Dear Liz: I just read your answer about switching from Medicare Advantage plans to original Medicare, and how you might not be able to get an insurer to write you a supplemental Medigap plan. I was with a Medicare Advantage plan for years and then my medical group stopped participating. I have many preexisting conditions and would not be able to find adequate or affordable coverage if I had to apply for a supplemental plan. Luckily another insurer gave automatic acceptance to the 32,000 of us who were thrown out of our medical group so I was able to get full coverage through a Medicare supplement.
I hope you will repeat this info in several columns so consumers are better informed. I had no idea you couldn’t easily switch back and forth.
Answer: To recap, Medicare Advantage is the private insurance alternative to original Medicare. Like other private coverage, Medicare Advantage plans have networks and benefits that can change from year to year. Original Medicare benefits typically don’t change, but many expenses aren’t covered so you generally need a private insurance supplement to pay for those costs.
If you want to switch from Medicare Advantage to original Medicare after the first year, however, you normally don’t have “guaranteed issue” rights for a Medigap supplemental policy and you could pay a lot more for this important additional coverage.
There is a “nuclear option” that would give you guaranteed-issue rights again, and that’s moving out of your Medicare Advantage plan’s coverage area. You have to actually move, not just temporarily relocate. But you would be able to switch to original Medicare and get a guaranteed-issue supplemental plan.
I have read your responses on this issue with interest. We currently have Kaiser as our HMO and would like to stay with them after my husband’s retirement in a couple of years, so we are leaning toward getting a Kaiser Medicare Advantage plan. But because of the problem with getting a guaranteed-issue supplemental plan after the first year, we want to cover all bases if we should ever want or need to switch to Original Medicare in the future. If we enroll in a Medicare Advantage plan, can we get a “Medigap” supplemental plan within that first 12 months, in addition to the Medicare Advantage plan? Or are the supplemental plans available only to people enrolled in Original Medicare?
To get a Medigap policy you must be enrolled in original Medicare. But HMOs have some advantages, which I’ll be discussing in an upcoming column.