Switch to Medigap? You Need to Start NOW

Below is my blogpost on www.mymedicareanswers.com, powered by Humana, Inc., on the of the nation’s largest carriers of Medicare plans (great site, great answers to consumer questions)

Medicare Advantage Disenrollment Period

This period runs between January 1st and February 14th. You can cancel your Medicare Advantage plan and return to original Medicare (Part A, Part B) and enroll in a standalone prescription plan (Part D). It is important to note that cancelling your Medicare Advantage plan does not automatically enroll you in a standalone prescription plan. You must do so separately. Not creating an unintended break in prescription drug benefits is very important if you are attempting to switch from Medicare Advantage to Medigap.

Want to Switch to Medigap? Begin NOW

If you are over 65.5 years old, then Medigap carriers will have the right to ask medical underwriting questions. All Medigap carriers have their own, specific criteria for acceptance, and they are allowed to do so. Sometimes, people say “I thought there was a ‘no pre-existing condition’ clause resulting from the PPACA.’” That is the case for primary health insurance, which is Medicare, not Medigap.

You will want to begin early for a variety of reasons. First, the medical underwriting process will not occur overnight. Depending on the carrier, and your medical situation, this can take weeks. That means that your effective date can be February 1 or March 1 at the earliest.

Second, you will need to have your answer from the Medigap carrier before selecting a standalone prescription plan. The reason? Enrolling in a standalone prescription plan can be done before February 14th, but it will result in the automatic cancellation of your Medicare Advantage plan. If you complete these steps in reverse order, then the risk is that you would not have additional health benefits, and would be exposed to the cost-sharing terms of original Medicare, i.e. you would be subject to the copays and deductibles of Medicare Part A and Part B alone.

You May Have Other Ways to Switch

The steps above presume that you do not have any other path to cancel your Medicare Advantage plan, if you want to switch to Medigap and a standalone prescription plan. However, you may, in fact, be able to cancel your Medicare Advantage plan, depending on your circumstances.

First, if you are within the first 12 months of enrolling in a Medicare Advantage plan, when you were first enrolled in Medicare Part B, then you have a “Trial Right,” which will mean that your Medigap application for Medigap Plans A,B,C, F, K,  and L will be accepted without restriction. This means that if you enrolling in Plan G or Plan K, this is not necessarily guaranteed. Importantly, certain carriers have relaxed this standard, and it is their right to do so.

Second, if you are not yet 65.5 years old, then you are still within your Medigap Open Enrollment Period, in which case you have the unrestricted right to enroll in any Medigap plan at any carrier that offers Medigap within your state.

Prescription Coverage is Key

The simple reason that the Medicare Advantage Disenrollment Period is a crucial (and frequently misunderstood) one is that you will want to have continuous prescription drug coverage. The only practical way to avoid having a break in prescription drug coverage is to use the MADP so that you can select a standalone prescription plan (Part D). Until February 14th, this is entirely possible. After that date, you will need an very extraordinary situation, or cancelling your prescription drug coverage will lead to the Part D late enrollment penalty, which is 1% per month that you have a break in prescription drug benefits. In 2016, that amount will be $0.3410 per month, and there is no expiry on the time that penalty will last.

– See more at: https://www.mymedicareanswers.com/people/jae_oh_cfp/blog/2016/01/01/want-to-switch-to-medigap-begin-now#sthash.hH1P0YNs.dpuf

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