Medicare Advantage EOP 1-9-2019 by Kim Anderson

Can I Switch from Medicare Advantage to Medigap during OEP (January 1 - March 31, 2019)?

by Kim Anderson

Starting in 2019, there's a new Medicare Advantage Open Enrollment Period (OEP).  It goes from January 1 through March 31 and it replaces the old Medicare Advantage Disenrollment Period (MADP) which ran from January 1 – February 14.  The Medicare Advantage OEP is somewhat more limited than the Fall Open Enrollment Period but is more robust than the previous MADP. As noted by the Centers for Medicare and Medicaid Services (CMS), the OEP will allow people “enrolled in a Medicare Advantage plan, including newly Medicare Advantage-eligible individuals, to make a one-time election to go to another [Medicare Advantage] plan” - or to leave their Medicare Advantage plan, join a stand-alone Medicare Part D plan, and return to Original Medicare Part A and Part B."  

Dropping your Medicare Advantage plan does not mean, however, that you can buy a Medigap policy because, in some States Medigap insurance companies may be allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy.  There are only a few situations that allow you to leave Medicare Advantage and pick up a Medigap plan without being subject to medical underwriting.

One situation is if you drop your Medigap policy to enroll in a Medicare Advantage plan for the first time.  If you then change your mind within the first 12 months, you have a trial right to change back to Original Medicare, Part A and Part B, and get your Medicare Supplement plan back (if it’s still available). If your original Medigap plan isn’t available, you can use your trial right to enroll in any Medigap Plan A, B, C, F, K, or L that’s sold in your state.

The second situation is if you are moving to a different state or part of the state and your Medicare Advantage plan does not serve that area, you also have special rights to return to Original Medicare and pick up a Medigap plan.

It's important to understand that if you had a Medigap policy in the past then left it to get an Medicare Advantage plan, when you return to Original Medicare, you might not be able to get the same Medigap policy back or in some cases, any Medigap policy unless you have a “trial right” (if you change your mind within the first 12 months, you have a trial right that lets you disenroll from the Medicare Advantage plan and switch back to the Medigap plan you had previously, if it's still being sold) or “guaranteed issue” right (in general, you qualify for a guaranteed issue right when you have other health-care coverage that changes in some way, such as if you lose the coverage for any reason that is not your fault such as Medicare Advantage does not cover that part of your state.)

If you have any questions or concerns about whether you chose the best Medicare Advantage plan for you - or whether you think you have made a mistake and are considering re-enrolling in original Medicare, reach out to one of our Medicare experts at Rooted Planning Group.  We are here to help.