Medigap to Advantage to Medigap

[SumDay]

DH is eligible for Medicare on 6/1, and we're trying to decide what to do for supplements.

In this article: Medicare Advantage Shopping: 10 Rules | Squared Away Blog I learned this:

"2. First-time Medicare enrollees might want to be strategic, Mills said. Sixty-five-year-olds who want to play it safe could choose a Medigap supplement initially, because they cannot be refused coverage by Medigap during the first six months after they first sign up for Part B. Medigap isn’t always available to people who’ve already been enrolled in an Advantage plan, because Medigap can deny coverage based on pre-existing conditions. Perhaps enroll in Medigap the first year to “play out the scenario and learn how it works,” she said. Enrollees can easily switch from Medigap to an Advantage plan during the next open enrollment period, which is always Oct. 15 through Dec. 7. The plans become effective Jan. 1."

So, is this saying that one could initially select a Medigap plan for the remainder of 2018, switch to an Advantage plan for 2019, and decide the Medigap was better for you and go back to Medigap in 2020?

I'm seeing the term "trial right" thrown around, and it sounds like you'd need to switch back to Medigap before the end of 2019.

Has anyone switched back and forth? Should we just get in a lane and stay there? Looks like most of his current docs are on the Advantage plan, but who knows what might happen in the future. Sure wish someone would get that crystal ball technology sorted out.

 

[gauss]

edit: My post below appears to be incorrect. SEE MBSC post #5 for additional details. - gauss
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When I read this, I don't see the three-way switch you are describing.

I see a two part play. First Medigap (because they can't medically underwrite if purchased when first available) and then if that doesn't work, go to Medicare Advantage.

I suspect that you could be prevented from going back to Medigap if you did not pass medical underwriting later in the process.

edit: At your "trial right" link posted above, I find the following:

Can I switch policies?

In most cases, you won't have a right under Federal law to switch Medigap policies, unless one of these applies:

• You're eligible under a specific circumstance or guaranteed issue rights
• You're within your 6-month Medigap open enrollment period

-gauss

 

[SumDay]

Thanks Gauss, now that I've put it in print, and I look at it again, you are correct.


Medicare is giving me a headache.

 

[Chuckanut]

IMHO, the Feds would love every Medicare eligble person to switch to an Advantage Plan.

Advantage type plans are, in the minds of many, the future of health care in the USA for everybody (not just those on Medicare). That is, we pay (or the Feds help us pay) a yearly subscription fee to the plan and the plan covers everything.

Presumably, the health care providers will then have a huge incentive to keep costs down. No more buying the latest high-tech, anti-matter powered, toe-nail fungus zapper just to have bragging rights.

 

[MBSC]

I'm seeing the term "trial right" thrown around, and it sounds like you'd need to switch back to Medigap before the end of 2019.

Thanks Gauss, now that I've put it in print, and I look at it again, you are correct.

Your initial post was correct. If you start with Medigap you can "trial right" into MA during an open enrollment period. If you don't like the MA plan, you have "guaranteed issue" rights to go back to Original Medicare+Medigap without underwriting within 12 months. When the 12 months of MA has expired you can still go back to Original Medicare but will need to pass medical underwriting for the Medigap.

If you join a Medicare Advantage Plan for the first time, and you aren’t happy with the plan, you’ll have special rights under federal law to buy a Medigap policy. You have these rights if you return to Original Medicare within 12 months of joining. If you had a Medigap policy before you joined, you may be able to get the same policy back if the company still sells it. If it isn’t available, you can buy another Medigap policy.

Reference: https://www.medicare.gov/supplement...edigap-and-medicare-advantage-plans.html#1372

You have a guaranteed issue right (which means an insurance company can’t refuse to sell you a Medigap policy) in these situations:

You dropped a Medigap policy to join a Medicare Advantage Plan for the first time, you’ve been in the plan less than a year, and you want to switch back. (Trial Right)

You have the right to buy:

The Medigap policy you had before you joined the Medicare Advantage Plan if the same insurance company you had before still sells it.

If your former Medigap policy isn't available, you can buy a Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state.

You can/must apply for a Medigap policy:

* As early as 60 calendar days before the date your coverage will end
* No later than 63 calendar days after your coverage ends

Reference: https://www.medicare.gov/supplement...eed-issue-rights-scenarios.html#collapse-4695

 

[TrvlBug]

Your initial post was correct. If you start with Medigap you can "trial right" into MA during an open enrollment period. If you don't like the MA plan, you have "guaranteed issue" rights to go back to Original Medicare+Medigap without underwriting within 12 months. When the 12 months of MA has expired you can still go back to Original Medicare but will need to pass medical underwriting for the Medigap.

In CA you can switch during your birthday month. I don't believe there are any restrictions. DH just switched companies on his Medigap. Other states may have something similar.

 

[MBSC]

In CA you can switch during your birthday month. I don't believe there are any restrictions. DH just switched companies on his Medigap. Other states may have something similar.

Yes, certain states have special rules where a person can switch from one Medigap to another Medigap without underwriting. In CA, the new Medigap cannot have more benefits. The OP is asking about switching between Medicare Advantage and Medigap. In this case, NY and CT would not require underwriting when going back to the Medigap regardless of how long it's been.