If you are thinking about switching from a Medicare Advantage plan to a Medicare Supplement Insurance plan during an Open Enrollment Period there are some things you should know to help make the transition smooth and avoid coverage gaps.
Common reasons for making the switch
Medicare Advantage plans are a form of managed care, with particular restrictions and guidelines for their members. These restrictions may include some or all of the following.
- Full-coverage when seeing pre-approved, in-network doctors and hospitals only
- Authorization required to see a specialist or receive specialized treatment
- Emergency coverage only when not in the plan’s geographical area
- Delays and denials for some types of care
Medicare Supplement Insurance plans do not have these types of restrictions and allow you and your doctors to manage your own care. These types of plans are designed to help you pay the out-of-pocket costs that Original Medicare doesn’t cover. More comprehensive Medicare Supplement Insurance plans—such as Plan G—tend to keep your healthcare spending more stable and predictable because after you pay your monthly premiums, most to all out-of-pocket expenses will be covered.
There are only certain times when you can make the switch from Medicare Advantage to a Medicare Supplement Insurance plan. Some of these occur on a yearly basis and some are specific to your circumstances. It is also illegal to have a Medicare Supplement policy and a Medicare Advantage plan at the same time so you will want to make sure you plan to drop the Medicare Advantage plan at the appropriate time.
- The Annual Enrollment Period (AEP) (October 15-Dec. 7). Plan changes made during this window will go into effect on January 1st of the following year.
- The Medicare Advantage Open Enrollment Period (January 1 – March 3)
- A Special Enrollment Period (SEP). You may qualify for this if you are moving,
your plan is discontinued or another qualifying circumstance (see below).
- Your Medicare Advantage trial period. The first 12 months you are enrolled in a Medicare Advantage plan is known as your trial period. During this one-time period you may drop your Medicare Advantage coverage and apply for a Medicare Supplement plan.
Plan your move
No matter how frustrated you are with your Medicare Advantage plan, it is never a good idea to cancel your plan until you have other coverage lined up. This is because If you do cancel your Medicare Advantage plan and are unable to qualify for a Medicare Supplement Insurance policy you may experience a gap in coverage that could leave you financially vulnerable.
Unlike Medicare Advantage plans, Medicare Supplement Insurance plans are allowed to use medical underwriting in their approval process, which means they can deny you coverage or charge you higher premiums depending on your medical history and current health status. If you cancel your current Medicare Advantage plan and do not qualify for Medicare Supplement Insurance coverage you may be left with only Original Medicare coverage until the next eligibility window opens and you can sign up for another Medicare Advantage plan. Original Medicare generally only covers about 80% of your health care costs and has no out-of-pocket limits, which can leave you exposed to significant expenses if you experience a serious illness or injury. So, if you’re planning to switch, it’s important to make sure you get approval for your new Medicare Supplement Insurance plan—and the monthly premiums are acceptable—before you make any changes to your current coverage.
Medicare Supplement Insurance carriers are not allowed to use medical underwriting if you have a guaranteed issue right or if you are in your 7 month Medicare Supplement Open Enrollment Period. A guaranteed issue right means you may be able to enroll in one or more Medicare Supplement Insurance options without being denied coverage or charged a higher rate due to your preexisting conditions. A guaranteed issue right situation can happen in the following ways:
- You move out of your current Medicare Advantage or Select plan service area
- Your current plan stops giving care, leaves Medicare or violates codes of ethical conduct regarding giving care
- You lose your secondary, non-Medicare health insurance coverage
- You have been in your first Medicare Advantage plan for less then a year (Trial Right)
Steps to follow for a smooth transition
You are not allowed to have a Medicare Advantage policy at the same time as a Medicare Supplement Insurance policy, so having your new coverage overlap your old policy is not an option. To avoid or limit coverage gaps follow the following steps to secure your new plan:
- Call or log on to your Medicare Advantage plan and find out the steps for canceling your policy. Do not cancel your plan yet.
- Research if you are within your Medicare Supplement Open Enrollment Period or if you qualify for a guaranteed issue right for any reason. Figure out what plans benefits matter to you most and what Medicare Supplement policies you may be interested in.
- Call at least three Medicare Supplement Insurance carriers to find out what plans you are likely to qualify for and what the premiums you will potentially pay. This can be done at any time, not just during an Open Enrollment Period.
- The best way to ensure you don’t have a coverage gap is to wait until you have a final determination from your Medicare Supplement Insurance plan before making changes to your existing Medicare Advantage plan during a valid Open Enrollment Period. Of course, you’ll need to do this within a valid enrollment period.
- If you qualify for a Medicare Supplement Insurance plan that meets your needs, cancel your Medicare Advantage plan during a suitable enrollment period and sign up for your new Medicare Supplemental Insurance plan. If you have a guaranteed issue right you can do this at any time.