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What Happens When You Change From Medigap to Medicare Advantage Plans

From Medigap to Medicare Advantage Plans

If you’re approaching the age of retirement, you’ve probably heard that the Original Medicare and Medigap combination is ideal, in terms of financial protection. However, the Medicare Advantage Plans cost less per month.

Many beneficiaries often wonder if making the switch from Medigap to Medicare Advantage is possible and whether it’s a smart move. The answer to both these questions is: yes. Let’s explore why.

Why Is It A Smart Move To Make The Switch?

How well your Medicare plan works for you depends on three things: cost, coverage and the plan itself. Starting off with Medigap, you get a chance to assess how well the plan is suiting your healthcare needs and budget. Upon eligibility, you automatically get access to enrollment in a Medigap plan.

In case Medigap does not work for you, if your health status changes, you can decide to either stay with the Medigap plan or switch to a Medicare Advantage Plan during the Annual Enrollment period. On the other hand, the switch from Medicare Advantage to Medigap is neither simple, nor guaranteed for approval.

Even though more than 33% of Medicare beneficiaries are enrolled in a Medicare Advantage Plan, making the switch needs careful consideration as the coverage provided differs greatly from Medigap plans.

Here are some key differences between the two plans.

Medicare Advantage

Medicare Advantage Provides a Smaller Network than Medigap

Those enrolled in the Original Medicare and Medigap plans have access a huge network of physicians (as many as 800,000) that provide care under Medicare. Medicare Advantage plans typically operate in smaller networks in selective counties in the area that you live.

This is why we suggest that if you’re making the switch, select a Medicare advantage plan that provides a network of at least 5000 providers or more. Our licensed agents at Seniors for Medicare can assist you with this process.

You May Need Referrals to See a Specialist

If you are enrolled in an HMO plan with Medicare Advantage, you will have to select a Primary Care Physician. In case you need to see a specialist, you will need to get a referral from your Primary Care Physician. This differs from Medigap plans, where you had the freedom to consult any Medicare provider without referrals.

In case you have a PPO plan, you may not need to obtain a referral to see a specialist within the Medicare Advantage network. You can also refer to a doctor outside the network at additional cost to you. However, it’s important to bear in mind that a doctor outside the network does not have to see you. They can decline their services if they do not want to bill your PPO plan.

Your Out-of-Pocket Charges Can Go Up To $6700 Per Annum

Medigap beneficiaries never have to bother with paying out of their pocket. However, with Medicare Advantage plans, you have to pay for services as you go along. Your plan’s summary of benefits will tell you how much each service costs. However, it’s crucial to note that some Medicare Advantage plans may charge 20% for chemotherapy, dialysis and radiation.

It’s always best to be prepared for the worst case scenarios when planning for a switch. If you’re looking for some guidance with your Medicare plans, or seek to enroll in one, reach out to us at Seniors for Medicare.

We are a licensed team of Medicare advisors based in New York and New Jersey. Reach out to us at 800-276-1753 to learn more.

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