Enrolling in Original Medicare after having a Medicare Advantage Plan

[JerryS109]

With Medicare enrollment coming up, it brought my attention to these questions.

My wife and I are currently enrolled in a Medicare Advantage Plan (MAP). I have begun to wonder if there are any benefits to switching to Original Medicare with Supplemental/Medigap insurance. But I have heard different things about moving from a MAP to Original Medicare.

It is true that, if you are enrolled in a MAP, it is difficult (or impossible) to switch to Original Medicare with Supplemental insurance?

If so, why?

[GailL1]

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@JerryS109 wrote:

With Medicare enrollment coming up, it brought my attention to these questions.

My wife and I are currently enrolled in a Medicare Advantage Plan (MAP). I have begun to wonder if there are any benefits to switching to Original Medicare with Supplemental/Medigap insurance. But I have heard different things about moving from a MAP to Original Medicare.

It is true that, if you are enrolled in a MAP, it is difficult (or impossible) to switch to Original Medicare with Supplemental insurance?

If so, why?

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There is NO “open enrollment” period for Medigap plans.  Open enrollment is only for Medicare Advantage (MA) plans or Medicare Prescription Drug (( PDP)Coverage plans where one can switch plans every year based on their health needs.

The problem isn’t switching from a MA plan to Traditional Medicare - you can do that all day long.  The problem is getting a MEDIGAP plan.  It is the Medigap plan that is restricted in most states.

MediGAP is a financial protection insurance used with Traditional Medicare because Traditional Medicare has NO annual or lifetime out of pocket maximum like MA plans have - MediGAP coverage makes no healthcare decision on what Medicare pays - if Traditional Medicare covers it, the MediGap plan covers it.  If Medicare denies it, the Medigap denies it.  It is only financial protection for your health care cost under Traditional Medicare.  

The ability to switch Medigap plans or the ability to pick one up after the initial enrollment period depends on the state you live in - Because if your state has NOT expanded MediGAP guaranteed issue (GI) rights higher than the Federal limit, then you can’t buy a MediGAP policy after your initial enrollment period WITHOUT UNDERWRITING.

Do you know what underwriting is in respect to Medigap plans?  It is the ability of the Medigap sponsor to decide your fate of Medigap coverage based on your current health.Now if you are healthy then it won’t matter and you should try if you want to switch to Original Medicare with a Medigap.  But even if you have a few things wrong with you, the plan sponsor can charge you more OR they could disallow any pre-existing for a specific amount of time like 6-months.  OR they can just deny you the Medigap coverage.

The reason for this is to hold down premium cost for everybody that has paid dearly for their Medigap coverage since their initial enrollment.  

Who wouldn’t want to switch to this form of Medicare when they are having lots of medical bills especially if they can buy a Medigap policy that may pay most of their Traditional Medicare out of pocket cost.   They would be coming from a MA plan where they haven’t been paying anyplace close to the monthly Medigap premiums.   

Even in some of the states that have expanded their GI rights, the only people who can switch Medigap policies are those who already have them.  And even in those states, their premiums are much higher than in states that don’t have these expanded GI rights.

It’s the same reason why most states don’t let those with Medicare who are less than 65 years old have access to all Medigap plans - in some states, they cannot buy a Medigap at all, in other states they are restricted to a certain plan or a couple of them.  These are the disabled (less than 65) and are usually high health care users.  For these disabled Medicare beneficiaries,  Federal law gives them no access to a MediGAP plan - a state can and some do.  But their premiums are sky high - I am talking $400 - $ 500  + a month for a Medigap plan.  

I came back to edit and add:  So many of the Disabled have to be satisfied with a Medicare Advantage plan or a Special Needs plan because of the high Medigap premiums.  However the nice thing is, when they turn 65 they get a do over in their selection because they are then qualified for Medicare based on their age and not disability.  So they are then affected by guaranteed issue rights where they cannot hold the health condition over them because this is their initial enrollment period under Federal law.

What state are you in and I will try to give you a link to their coverage options - usually this info is at the State Dept of Ins.

[PlG312834]

Wow great info!

if a patient currently on SSD turns 65 in 2025 and has Medicare advantage, does he apply for OG medicare/medigap/ part D as new request, or just apply ffor medigap and part D? 

[GailL1]

@PlG312834 - you will only need the Medigap and Part D plan - you should already have Medicare Part A and Part B.

You must do it within your grace period for signing up.

When you pass from SSDI (under 65) you cross into another enrollment realm that is more regulated by law - meaning that you are eligibility for Medicare based on age rather than disability which isn’t protected by Federal law.  So your guaranteed issue period begins again.  

Here is the rule and the instructions

Medicare.gov - Get Ready to Buy 

From link:  notice it says this”

Your Medigap Open Enrollment Period

Under federal law, you get a 6 month Medigap Open Enrollment Period. It starts the first month you have Medicare Part B and you’re 65 or older. During this time, you can: (see the link for the rest)

Then further on down the page it says:

What if I have Medicare because of a disability or End-Stage Renal Disease (ESRD)?

If you’re under 65 and have Medicare because of a disability or ESRD, you might not be able to buy a Medigap policy until you turn 65.

read more at the link ~

So as long as you apply for a Medigap plan during your Medigap Special Enrollment period, you will NOT have to pass underwriting to get a Medigap plan because you are applying based on your age. 

You should already have Medicare Part A and Part B - if you get a Medigap, you will also have to get a Part D - a stand alone Prescription Drug plan because you will no longer have the prescription coverage that is probably included in your MAPD plan that you have now.

More reading material for you -

AARP.org - Can I get Medigap insurance if I’m under 65? 

AARP.org- When is the best time to buy Medigap? 

AARP.org- Does Medicare cover preexisting conditions? 

further down this page, it says . . . 

Keep in mind

If you are younger than 65 and on Medicare because of a disability but have been rejected for a Medigap policy or qualify only for one that charges you very high premiums, the clock will reset when you turn 65. 

At 65, you will be eligible for Medicare based your age instead of your disability. And you will be able to buy any Medigap policy with full federal protections if you purchase it within six months of signing up for Part B or qualify for other federal or state guaranteed issue rights.

[JerryS109]

(I replied from my iPad but I don't see my reply here. My apologies of my reply appears twice.)

Thanks, @GailL1 . There's a lot of information in your reply. I'll probably have to read it a couple of times. 

I live in Texas and the UHC Annual Notice of Changes for 2025 says the "The State Health Insurance Assistance Program (SHIP) is an independent government program with trained counselors in every state. In Texas, the SHIP is called Texas Department of Aging and Disability Service (HICAP)." There's a phone number but I did not see any reference to online resources.

[GailL1]

@JerryS109 

Texas has nothing special passed in regards to guaranteed issue of Medigap plans.

Texas Dept of Insurance - Medicare Supplemental Plans 

Go down the page to the heading of Medicare Supplemental Insurance for the details.  They also give a list of companies that offer it in Texas .  

Yes, you can touch base with the TX SHIP office for guidance - Word of caution, since Medicare open enrollment begin real soon - they are gonna be slammed especially this year when many plans are changing and people are needing to look for other plans that meet their needs.  So do it soon -

If you want to check with an independent Medicare Insurance broker, who writes for a lot of different companies, the more experienced ones have a pretty good idea if you would have to go thru underwriting and with which companies.  

This Medicare page gives the SHIP contact by state under “Talk With Someone” and says that you can look up Medigap (Supplemental) policies by zip code and it gives premium cost -(top of page) 

Medicare,gov - Helpful Tools 

Good Luck