Top 5 Reason to Be in a Medicare Supplement Medigap Plan

Deciding whether to switch from a Medicare Advantage plan to a Medigap (Medicare Supplement) plan depends on your individual needs and preferences. Each type of plan has its pros and cons, but here are five reasons why some people might find Medigap plans more attractive than Medicare Advantage:

Top 5 Reasons Medigap Might Be Better Than Medicare Advantage:

1. Freedom to Choose Doctors and Specialists
   Medigap plans allow you to see any doctor or specialist who accepts Medicare, without requiring a referral. Medicare Advantage plans often have networks of providers and may need referrals to see specialists, which could limit your choices.

2. No Network Restrictions
   Medicare Advantage plans are often HMO or PPO plans with specific networks. If you travel frequently or live in multiple states, Medigap offers better flexibility as it doesn’t require you to stay within a network. You can access care nationwide with any Medicare provider.

3. Lower Out-of-Pocket Costs
   Medigap plans typically cover most or all of your out-of-pocket costs, such as deductibles, coinsurance, and copayments, which can result in fewer unexpected expenses. Medicare Advantage plans may have more cost-sharing requirements, such as copays for office visits and procedures.

4. No Need for Prior Authorization
   Medicare Advantage plans often require prior authorization for certain procedures, services, or treatments, which can delay or restrict access to care. Medigap plans don’t require prior authorization for services covered by Original Medicare, allowing you to receive care more efficiently.

5. Guaranteed Coverage for Life (if you enroll at the right time)
   Once you are approved for a Medigap plan, you generally keep that coverage for life as long as you pay your premiums. Medicare Advantage plans renew annually, and the plan's terms and network may change from year to year, potentially impacting your care.

Can You Get Approved for Medigap?

• Medigap Open Enrollment Period: If you’re within six months of enrolling in Medicare Part B (and are at least 65), insurers cannot deny you coverage or charge more due to pre-existing conditions.

• Underwriting: If you apply for Medigap outside of this period, insurers may require medical underwriting, meaning they could deny your application or charge higher premiums based on your health. Some states have special enrollment periods or rules that could allow you to switch to Medigap without underwriting.

Best States for Medigap Approval

Some states make it easier for people to switch to Medigap plans. These states may have regulations that limit or eliminate medical underwriting for certain individuals:

1. New York
   In New York, Medigap insurers cannot deny you coverage or charge you more based on your health, regardless of when you apply.

2. Massachusetts
   Like New York, Massachusetts requires Medigap insurers to accept you at any time without medical underwriting.

3. Connecticut
   Connecticut has a similar rule, allowing beneficiaries to switch Medigap plans without medical underwriting at any time.

4. Maine
   In Maine, certain conditions allow for switching Medigap plans without underwriting, such as leaving a Medicare Advantage plan or moving out of the service area.

5. California (with the Birthday Rule)
   California allows you to switch Medigap plans around your birthday each year without medical underwriting as long as the plan is either from the same class or a lower plan class.  An example would be going from Carrier ABC Plan G to Carrier XYZ Plan G, or Carrier ABC Plan G to Carrier XYZ Plan N.  A beneficiary can not go from Carrier ABC Plan G to Carrier XYZ Plan F.

If you’re considering a switch, it’s a good idea to review your specific situation, including any pre-existing conditions, current healthcare needs, and how often you travel or use healthcare services. Also, note if your health provider is dropping your carrier or not.  You can also consult with a Medicare advisor or insurance agent who specializes in both Medigap and Medicare Advantage plans.  Contact us today!