Switching From MAPD to Medigap

Switching from MAPD to Medicare Supplement Plans

If you’re considering switching from an MAPD to Medicare Supplement plans, you’re not alone.  Many people consider this every year.  But before you go ahead and apply, it is important to make sure you know exactly what you’re getting into and what to expect. Below are some helpful tips when it comes to switching from MAPD to Medicare Supplement plans.

#1 Health Questions

Many people think that since the Affordable Care Act was passed, insurance carriers are not allowed to ask health questions. Although this is true for non-Medicare health insurance, Medicare has its own rules.

Medicare Supplement plans are allowed to ask you health questions if you do not have guaranteed issue rights to purchase one of these products. Depending on the answers you give on the application, you can be charged a higher premium or denied coverage completely. If you want to switch from an MAPD to a Medicare Supplement plan, there’s a good chance you do not have guaranteed issue rights.

#2 Guaranteed Issue Rights

These are rights that allow you to bypass the medical questions on a Medicare Supplement application. The two most common scenarios are turning 65 or enrolling in Part B after losing employer coverage.

If you recently turned 65, you have 6 months to apply for a Medicare Supplement plan. Keep in mind, you will need to be enrolled in Part B first.

If you are over 65 and retiring from your job, losing your employer’s health insurance plan, and newly applying for Part B then you also have 6 months to apply for a Medicare Supplement plan without health questions.

Here are some less common scenarios that allow you to enroll in a Medicare Supplement plan without health questions:

  • You’re in a Medicare Advantage Plan (like an HMO or PPO), and your plan is leaving Medicare or stops giving care in your area, oryou move out of the plan’s service area.
  • You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending.
  • You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you’ve been in the plan less than a year, and you want to switch back.
  • You joined a Medicare Advantage Plan (like an HMO or PPO) or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare.

These aren’t all of the guaranteed issue rights. You should refer to Medicare’s website for a more complete list.

#3 But What About Nevada’s Medicare Supplement Birthday Rule?

Yes, in 2021 Nevada State Legislature passed Assembly Bill 250 (AB 250) also known as the birthday rule. This allows individuals with a Medicare Supplement plan to switch insurance carriers during a set time frame each year around their birthday. If you want more information about how exactly this works, you can reach out to our office here: https://healthbenefits.net/medicare/

Unfortunately, this does not apply to people who are switching from an MAPD to Medicare Supplement plans. It only applies to individuals who are currently enrolled in Medicare Supplement plans.