As your medical and health needs change, you may find that your existing Medicare coverage is no longer the best option for you. Navigating health insurance changes can feel overwhelming and confusing, but with a little preparation, you can make the change to the coverage that suits you better.  

Can I switch from Medigap to Medicare Advantage? 

Some people who currently have Medigap, or Medicare Supplement Insurance, are looking for a more flexible and economical option. You can make the switch from Medigap to Medicare Advantage. In many cases, Medicare Advantage can be a better choice and provide the best mix of coverage, so it could be a good idea to make the switch. However, there are a few things to consider when making the adjustment.

When can I switch from Medigap to Medicare Advantage? 

If your financial situation or your health conditions have changed, it might be time to switch from Medigap to Medicare Advantage. However, you cannot switch at any time. You’ll have to wait for the Annual Enrollment Period, which happens every fall from October 15 to December 7. Decide if you will switch before the Annual Enrollment Period, so you have time to gather all the necessary information and become familiar with the changes.  

Why switch from Medigap to Medicare Advantage? 

Cost is often a driving factor for people thinking about switching their coverage. Medigap provides a larger network but is often pricier than many Medicare Advantage plan premiums. If you are in relatively good health and are not concerned with hereditary health conditions that could develop, then switching to a Medicare Advantage plan could significantly lower your monthly healthcare expenses. Often, you can get Medicare Advantage plans for $0 in premiums (this is a premium you pay in addition to the monthly Medicare Part B), and if there is a sudden health event, you would pay the deductible first before coverage kicks in. Often the deductible for this type of plan is much higher. 

Another reason why so many people opt to switch from Medigap to Medicare Advantage is the ability to find a plan offering certain areas of coverage that Medigap won’t cover. And once you hit your spending cap with your Medicare Advantage plan, the plan will cover any additional costs. You can review the different Medicare Advantage plans available to find the one that offers the deductible and spending cap that are most comfortable for your budget and savings.  

Why do you need more than just Medicare? 

When you become eligible, you can sign up for Original Medicare, which the government provides. Medicare covers hospital and medical coverage, but you must usually pay your deductible first and then the coinsurance—20 percent of your Medicare-approved amount. When you use Part B, you’ll need to pay a premium.  

Original Medicare does not automatically cover Part D, so you’ll need to decide if you want to enroll in a plan, and you’ll pay a premium for that plan. And unfortunately, there’s no yearly limit. So if you have a serious health issue, you’ll continue to pay for as long as you need treatment. Medigap policies can help patients handle the financial burden of coinsurance and other out-of-pocket costs.  

Is Medicare Advantage better than Medigap? 

The answer is—it depends. Medicare Advantage out-of-pocket costs can vary. In some cases, they may be lower, while for other services, they are higher. In addition to paying your Medicare Part B premium, you may also have to pay a premium for Medicare Advantage. So it’s essential to look closely at the available policies.  

Medicare Advantage places a yearly limit on Part A and Part B out-of-pocket costs, but different plans offer different limits. You cannot combine Medigap and Medicare Advantage, but you wouldn’t need Medigap if you have Medicare Advantage. And most Medicare Advantage plans include prescription drug coverage, allowing you to manage all of your healthcare needs with a single insurer. Finally, consider your dental and vision costs. You might benefit from switching to a Medicare Advantage policy that provides coverage for these things if you expect you will be spending on dental or vision care. 

Are all Medicare Advantage Plans the same? 

While Medicare Advantage Plans are standardized and approved by the government, they may offer different provider networks. If you don’t want to switch your provider or you are seeing a specific doctor or specialist, you will need to examine the plans to determine which, if any, cover your current providers. And different Medicare Advantage Plans cover care in different hospitals and facilities.  

You should also consider whether you’ll go with a Medicare Advantage Plan that is more like an HMO or one that functions more like a PPO. If you are looking for less costly care, you’ll want to keep as much of your care within your network as possible.  

Things to consider when switching your coverage 

If you take several medications, check your potential plan choices for what drugs are covered and which are not. Your prescription could be expensive to pay for out-of-pocket, or your new plan might cover it but require prior authorization. In addition, ensure your primary care physician can do the referral for the specialists you need, or you may have to pay much higher fees.  

Remember, if you decide to switch back to Medigap, you can only do so if you qualify for guaranteed issue rights. But if this is the first time you’re switching from Medigap to Medicare Advantage, you can test things out to make sure you made the right choice. If you decide you would rather have Medigap, you can change back if you do so within 12 months.  

There is a lot to consider when making a healthcare coverage change. Take your time and educate yourself about the pros and cons of each path to be sure you’re getting the coverage you need to thrive. You can benefit from using an online digital Medicare advisor that recommends the type of plan that may fit your lifestyle and medical needs.