You’ve decided you no longer want your Advantage Plan, and instead want to apply for something that has a little more coverage.
Going from Medicare Advantage to a Supplement is very easy. As long as you are within the correct enrollment period, you can apply for coverage by answering a few health questions. Most people do this during the Annual Enrollment Period. Once you are approved, your coverage will start January First. Make sure not to drop your current coverage until you have documents showing you’ve been approved.
Why do most people leave their Advantage Plan?
Suppose you joined a Medicare Advantage plan because it had little to no monthly premiums.
Now that you’ve used it, you realize it wasn’t the low-cost alternative you thought it would be.
It is not uncommon to buy a Medicare Advantage Plan then decide that it does not meet your needs.
You want a plan that would be more cost-effective and does a better job of covering your providers.
Switching from Advantage to Original Medicare is easier than you think.
As long as you understand the different enrollment periods and regulations, making changes to your coverage can be a breeze.
Keep reading to learn more.
What is Medicare Advantage?
Medicare Advantage is coverage that you can get as an alternative to Medicare.
It combines your hospital and medicare coverage into one plan. Most plans also include prescription drug benefits as part of the package.
Instead of being on traditional Medicare, you would be in an HMO or PPO type program. It combines all your benefits into one plan.
In addition to the basic coverage, it may include programs like Dental and Vision, as well as gym memberships.
The premiums are usually lower, but you do limit your coverage and your expenses could be higher.
You can read more details about Medicare Advantage Plans here.
How is Medicare Supplement different from Medicare Advantage?
As you read above, a Medicare Advantage plan is an alternative to Medicare.
A Medicare Supplement, or Medigap plan, is a plan that you can purchase in addition to your Medicare coverage.
Unlike Advantage, you keep your Medicare Benefits as primary.
Medigap plans are typically more expensive, but they offer more benefits. In some instances, as much as 100% coverage.
You will need a separate drug plan if you decide to get a Supplement and stay with original Medicare.
We talked about the details of Supplements here.
Switching from Medicare Advantage to a Supplement
Maybe you chose a Medicare Advantage plan over a Medicare Supplement because of the lower monthly premiums.
However, after being on the coverage, you notice the out of pocket costs on your Advantage plan is a lot higher.
You decide you want to pay a higher monthly premium for a Medicare Supplement to lower your out of pocket medical expenses.
There are a couple of different ways to do so:
- Medical Underwriting
- Enrollment Periods
- Trial Right
When you are new to Medicare, you can purchase any supplement you want regardless of any pre-existing conditions you might have.
If you are not new to Medicare, you will have to go through medical underwriting.
Each company has different guidelines they use to approve someone.
Being subject to medical underwriting means you have to answer health questions on your application for coverage.
The insurance company examines your medical and prescription drug history to make their decision.
Having a pre-existing condition does not automatically disqualify you.
Some companies do not ask health questions at all. At the same time, some states do not allow companies to ask about your health.
Most insurance agents know the different guidelines.
Just make sure to work with someone who represents multiple companies and look at your options.
There are a couple of times during the year when you can switch from an Advantage plan to Original Medicare and get a Supplement.
- The Annual Election Period (AEP)
- The Medicare Advantage Open Enrollment Period (MA-OEP)
October 15 through December 7, with a January 1 start date for new coverage.
January 1 through March 31, with new coverage beginning the first of the month following the month you apply.
We talked about these enrollment periods in more detail in another post, which you can read here.
Again, switching during either of these periods is contingent on the fact that you can medically qualify, and the insurance company approves your application.
The exception to this guideline is if you are within your Trial Right period, which allows you to leave your Medicare Advantage plan and get a Supplement with no health questions.
Keep reading to learn more.
You have a Trial Right option to leave the Advantage Plan back to Original Medicare if you:
- Joined an Advantage plan when you were first eligible for Medicare Part A and Part B at age 65.
- It’s been less than a year that you’ve been on that plan.
- You got a Medicare supplement plan, switched to Advantage, and want to go back within the same year.
In most cases, this Trial Right window allows you to purchase any Medicare supplement available to you in your area.
There are almost no restrictions on which supplement plan you can get.
Important note – Both Part A and Part B need to start the same month you turn 65.
You can apply for a supplement as early as 60 days before your Advantage coverage ends.
Medicare gives you 63 days after your coverage ends to get a Supplement with no health questions.
If you took out a Supplement, then went on Advantage but want to go back to a Supplement, you can only do so with the same one you had originally.
If the original plan is no longer available, you can use your Trial Right to purchase any Plan you’d like.
Let’s Look at Some Examples
Mary joined Super-Value Plus Advantage Plan when she was new to Medicare.
She’s always had been perfectly healthy and wasn’t too worried about going to the hospital anytime soon.
She decided she would save her money than pay a higher premium for a Medicare Supplement.
Unfortunately, Mary was in a car accident.
She had numerous injuries that required extensive testing, procedures, surgeries, and follow-ups.
Mary had different copayment amounts associated with each visit and treatment and ended up paying thousands of dollars out-of-pocket.
Her cost was $6540 after her Medicare Advantage plan paid its portion.
Mary realized that a year’s worth of monthly premiums for a Medicare Supplement would have cost much less than the medical bills she incurred on her Advantage plan.
She is new to Medicare and has only had her Advantage plan for a few months.
Using her Trial Right option, she purchased a Medicare Supplement plan.
Going on Medicare can be very overwhelming.
Sometimes we make a decision and realize that it’s not the best option to meet our needs.
The good news, there are programs and rules in place that allow you to change your mind.
Remember, it’s is very uncommon to be stuck in any one program.
Knowing what your rights are and what options you have can help you make the changes you need.
If you do not like your benefits, you can always change them.
If you have any questions, use the search tool at the top of this page or on the home page.
Or, if you would like further detail on any of the topics we discussed, please fill out a contact form and submit your question.
If you prefer to speak by phone, call us at 888-209-5049.