Rules For Switching From Medicare Advantage To Medicare Supplement Can Benefit Seniors

Managed Care Weekly Digest

By a News Reporter-Staff News Editor at Managed Care Weekly Digest -- The best time to lock-in the choice of a Medicare Supplement insurance policy is during the Open Enrollment Period when consumers have guaranteed rights to buy any Medigap policy available in the state. After Open Enrollment, there are little known situations when consumers still have guarantees enabling changes according to a leading Medicare insurance expert (see also Medicare and Medicaid).

"Understanding guaranteed issue rights is extremely important for consumers especially if one wants to or needs to change Medicare insurance plans," explains Jesse Slome, director of the American Association for Medicare Supplement Insurance (AAMSI). "The guaranteed rights provision requires insurance companies accept pre-existing health conditions for Medicare Supplement insurance coverage regardless of past or present health problems."

"When someone turns 65 and first signs up for Medicare Part A and B, there is a six month window to secure a guaranteed issue Medigap plan," Slome explains. "After that period an insurance company can charge more or even decline applicants because of existing health conditions."

Switching From Medicare Advantage to Medicare Supplement Insurance

Since the 1970s, Medicare beneficiaries have multiple coverage options. One can receive care through private health plans, mainly health maintenance organizations (HMOs) under the program commonly called Medicare Advantage. "Some 17 million individuals, about one in three people, are enrolled in Medicare Advantage plans," explains Slome. Over 13 million individuals have traditional Medicare coupled with Medicare Supplement insurance according to AAMSI.

"Many consumers don't clearly understand the differences between Medicare Advantage and Medicare Supplement (Medigap) coverage," Slome notes. "Seniors are permitted to switch back and forth between traditional Medicare and Medicare Advantage during the open enrollment period, but choosing Medicare Advantage from the start, could be an irrevocable decision giving up the right to purchase supplemental insurance later in life."

Understanding the different plan benefits, costs, limitations such as lock-in rules, and guaranteed (health) issue rights are vital Slome recommends. As a benefit to consumers, the "Trial Rights" privilege provides the right to switch from a Medicare Advantage plan to any Medigap policy within the first year. "Under certain circumstances the right may last for an extra 12 months," Slome shares.

The "Guaranteed Issue Right" to switch from Medicare Advantage to Medigap also applies when moving outside of the current plan's service area. "Millions of retired seniors move each year and that may be an opportunity to consider changing plans," Slome adds. "There are time limits that must be met to avoid having to satisfy health criteria; a significant advantage not to be overlooked." Similar provisions apply if a Medicare Advantage plan goes out of business.

According to Slome, a little-known provision permits switching from Medicare Advantage when the consumer can claim proof of having been misled. "The insurance agent might not have clearly stated the requirement to use 'in-network' doctors," is one example Slome cites.

Tips For Getting The Best Medicare Insurance Options

"Before selecting a Medicare plan that one is locked into for years and maybe decades, consider future lifestyle changes and health care preferences," Slome advises. "And, be sure to understand the future right to switch especially the opportunity to change without having to meet health requirements."

Keywords for this news article include: Health Policy, Medicare and Medicaid.