This Ultimate Guide to Medicare Insurance switching will break down all your rights and rules for when and how you can switch to a different Medigap, Medicare Advantage, or Part D drug plan.

Overview

If you are Medicare-eligible, you have probably already enrolled in Original Medicare Parts A and B. Most Americans then go on to choose additional insurance such as Medigap, Medicare Part D, and Medicare Advantage.

With so many different plans, carriers, and deductibles, picking the wrong Medicare insurance plan can happen. Not only that, but a plan that used to make sense when you first enrolled, may no longer work. Enter Medicare Insurance switching.

Senior checking her Medigap plan

Fortunately for everyone, there are safeguards in place for you to be able to switch your Medicare insurance if you feel another plan would save you money or be a better fit.

By the way, it goes without saying that if you have yet to select a Medicare Insurance plan, you should start with the best plan possible. Contact Senior65.com and we can help you do exactly that.

But today we will focus on switching. Below is a summary chart of all the switching options. Find your situation and click on the “Learn More” options to read all the details about it.

Switching Scenario Underwriting States Enrollment Window
Medigap to Medigap
Basic Medigap Switch Yes Anytime All States
Initial Enrollment Switch No Initial Enrollment All States
Free Look Period Switch No All States Anytime
Birthday Rule Switch No California and Oregon 30 to 60 days after birthday
Guaranteed State Switch No CT, NY, ME and WA Anytime
Anniversary Rule Switch No Missouri 30 days before expiration
Passing Switch No All States 60 calendar days before to 63 after coverage ends
Bankruptcy or Misled Switch No All States 60 calendar days before to 63 after coverage ends
Medigap SELECT Switch No All States Same as above or a year
Medicare Advantage to Medigap
Trial Right Switch No All States 60 calendar days before to 63 after coverage ends
Moving or Plan Leaving Switch No All States 60 calendar days before to 63 after coverage ends
Misled Switch No All States 60 calendar days before to 63 after coverage ends
Medicare Advantage or Part D
Initial Enrollment Switch No Initial Enrollment Jan 1st to March 31st
AEP Open Enrollment No All States October 15th to December 7th
Open Enrollment No All States Jan 1st to March 31st
Moving or Plan Leaving Switch No All States 60 calendar days before to 63 after coverage ends
Misled Switch No All States 60 calendar days before to 63 after coverage ends
Institution Switch No All States Two full months
5 Star Rule No All States December 8th to November 30th
Medigap to Medicare Advantage
AEP Open Enrollment No All States October 15th to December 7th

Switching Medigap

Well, as you can see there are a lot of options outlined in the chart above. Now that you have taken a look at all the possibilities, it’s time to expand on each of them. Let’s start with Medigap.

Why switch Medigap?

There are a number of reasons why you would want to switch Medigap plans, which usually can be boiled down to:

  • Your premiums have gotten too expensive
  • You are paying for benefits you don’t need
  • You would like more benefits covered
  • You are not satisfied with your current insurance company

Basic Medigap Switch

You can always switch from one Medigap plan to another at any time of the year, but you will have to answer health questions before being approved on the new plan.

Basic Medigap Switch Example: you enrolled in Medigap Plan F five years ago but the price is now too expensive. You decide to switch to Plan G which has a lower premium. You apply for the new plan and answer about twenty health questions in the application. The new insurance company may approve or decline your application.

Next Step: if you would like to execute a “Basic Medigap Switch,” the first place to start is getting a quote of new Medigap plans in your area. After you get a quote, contact Senior65 to apply for the best best-priced plan. We can take your answers right over the phone.

Note: there are situations listed below where you can switch without answering any health questions.

Initial Enrollment Medigap Switch

Those who are enrolled in Medigap and have less than 6 months from their Part B effective date are in their initial enrollment period. During this time, you are guaranteed to be approved on a new Medigap plan if you want to make a quick switch.

Initial Enrollment Medigap Switch Example: you enrolled in Plan G when you first turned 65, but three months later you see another insurance provider is selling the same Plan G for less. You can switch to the new plan even if you have already been to the doctor under your first Medigap plan.

Next Steps: if you are within 6 months from your Part B start date, give us a call and we can help you switch to a new Medigap plan right over the phone.

Medigap Free-Look Period

If you are not sure about your Medigap plan and would like to try another one, you can do so with this option. You just need to apply for a different plan stating that you will cancel your first policy. At the end of the 30 day period since you are approved on your second policy, you can decide which one you like the most. Note that you will have to pay both premiums for one month

Medigap Free-Look Period Example: you enrolled in Plan F but heard that Plan G is usually a better deal so you would like to try it out. You decide to enroll, and once you are approved and 30 days have passed, you switch to Plan G. Of course you can also cancel your Plan G and just stay with Plan F.

Next Steps: give us a call here at Senior65 to understand which plan you would like to try out and get enrolled in no time. We will help you go through the whole process of enrolling and cancelling whichever plan you decide not to move forward with.

Birthday Rule Medigap Switch

California and Oregon offer something called the Medigap Birthday rule. If you are a resident who is currently enrolled in a Medigap plan, you can change to an equal or lessor plan around your birth month with no medical questions asked. Each state has slightly different rules about exactly when you can trigger the birthday rule.

Birthday Rule Medigap Switch Example: you live in California and you have had a Plan G with Mutual of Omaha for 3 years. Your friend tells you she has Medigap Plan G from Blue Shield that costs less. You can switch to the new Plan G without answering health questions if you apply during the Birthday rule window.

California allows you to exercise the Birthday rule within 60 days of your birthday. To learn more about CA Medigap Birthday Rule Switch click here.

To learn more about Oregon’s Medigap Birthday Rule Switch please call us at 800-930-7956. Oregon residents must switch within 30 days of their birthday, starting on that day.

Next Steps: Oregon and California residents should give us a call roughly one month before their birthday so we can price plans and schedule a switch to a lower-priced plan.

Guaranteed Issue State Medigap Switch

Some states have laws that allow for any Medicare-eligible person who applies for Medigap to be automatically approved regardless of their health condition. Those states are called guaranteed issued states and they usually allow for easy Medigap switching. For example, Connecticut and New York have  100% guaranteed issuance any time of the year. Maine allows Medigap enrollees to switch to a plan that has the same or fewer benefits, at any time of the year. Washington state allows enrollees to switch from any Medigap to any other Medigap except Plan A at any time of the year.

Guaranteed Issue State Medigap Switch Example: you live in Washington State and want to move from Plan F to Plan G. You apply for G and must be approved regardless of your health condition.

Learn more about Connecticut Medigap switching laws

Learn more about New York Medigap switching laws

Learn more about Maine Medigap switching laws

Learn more about Washington State Medigap switching laws`

Next Steps: if you live in Connecticut, New York, Maine, or Washington State, give Senior65.com a call and we can get you on a new lower-priced plan. Most new plans will start on the first of the following month you apply.

Anniversary Rule Medigap Switch

Missouri is the only state that currently offers the Medigap Anniversary Rule. This state law allows you to switch plans during the anniversary date of when you first signed up for coverage. You must switch to an equal (not lessor) plan.

Anniversary Rule Switch Example: you first enrolled in a Medigap Plan F in Missouri on October 1st of 2019. Two years later you want to switch to another insurance company’s Plan F with a better price. In this example, you apply for the new plan in September of 2021 and you will be guaranteed to be approved. Your new plan would start in October.

Read our detailed article about Missouri’s Anniversary Rule here.

Next Steps: MO residents can call Senior65.com to switch Medigap plans. Give us a call 30 days before the “Anniversary” date of your enrollment. If you are not sure which month you enrolled in your current Medigap plan, give us a call and we can help you figure it out.

Spouse Passes Away Medigap Switch

You can switch your Medigap plan without questions if you were enrolled through your spouse or primary member, and they die. You have 63 days to apply for coverage.

Spouse Passed away Medigap switch example: your wife was the primary on your Medigap Plan F. Your plan offered a 10% household discount. She dies on March 10th and the insurance company removes your household discount. You want to switch to a stand-alone Medigap Plan G at a better price. You apply on March 20th for a new plan and you are guaranteed to be approved on the new plan regardless of your health.

Next Steps: if your spouse has recently passed away we send our heartfelt condolences. Give us a call to discuss your options.

Bankruptcy or Misled Medigap Switch

You can switch without underwriting questions if your current plan commits fraud, somehow deceives you, or goes bankrupt.

Misled Medigap Switch Example: you purchased a Medigap Plan F and the insurance company told you the monthly price would not increase for any reason. You get a 5% increase the following year. You can apply for a new plan with a different company letting them know in the application that you were misled by your previous plan. If your reason is accepted, you must be approved on the new plan.

Next Steps: if you felt you were misled when you enrolled on your current Medigap plan, give us a call to review the process for switching.

Medigap SELECT Switch

Medigap SELECT plans usually offer the exact same benefits as their lettered counterparts but have a smaller network of doctors and a lower price. If you move out of the Medigap SELECT policy’s service area, you will have the right to get other Medigap policy (with same or less benefits) without questions. You need to have had your policy for more than 6 months.

Medicare SELECT Medigap switch example: you purchased a Medicare SELECT Plan G in Texas. You move to California. You can apply for a standard Medigap Plan G in CA and you must be approved regardless of your health history.

Note: one other switching option is available with Medicare SELECT. If you had a Medigap plan but switched to Medigap SELECT for the first time, you have a year to switch back to the Medigap policy you had, with the same company you were enrolled with. If your former policy is not available, you can choose another plan with another company.

Next Steps: if you have moved outside your Medigap Select area, call us and we can help you get approved on a new standard Medigap plan.

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Switch from Medicare Advantage to Medigap

The last section focused on people switching from one Medigap plan to another Medigap plan. If you want to switch from Medicare Advantage to Medigap, you also have options at your disposal.

Some of the reasons you might want to go from MA to Medigap are:

  • You want a bigger network of doctors
  • You want more benefits
  • You want to avoid deductibles, co-pays and co-insurance

Medicare Advantage Trial Right Switch

If you joined a Medicare Advantage plan during your initial enrollment period, and within the first year you decide you would prefer Medigap, the Trial Right lets you switch without underwriting. You can apply as early as 60 calendar days before the date your coverage will end, and no later than 63 calendar days after your coverage ends. In the state of Maine, your trial period is extended to three years, instead of one.

Trail Right Switch Example: you enrolled in a Medicare Advantage plan when you first turned 65 on March 1st. After 8 months, you are very unhappy with your plan’s network of doctors. The following February you apply for a Medigap Plan G to start on March 1st. You are guaranteed to be approved under the MA trial right.

There is also one similar case under the Medicare Advantage Trial Right Switch. If you had a Medigap plan but switched to Medicare Advantage for the first time, you have a year to switch back to the Medigap policy you had, with the same company you were enrolled with. If your former policy is not available, you can choose another plan with another company.

Learn More about the Medicare Advantage Trail Right Switch here.

Next Steps: if you are in the first year of your first Medicare Advantage plan, give us a call and we can help you switch to a Medigap plan right over the phone.

Medicare Advantage Moving or Plan Leaving Switch

If you have a Medicare Advantage plan but you move out of your plan’s area of coverage, you can switch to Medigap (and Part D) without answering health questions. You can also apply for a different Medicare Advantage plan using this Special Enrollment rule. Finally, if your plan is leaving Medicare or stops giving care in your area, this rule allows you to switch to any Medigap or Medicare Advantage plan. You have this option from 60 calendar days before the date your coverage ends and up to 63 calendar days after.

Medicare Advantage Moving Switch Example: you live in Los Angeles and have a Medicare Advantage plan. You move to San Diego and learn that you are outside of your current plan’s network. You are allowed to switch to a Medigap plan or a Medicare Advantage plan regardless of your health. If you select Medigap and your old MA plan included drugs, you will be able to enroll in a Part D drug plan during this time, as well.

Next Steps: do you have a MA plan and are moving to a new location? Give us a call and we can help you enroll in a Medigap plan for the first time (or switch to another MA plan).

Medicare Advantage Misled Switch

If your Medicare Advantage company hasn’t followed the rules or has misled you, you can switch to Medigap up to 63 calendar days after your coverage ends or you can enroll in another Medicare Advantage plan.

Medicare Advantage Misled Switch example. you enrolled in a MA plan and were told by the company you enrolled with that you could see any doctor you wanted but later learned that you are not covered for doctors outside the MA network. You can switch to a new plan, stating that you were misled on the application.

Next Steps: do you feel like your current Medicare Advantage plan misled you when you were enrolling? Give us a call to review the rules and see if you qualify for a guaranteed issued switch.

Switch Between Medicare Advantage plans (usually applies to Part D)

This section is dedicated to those who want to switch from one Medicare Advantage plan to another. If you are not happy with your Medicare Advantage plan (MA) you have many options for switching. Most of the rules below also apply for Part D drug switching as well.

Reasons for switching from one Medicare Advantage plan to another:

  • You are not happy with the doctors in your current network
  • You want a lower out of pocket maximum
  • Other plans offer better benefits such as a gym membership

Medicare Advantage Initial Enrollment Switch

If you enroll in Medicare Advantage during your initial enrollment period, you can switch your plan or go back to Original Medicare. You need to do this within the first 3 months after your Part B effective date. This also applies to Part D drugs.

Medicare Advantage Initial Enrollment Switch Example: you turned 65 and signed up for the same Zero Premium Medicare Advantage plan as your friend. Once you learned more about the plan, you figured out it wasn’t a great deal since none of your favorite doctors participate. You can switch to another MA plan during your initial enrollment period even if you have already been to the doctor on your old plan.

Next Steps: if you are still within your initial enrollment period, give us a call and we can help you right over the phone.

AEP Open Enrollment Switch

The Annual Election Period or AEP is sometimes also referred to as Open Enrollment. AEP goes from October 15th to December 7th. During AEP, you can change your Medicare Advantage plan for another. The new plan would begin on the first day of the following year (Jan 1st).

Annual Election Period Switch example: you have a Medicare Advantage plan but you are not happy that they charged so much when you went to the hospital. You have researched with your agent a Medicare Advantage plan that has a much lower out-of-pocket maximum. You can apply to switch to a new MA plan between October 15-Dec 7th and your new coverage would start on Jan 1st of the following year.

Next Steps: contact us between the dates above to switch in no time.

Medicare Advantage Open Enrollment Switch

Open Enrollment period for Medicare Advantage goes from January 1st to March 31st. During Medicare Advantage Open Enrollment, you can switch your Medicare Advantage plan. You can also drop your Medicare Advantage and return to Original Medicare, in which case you can enroll in Part D. Note: Medigap does not have an Open Enrollment period.

Medicare Advantage Open Enrollment Switch Example: you have an average Medicare Advantage plan but you forgot to switch plans during AEP (Oct 15-Dec 7th as listed above) because you were focusing on holiday entertaining in December. You can still switch during the Medicare Advantage Open Enrollment period in the new year. You could switch in March and your new plan would start on April 1st.

Here is a detailed article about Medicare Advantage Open Enrollment Period.

Next Steps: give us a call between January 1st and March 31st to switch your Medicare Advantage plan for a better one.

To be clear, you will not be able to switch from Original Medicare to Medicare Advantage during this period.

Medicare Advantage and Part D Special Enrollment Switch

As stated, there are some occasions that trigger a Special Enrollment period. Please refer to Moving or Plan Leaving Switch, or Misled Switch above in this article.

Institution Switch

According the Center for Medicare Services (CMS): if you moved into, currently live in, or moved out of skilled nursing facility or long term care hospital, that would trigger a Special Enrollment event.

You could join a Medicare Advantage Plan or Medicare Prescription Drug Plan for the first time. During this time you can switch from your current plan to another Medicare Advantage Plan or Medicare Prescription Drug Plan. You could also drop your Medicare Advantage Plan or Medicare prescription drug coverage as part of this Special Enrollment time.

Your chance to join, switch, or drop coverage lasts as long as you live in the institution and for 2 full months after the month you leave the institution.

Medicare Advantage and Part D “5-Star Rule”

Another type of Special Enrollment is the “5-Star Rule”. If you can find a 5 star Medicare Advantage or Part D plan in your area, you can switch your current plan to that Medicare Advantage or Part D.

You can use this Special Enrollment Period only once between December 8th and November 30th.

You should take into account that Medicare is pretty stingy with its ratings. Even a 4-Star plan is sometimes hard to find. Nevertheless, we can help you find one in your area.

One more thing. If you move from a Medicare Advantage Plan that has drug coverage to a 5‑Star Medicare Advantage Plan that doesn’t, you may lose your prescription drug coverage. You’ll have to wait until your next enrollment opportunity to get drug coverage, and you may have to pay a Part D late enrollment penalty

Switch from Medigap to Medicare Advantage

If you have a Medigap plan, but want to get Medicare Advantage, the best time to do so is during AEP Open Enrollment, from October 15th to December 7th.

Overall, Medigap clearly offers better coverage than Medicare Advantage. However, premiums can be somewhat expensive in comparison. That is the main reason why someone would want to switch from Medigap to Medicare Advantage.

Conclusion

As you can see, there a lot of times and possibilities to switch your Medicare Insurance.

Medicare Advantage and Part D usually have set times, while in the case of Medigap you can switch at any time by answering questions.

There are also many chances to switch your Medigap without going through underwriting.

It can all be very confusing and challenging, but we hope to have made a bit easier for you. Please don’t hesitate to leave a comment with your question or call us at 800-930-7956.

If you are looking to switch, contact us at the number above or apply online. Even if you are not guaranteed to be approved and have preexisting conditions, we can help you switch. Just give us a call.

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