the plans formulary or cost a lot more.
- You signed up for a Medicare Advantage plan that didnt include drug coverage.
- The plan doesnt cover the services thought it would.
Its a good idea to go use your plan early to make sure you get the services and coverage and services you thought you would get. If you dont, then you have this short window to make a change.
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When And How Can I Disenroll
If youre still sure about disenrolling from your Medicare Advantage plan, you can do so during a specific time period each year: January 1 through February 14. This is a designated disenrollment period. You cant use it to switch from one MA plan to another or join an MA plan if you have original Medicare. You can only do two things during this period:
- Leave your Medicare Advantage plan and join original Medicare
- Sign up for a Medicare Part D drug plan if you switch to original Medicare
The process for switching depends on your plan. Start by contacting your plan provider or 1-800-MEDICARE for specific information. Make sure that youre getting the coverage you want before dropping your MA plan. If the plan isnt working, it may be worth waiting until the open enrollment period October 15 to December 7 to find a new MA plan that better fits your needs. No matter what you choose, carefully review your options before signing up for a plan, and dont hesitate to ask questions first.
Can You Join A Medigap Plan After Leaving Medicare Advantage
Medicare Supplement Insurance, more commonly known as Medigap, helps pay some of your out-of-pocket costs under Original Medicare. You cannot have both Medigap and a Medicare Advantage plan.
If you plan to stay with Medicare Parts A and B, we nearly always recommend applying for a Supplement plan during your Medigap Open Enrollment Period, which begins once you are aged 65 or older AND have Medicare Part B. Your Medigap OEP is one of the few times your application will not undergo medical underwriting thanks to guaranteed issue rights.
Medical underwriting is how the insurance company determines whether to sell you a Medigap policy and what to charge for it. Guaranteed issue rights mean that you cannot be denied a Medicare Supplement policy nor charged a higher premium â even if you have preexisting medical conditions.
If you leave an Advantage plan to return to Original Medicare, the only way to avoid medical underwriting is if this was both the first time you had Part C AND you make the switch back to Original Medicare within 12 months.
Some states offer a bit more flexibility when it comes to joining a Medigap plan. And two â New York and Connecticut â don’t allow medical underwriting at all. For details on your state’s Medicare Supplement guidelines, check your State Health Insurance Assistance Program .
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Changing From Medicare Advantage To Medigap
You cannot enroll in both Medicare Advantage and Medigap. If youd like to switch from an MA plan to a Medigap plan alongside Original Medicare, you must meet certain requirements or do so during a specific time of the year.
First, youd drop your MA plan coverage and return to Original Medicare , then youd apply for a Medigap insurance plan. Or, you can apply for the Medigap plan first, and once you are approved, drop your MA coverage.
You can change from Medicare Advantage to Medigap coverage if:
- You move outside your plans service area
- Your MA plan leaves your area
- Your MA plan ends its contract with Medicare
- You move into a nursing facility or other institution, or move from a nursing facility back home
- You joined a Medicare Advantage plan when you were first eligible for Part A, and within the first 12 months of joining, decide you want to switch back to Original Medicare
Otherwise, youre able to change plans during a designated enrollment period.
Keep in mind if you switch from an MA plan to Medigap, youll likely be losing your Part D prescription drug coverage . If this is the case, youll want to be sure to enroll in a stand-alone drug plan as well.
What Can I Do During Medicare Advantage Open Enrollment
During Medicare Advantage Open Enrollment, you can:
- Switch to a different Medicare Advantage plan or Medicare Advantage Drug Plan
- Go back to Original Medicare
- If you go back to Original Medicare, you can enroll in a Medicare Part D prescription drug plan.
You can only make one change between January 1-March 31, so make sure you choose wisely.
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Whats The Difference Between Original Medicare And Medicare Advantage
Original Medicare is a health plan administered by the federal government. Its also known as Medicare Part A and Medicare Part B,. With Original Medicare, you work with any doctor or healthcare provider accepting Medicare. And you dont need referrals to see a specialist, so long as that specialist accepts Medicare.
You can also add a Medigap policy to your health plan. Medigap is also known as Medicare Supplement Insurance.
Medicare Part C, or Medicare Advantage, works in a different way. With Medicare Advantage, you get health insurance through a private health insurance company. That health plan must follow guidelines from the Centers for Medicare & Medicaid Services . It must offer at least the same coverage as Original Medicare.
With Medicare Advantage, you work with doctors and providers within your healthcare network. You may need a Primary Care Physician to recommend you to see a specialist. And you may need to follow other network guidelines.
However, most Medicare Advantage plans offer additional benefits. That means coverage and services not available to Original Medicare beneficiaries.
You cant have both Medicare Advantage and Medigap. With either plan, you can add Medicare Part D so long as you dont already have prescription coverage.
Ready To Change Coverage Youre Not Alone
Youve done your homework, carefully compared Medicare coverage options, and youve become one of more than 63 million Americans enrolled in some kind of Medicare plan.
And now whats this? Youre ready to change your Medicare plan or your coverage?
Youre not alone. Hundreds of thousands of Medicare enrollees take a hard look at their Medicare coverage and decide to switch each year . Many beneficiaries are looking for improvement in their access to providers or specific medications, while others complain that they chose coverage based on inaccurate information theyd received. Others cite claims denials for medical services they expected would be covered.
But while there are a variety of reasons a consumer might want to make a leap to new coverage, the options for coverage switches are limited. With that in mind, weve put together a summary of your options for changing your coverage.
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Can I Keep My Medicare Coverage In A New Location
In this unpredictable world, one thing is for certain: life happens. No matter what age you are, there is always some possibility that you will want to relocate. Perhaps you want to be closer to family as you age, or youd just prefer a more accommodating climate.
No matter the reason, if you are moving, youll want to make sure you have access to the proper Medicare health insurance you require. While some parts of Medicare do travel with you wherever you roam, there are other parts that are location-specific. Lets take a deeper look at each part of Medicare and what you should do in the event that you decide to relocate.
Can You Change Your Medicare Plan Anytime
You can change your Medicare plan anytime if you encounter certain, specific unforeseen circumstances. But generally, you can join, change or drop your Original Medicare health plan, a Medicare Advantage plan only during Medicares three enrollment periods.
When You Can Change Medicare Coverage
- Initial Enrollment Period
- The initial enrollment period is when you first become eligible for Medicare. This includes the seven-month period that includes the month you turn 65, the three months before your birthday month and the three months following your birthday month.
- Open Enrollment Period
- Original Medicares open enrollment period runs from Oct. 15 through Dec. 7 of each year. If you join, change or cancel your Medicare plan, the change will automatically take effect on Jan. 1 of the new year as long as the new plan gets your request by Dec. 7.
- Medicare Advantage Open Enrollment Period
- The open enrollment period for Medicare Advantage runs from Jan. 1 through March 31 of each year. During this period, you can switch from one Medicare Advantage plan to another. You can also switch from your Medicare Advantage plan to Original Medicare and join a Medicare Part D prescription drug plan at the same time. You can make this change to Original Medicare only once.
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Changing From Medicare Advantage To Original Medicare
Changing from Medicare Advantage to Original Medicare is a very simple process once youre ready and eligible to switch. There are three ways you can make the change:
When Can You Disenroll From A Medicare Advantage Plan
Like switching Medicare Advantage Plans, you can only disenroll from a Medicare Advantage Plan during certain times of the year.
You can disenroll from your plan during the annual election period, special election periods or during the annual Medicare Advantage Open Enrollment Period, Dworetsky says. Medicare will automatically disenroll you from your old plan if you switch to a different Medicare Advantage plan during any of these periods.
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Can I Switch From Medicare Advantage To Medigap
There are generally only a few situations that allow you to leave Medicare Advantage and pick up a Medigap plan without being subject to medical underwriting.
If you joined a Medicare Advantage plan when you were first eligible for Medicare and you arent happy with the plan, youll have special rights to buy a Medigap policy if you return to Original Medicare within 12 months of joining.
If you are moving to a different state or part of the state and your Medicare Advantage plan does not serve that area, you also have special rights to return to Original Medicare and pick up a Medigap plan.
Remember, If you had a Medigap policy in the past then left it to get an MA plan, when you return to Original Medicare, you might not be able to get the same Medigap policy back or in some cases, any Medigap policy unless you have a trial right or guaranteed issue right.
Annual Medicare Advantage Open Enrollment Period
For Medicare Advantage enrollees who are no longer in their trial period, theres an annual Medicare Advantage open enrollment period that became available starting in 2019. It runs from each year, and allows Medicare Advantage enrollees to switch to Original Medicare or to a different Medicare Advantage plan.
The ability to switch plans during the January March enrollment period is limited to one plan change per year. This open enrollment period replaced the Medicare Advantage disenrollment period that was used from 2011 to 2018, and provides more flexibility to Medicare Advantage enrollees .
When Medicare Advantage enrollees switch to Original Medicare during the January-March open enrollment period, theyre also eligible to purchase a Part D Prescription Drug Plan. But a person who has Part D coverage with Original Medicare cannot switch to a different Part D plan during the January March open enrollment period, since this window only applies to Medicare Advantage enrollees.
Alternatively, you can switch to a different Medicare Advantage plan during this period, if the one you have is not meeting your needs.
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My Drug Plans Formulary Changed In The Middle Of The Year Is That Allowed
Part D plans sometimes change their formularies during the course of the year. This happens because new drugs come on or are taken off the market, generic versions of a brand name drug become available or there are new clinical guidelines about the use of medication. Part D plans are required to provide 60 days notice to all plan members about a formulary change before it happens.
Is Your Healthcare Plan Still Meeting Your Healthcare Needs
Are changes to your current Medicare plan costing you a little bit more this year? Are you taking any new drugs that may cost less on another plan? Is your doctor still in your plans network? Plans can change from year to year. Maybe its time to consider your options. Our can help you compare our plans costs and coverage with your current plans to help you make sure youre getting the most from your healthcare dollar.
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Understanding Your Trial Rights
The first time you enroll in Medicare Advantage youll be granted Medigap trial rights. Thats true whether its during your initial enrollment period or later. Your Medicare Advantage trial rights extend over is a 12-month window. The window begins the first month of your Medicare Advantage coverage.
During that window, you can drop Medicare Advantage and return to Original Medicare. You may also re-enroll in your Medigap plan so long as its still available. But youll need to wait for certain times of the year to switch plans.
Want to disenroll from Medicare Advantage and re-enroll in Original Medicare? Youll need to wait for an Open Enrollment Period. These periods are:
- Medicare Advantage Open Enrollment from January 1 to March 31 annually, or
- Fall Open Enrollment Period from October 15 to December 7.
However, you can make the switch outside of these periods if you qualify for a Special Enrollment Period .
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When Can I Switch From Medicare Advantage To Medicare Supplement Insurance
by Christian Worstell | Published April 26, 2021 | Reviewed by John Krahnert
If youre enrolled in a Medicare Advantage plan, and wish to switch to a Medicare Supplement Insurance Plan, you must drop your Medicare Advantage plan and enroll in Original Medicare .
You can do so during certain enrollment periods that occur throughout the year.
Find out when they are, and what steps to take to ensure you get the right coverage for you.
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Medicare Annual Election Period
Also known as Medicare open enrollment, AEP lasts from October 15 through December 7. If you choose to change from one Medicare Advantage plan to a different one, or if you want to completely disenroll from your Medicare Advantage plan during this time, the cancellation will take effect on January 1.
- You can also enroll in a Medicare Part D prescription drug plan during this time.
Why Switch To Medicare Advantage
Medicare Advantage provides all the benefits offered by Medicare Part A and Part B, and most Medicare Advantage plans also include prescription drug coverage. If youre relatively healthy or you dont frequently use healthcare, switching to Medicare Advantage could end up saving you money.
Beyond potential savings, many people switch to Medicare Advantage for supplemental benefits.
Supplemental benefits are items and services that Original Medicare doesnt provide. They can include the typical vision, dental, and hearing benefits, or even a membership to SilverSneakers or Silver& Fit. Recently, however, plans are going beyond typical supplemental benefits and including extras such as an allowance for over-the-counter medications, transportation services, and meal delivery. Many plans offer these benefits as a free perk, while other plans require an additional premium for extras such as dental and vision.
Here is a list of supplemental benefits available through Medicare Advantage and the percentage of Medicare Advantage enrollees who have that benefit as part of their plan:
Data from Kaiser Family Foundation. Updated 5/18/201
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