En español | Medigap insurance works only with coverage from the original Medicare program. It covers some or most of your out-of-pocket costs (deductibles and copays) in the original program, depending on the policy you buy. But it doesn’t cover any out-of-pocket expenses in a Medicare Advantage plan.
This is a major consideration if you have a Medigap policy and you’re thinking of switching from original Medicare to a Medicare Advantage plan, because once you give up a Medigap policy you may not be able to get it back on the same terms.
However, there are some circumstances in which — if you drop out of Medicare Advantage and switch to original Medicare — you have the right to buy a Medigap policy with full protections under federal or state law (also known as “guaranteed issue”), which means that during certain time frames insurance companies cannot refuse to sell you a Medigap policy or charge higher premiums based on your health status or preexisting medical conditions. These circumstances include:
- You can drop out of a Medicare Advantage plan, switch to original Medicare, and buy a Medigap policy, provided that you enrolled in the Medicare Advantage plan when you first joined Medicare at age 65 and you have been in the plan for no longer than 12 months. (This first year counts as a trial period.)
- If you dropped a Medigap policy to join a Medicare Advantage plan, you can return to original Medicare and get your Medigap policy back on the same terms provided that this is the first Advantage plan you’re ever had and you’ve been in it for no longer than 12 months. (This first year also counts as a trial period.)
- You can drop out of a Medicare Advantage plan, switch to original Medicare and buy a Medigap policy if you live in one of the few states that allow residents to buy policies with guaranteed issue at any time of any year or once a year during your birthday month. (Check state law with your state department of insurance.)
- You can switch to original Medicare and buy a Medigap policy within 63 days of moving your home out of your Medicare Advantage plan’s service area.
- You can switch to original Medicare and buy a Medigap policy within 63 days of losing coverage from your Medicare Advantage plan if it has ceased service in your area for any reason.
Note that these rights apply only to Medicare beneficiaries who are age 65 and over. They do not apply if you are younger and have Medicare on the basis of disability, unless you receive similar protections under the laws of your state.