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Escaping Medicare Advantage
Several times a week, we get calls from people who chose to go with a Medicare Advantage plan over Medigap, only to find out it is not the low-cost alternative they thought it was. If you found this article, that might be you. We are not here to point fingers or deride your decision. We are here to help you. The Medicare Advantage Trial Right option could be an option for you.
Too many people in my industry push the “Advantage” plans over traditional Medicare with a Medigap plan. I have people tell me often that their agent or phone rep for their provider told them it was “free Medicare.” That is not true. Even though some plans have no premium, there are co-pays, deductibles, and co-insurance payments of up to 20% that you still have to pay out of pocket. In 2025, the most you will pay out of pocket for your healthcare portion is $9,350. The prescription drug benefit under Medicare Advantage plans (MAPD) has a separate deductible and co-pays.
Why Agents and Companies Push Medicare Advantage – MONEY!
There are many reasons that agents and insurance companies push these plans:
- An agent makes more than twice the commission on a new Medicare Advantage enrollee as they do on a Medigap policy. It is in their best interest – not yours – to enroll you in that plan!
- Some agents deceptively refer to Medicare Advantage plans as “free Medicare.” They point out the very low or even zero-dollar premium amount and sell the plan based on that. It is a deceptive practice that makes it easy to sell those plans.
- Some of the largest Medicare Advantage providers have been accused of fraudulently overbilling Medicare for reimbursement costs. They have been accused of “coding” certain patients as being sicker than they really are. Another Medicare Advantage provider – Freedom Health – settled a $32 million whistleblower lawsuit for the same practices. As of this writing, four more of the largest Medicare Advantage providers in the country are also under investigation by the US Justice Department for the same practices. These companies are reimbursed based on how much treatment a policyholder needs. If they are coded as sicker, the insurance company generally gets more reimbursement for their care. Medicare Advantage is a big money-maker for the insurance companies – especially when they use deceptive practices to steal overpayments from the government. I covered this situation and how it affects you in this YouTube video (click).
Finding an Option For a Way Out
Regardless of the reasons why you chose the Medicare Advantage plan, you are probably here because you want out. The Medicare Advantage Trial Right could let you move to a Medigap plan with guaranteed issue rights. In other words – there is no underwriting to get a Medigap plan.
The biggest issue when going back to original Medicare is being able to qualify medically for a Medicare supplement plan. Once you are out of your Medicare Open Enrollment or a Guaranteed Issue period, you must pass underwriting to qualify for a Medigap plan.
This is where the Catch-22 happens. Most people are happy with their Medicare Advantage plan right up until the time that something happens to their health. But once you receive a diagnosis, the chances of being able to move to a Medigap plan drastically go down. Once that happens, many people find themselves stuck in a restrictive Medicare Advantage plan with no options to move to original Medicare where the coverage is better.
Medicare Advantage Trial Right
Medicare has a trial right policy that allows you to “get out of jail” if you find yourself stuck. There are some limitations to this Medicare Advantage trial right.
If it is your first time in a Medicare Advantage plan and you are not happy with it, you will have special protections under federal law to buy a Medigap plan. These rights are available to you if you have been on your plan less than a year.
If You Previously Had Medigap Coverage
If you left a Medigap policy to enroll in a Medicare Advantage plan and have been in the MA plan less than a year, you have a right to buy the same plan from the same company that you had before. It also has to be the first time you switched from Medigap to a Medicare Advantage plan. You can only use this option once.
This is assuming that the same company still offers it. If your Medigap plan is no longer available from the same insurance company, you can choose another company. You will be allowed to choose a Medigap Plan D, G, or High Deductible G that is sold by any insurance company in your state.
This is not an either/or situation. You must go back to the same plan you had previously if it is available. The second option can only be utilized if that plan is no longer for sale in your state.
If You Joined a Medicare Advantage Plan at Age 65
If you joined a Medicare Advantage plan when you were first eligible for Part A at age 65, you can switch to original Medicare at any time within the first 12 months in that plan. Under this Medicare Advantage Trial Right scenario, you have a right to purchase any Medigap plan available from the company of your choice in your state.
If You Have Been in Your Medicare Advantage Plan More Than 12 Months
There are a couple of other situations listed on the Medicare.gov website that allows you to move from Medicare Advantage to a Medigap plan with guaranteed issue rights.
- Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.
- You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn’t followed the rules, or it misled you.
If none of the previous scenarios apply to you, the Medicare Advantage Trial Right will not be available. You will need to pass underwriting requirements to move to a Medigap plan. Call us and we can go over the underwriting requirements to see if you would qualify.
Medicare Advantage Trial Right is Available Year-round
All of the above Medicare Advantage Trial Right options are available at any time during the year. In other words, you do not have to wait for the Annual Enrollment Period (AEP) to use these options. AEP lasts from October 15 to December 7 every year.
Unlike Medicare Advantage plans, Medicare supplement plans can be changed at any time of the year. But moving off of a Medicare Advantage plan must be done during the Annual Enrollment Period (AEP) or the Disenrollment Period that runs from January 1 through February 14 each year. That is unless you qualify for a Special Enrollment Period or Trial Right exception.
You may be one of those in a situation that requires you to go through underwriting to qualify for a Medigap plan. Do not disenroll from your Medicare Advantage plan until you have been approved for a Medigap plan. If you are not sure or need help with it, call us. It never fails that every year we have to try to help fix situations where some other agent moves someone out of a Medicare Advantage plan and back to original Medicare, and then the person does not get approved. It makes for a huge mess!
If you have any questions or need help in any way, you can call us at 1-888-228-6119. You can also use the form to send us a question or leave a comment below.
YouTube Video – Who Gets The Advantage??
I address some of the issues mentioned above in this YouTube video. Check it out and hit the SUBSCRIBE button in the bottom right corner. That will keep you up to date on the latest Medicare information we bring to you.
I have been working with seniors turning 65 and all the way up into their late nineties for over 24 years now. Let me put that experience to work for you. Call the number below and I will put my office to work for you now and into the future.
Keith Murray
1-888-228-6119