You sign up with a Medicare Advantage insurance plan, but later determine that a Medicare Advantage plan is not for you. You have reached the conclusion that a Medicare Supplement plan would be a better fit for your needs.
So, what can you do, and when can you do it?
New Brunswick, New Jersey
This is an issue that occurs more often the most realize. Medicare Advantage plans can be of great benefit and a perfect fit for many who are covered under Medicare. However, Medicare Advantage plans are not for everyone.
Many individuals, for a myriad of reasons, simply prefer Medicare Supplement Insurance. In New Jersey, about 30% of Medicare beneficiaries are utilizing Medicare Advantage plans. Around 22% are utilizing a Medicare Supplement plan.
Regardless of which plan type you prefer, the good news is, it is possible to switch from a Medicare Advantage plan to a Medicare Supplement plan (and visa-versa), as long as you follow certain federal guidelines.
Regardless of what plan you have, you are still under the Original Medicare Umbrella.
Whether you are covered by a Medicare Supplement plan, or a Medicare Advantage plan, Original Medicare is still behind everything. So, in a sense, you have the same horse, you are just changing the saddle.
Good to know: Just because a hospital or office is "in-network" doesn't mean all its doctors are. Think you're covered because you took the time to make sure your hospital or doctor's office was approved as being in your network? Think again. It's just not that simple. Individual providers, labs, tests, specialists, and others that work within the facility may still be out of network. Yes, exasperating, but true. It's tedious but important to, when possible, ask everyone involved in your treatment if they are an "in network" provider.
Medicare Advantage and Medicare Supplement Insurance Address Original Medicare Differently.
Medicare Advantage plans offer an alternate way to get your Original Medicare Part A and Part B benefits. The private insurance carriers that offer Advantage plans usually throw in some extra plan benefits above those of original Medicare
to make the Advantage plans a more attractive option. Such benefits may include vision, dental, and hearing care. They may also include Medicare Part D prescription drug coverage.
Medicare Supplement plans follow a more traditional format. Medicare Supplement Plans offer coverage for "gaps" in the coverage of original Medicare. These gaps refer to out-of-pocket expenses that you would incur if you were medically covered only by original Medicare.
Medicare supplement plans pick up certain copayment, coinsurance, and deductible costs that would otherwise be your responsibility. In most cases, Medicare supplement insurance plans do not add any additional benefits. They just provide financial protection where original Medicare coverage is less than complete.
The Guidelines for switching plans.
It is against federal law to be covered by both a Medicare Supplement plan and a Medicare Advantage plan at the same time. To switch from a Medicare Advantage plan, you need to first cancel the plan and return to original Medicare. Then, you can apply for a Medicare Supplement insurance plan.
Good to know: Do the math. When shopping for health insurance, most people focus on the monthly premiums, but you also need to take a close look at deductibles. For example, if you have a choice between a lower silver plan premium of $345 a month for a plan with a $5,500 deductible, and a higher gold plan premium at $465 a month with a $1,750 deductible, you may be better off with the second plan if you anticipate needing more than $1,500 in medical care. With the second plan, your total annual cost for the premium and deductible comes to $7,330, a $2,310 savings over the lower premium plan.
In most cases, you can only switch from a Medicare Advantage plan during certain times of the year:
The Medicare Advantage Open Enrollment Period (OEP) between January 1 and March 31.
The Annual Election Period (AEP), between October 15 and December 7.
Outside these periods, you can only switch between Medicare Advantage and Original Medicare if you meet certain qualifying events, such as changing your residency to a location that is outside your plan's service area.
You need to have a good understanding of the federal guidelines for making this kind of plan switch. Switching plans within the right time of year, and properly following federal guidelines, will afford you guaranteed-issue rights.
When you have guaranteed issue rights, your application for Medicare Supplement coverage cannot be declined (generally 63 days from the date you leave your Medicare Advantage plan).
There are many issues to understand and consider before switching from a Medicare Advantage plan to Medicare Supplement Insurance. Be certain to speak with a Medicare insurance specialist before making this change.