Sometimes. You can switch from Medicare Advantage back to Original Medicare during an enrollment period, but outside your Medigap Open Enrollment Period, insurers in most states don't have to sell you a Medigap policy unless you have a "guaranteed issue right." Federal law gives you that right in certain cases, such as when your plan leaves your area or you're within your first year in Medicare Advantage.
Why does this matter for my bills?
Original Medicare by itself has no yearly limit on what you pay. Medicare.gov says that after the Part B deductible, you generally pay 20% of the Medicare-approved amount for most Part B services. For a hospital stay, there's the Part A deductible for each benefit period.
A Medigap policy helps pay those costs. Without one, a big hospital stay or ongoing treatment can leave large bills. So find out your Medigap options before you leave a Medicare Advantage Plan. See Medigap plans: what they pay.
When must an insurer sell me a Medigap policy?
Medicare's Medigap booklet lists the most common situations under federal law. If you have a Medicare Advantage Plan, you have a guaranteed issue right if:
- Your plan is leaving Medicare.
- Your plan stops giving care in your area.
- You move out of the plan's service area.
- Your plan's network has a significant change.
In these cases, the right applies only if you switch to Original Medicare. Joining another Medicare Advantage Plan doesn't trigger it. You can buy Medigap Plan A, B, D, or G from any insurer selling them in your state (or C or F if you were eligible for Medicare before January 1, 2020).
Trial rights cover two more situations:
- You joined a Medicare Advantage Plan when you were first eligible for Medicare Part A at 65, and you decide to switch to Original Medicare within the first year. You can buy any Medigap policy sold in your state.
- You dropped a Medigap policy to join a Medicare Advantage Plan for the first time, and you've been in the plan less than a year. You can get your old Medigap policy back if the same company still sells it. If not, you can buy Plan A, B, D, or G (or C or F if eligible).
Your state may give you more rights. Your State Health Insurance Assistance Program (SHIP) or state insurance department can tell you.
What's the deadline?
For the Medicare Advantage situations above, the booklet says you can apply:
- As early as 60 days before your Medicare Advantage coverage ends, if you're choosing to leave.
- No more than 63 days after your Medicare Advantage coverage ends.
The Medigap policy can't start until your Medicare Advantage coverage ends. Mark the 63-day deadline on your calendar.
What if I don't have a guaranteed issue right?
You can still apply for Medigap. Medicare.gov says that outside your Medigap Open Enrollment Period, insurers may use medical underwriting. They can look at your health history and may:
- Turn down your application.
- Charge you more.
- Make you wait for coverage of a pre-existing condition.
Some states have extra protections. Ask your SHIP what applies where you live.
What's the safest order to do things?
If you're leaving by choice and don't have a guaranteed right, a careful order is:
- Apply for the Medigap policy first. Ask the insurer whether they'll accept you and what the premium will be.
- Get the approval in writing, with the start date.
- Then leave your Medicare Advantage Plan, during an enrollment period, so coverage ends the day before the Medigap policy starts.
- Join a Medicare drug plan at the same time if you want drug coverage. Medigap policies sold today don't include drug coverage.
What to say when you call a Medigap insurer:
"I'm thinking about leaving my Medicare Advantage Plan and going back to Original Medicare. Do I need to answer health questions to buy Plan [letter] from you? If you approve me, what would the monthly premium be, and when could the policy start? Can you send me the approval in writing?"