Medicare Insurance Switching: Ultimate Guide

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 (If you want to know when your coverage will start, you can read our updated article: Medicare Part B: New Start Dates For Coverage In 2023). Most Americans then go on to choose additional insurance such as Medigap (Med Supp), 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.

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. You may already have read our popular overview article on switching Medigap plans, but this plan covers every plan-switching option that we are aware of. Below is a summary chart of all the switching options. Find your situation and click on the underlined name of the option to read all the details about it.

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 would you want to switch Medigap plans?

There are several 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

What is a Basic Medigap Switch?

You can always switch from one Medigap (MedSup) 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: So as you can see you can switch Medigap plans at any time of the year BUT you will have to answer health questions to be approved. if you would like to submit a “Basic Medigap Switch,” the first place to start is by getting a quote for new Medigap plans in your area. After you get a quote, apply online or contact Senior65.com 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.

What is the Medigap Initial Enrollment 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, which is sometimes called Medigap Open Enrollment, 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.

Birthday Rule Medigap Switch

California, Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, and Oregon all offer something called the Medigap Birthday rule. If you are a resident who is currently enrolled in a Medigap plan, you can usually change to an equal or lesser plan around your birth month with no medical questions asked under this switching opportunity. Each state has slightly different rules about exactly when you can trigger the birthday rule and which plans you can switch to. Illinois and Louisiana’s version of the Birthday requires that you stay with the same insurance provider.

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 which costs less. You can switch to the new Plan G without answering health questions if you apply during the Birthday rule window.

• Learn more about the California Birthday Rule Switch here.
• Learn more about the Idaho Birthday Rule Switch here.
• Learn more about the Illinois Birthday Rule Switch here.
• Learn more about the Kentucky Birth Rule Switch here.
• Learn more about the Louisiana Birthday Rule Switch here.
• Learn more about the Maryland Birthday Rule Switch here.
• Learn more about Nevada Birthday Rule Switch here.
• Learn more about the Oklahoma Birthday Rule Switch here.
• Learn more about the Oregon Birthday Rule Switch here.

Discover the Ultimate Resource on the Medigap Birthday Rule for Every State. Next Steps: If your state has the birthday rule, you should give Senior65.com a call at 800-930-7956 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 at 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`

Anniversary Rule Medigap Switch

Missouri offers the Medigap Anniversary Rule which is similar to the Birthday rule offered in some other states. MO law allows you to switch plans 30 days before and 30 days after the anniversary date of when you first signed up for coverage. You must switch to an equal (not lessor) plan to have guaranteed issued Medigap on the new plan.

Anniversary Rule Switch Example: You first enrolled in a Medigap Plan F in Missouri on October 1st of 2021. 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 30 days before or 30 days after October 1, 2023

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

Next Steps: MO residents can call Senior65.com to switch Medigap plans. The best time to give us a call is 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.

Massachusetts State-Sponsored Medigap Open Enrollment

Those on Medigap do not have a typical “open enrollment” season to switch plans…unless they live in Massachusetts. From February 1 – March 31 anyone can join or switch Medigap plans during this time, as long as they reside in the Bay State.

State-Sponsored Medigap Open Enrollment Example: You live in Boston and have a Medigap plan but now you want to switch to a different insurance provider. You enroll in the new Medigap plan on March 15th during your state’s special open enrollment. You are approved regardless of your current state of health. Your new coverage would begin on April 1st.

Learn more about how Medigap plans work in Massachusetts.

Loss of Spouse Medigap Switch

You may be able to switch your Medigap plan without health questions if you were enrolled through your spouse’s work-sponsored Medigap plan and they die.

Spouse Passed Away Medigap Switch Example: Your wife was the primary on your work-sponsored Medigap Plan F for the two of you. She dies on March 10th. You want to switch to a stand-alone Medigap Plan G. This may be possible depending on how your wife’s company set up the plan.

Next Steps: If your spouse has recently passed away we send our heartfelt condolences. Call your spouse’s HR department for next steps.

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 another Medigap policy (with the same or fewer 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 two years later. You can apply for a standard Medigap Plan G in CA and you should 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.

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.

Medicare Advantage “Underwriting Holiday” Switch

Insurance providers have the option to approve applicants without reviewing health questions (called underwriting) if they want. While very rare, some companies offer promotions called “underwriting holidays,” where they approve everyone who applies regardless of their health history. Blue Shield of CA has offered a promotion for the last three years which allows anyone living in California with a Medicare Advantage plan to switch to any Medigap plan the company offers. There is no health review.

Medicare Advantage “Underwriting Holiday” Switch Example: You enrolled in a MA plan and after 10 years you decide you want to be on Medigap instead but you have pre-existing conditions that would keep you from Medigap approval. You apply for Blue Shield Medigap during their Underwriting Holiday promotion and your plan will be approved. To complete this switch you would have to enroll in a part D drug plan which would disenroll you from your Medicare Advantage plan.

Next Steps: The Blue Shield Underwriting Holiday promotion has been offered in Dec – Feb in the past but give us a call at 800-930-7956 to confirm it is still being offered.

Medicare Advantage Price Increase or Doctor/Benefit Decrease Switch

If you live in CA and your Medicare Advantage plan increases premiums, raises copayments for physician or hospital services or drugs or discontinues its relationship with a Medical provider you are currently receiving services from, you can switch to a Medigap plan offered by your same Medicare Advantage company. If your MA company doesn’t offer Medigap then you can go to any Medigap provider in your state. Different CA insurance companies have different windows for enrollment and rules. A few require that you make this switch during the Annual Election Period of Oct 15-Dec 7th but others do not. Call us for details.

Medicare Advantage Price Increase or Doctor/Benefit Decrease Switch Example:

You get a notice that your California Humana MA plan is doubling in price. You can switch to a Humana Medigap plan without medical underwriting.

Next Steps: If your California MA plan has increased or your doctor has been removed from your MA network for reasons other than quality of care, give Senior65.com a call to see if you can switch without underwriting. Note: Keep any notification of the price increase or doctor network change so we submit it with your application.

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Switch Between Medicare Advantage plans

(These same rules usually apply for switching from one Part D plan to another)

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 to 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

The 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 to the Center for Medicare Services (CMS): if you moved into, currently live in, or moved out of a 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 are 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 it 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.