Ask The Advisor: November 2015

Ask The Advisor: November 2015

Can I Get My Old Medicare Supplement Back?

Q: I’m in my 80s and I’ve been covered by a Medicare Advantage plan for several years. Recently I had to have a hip replacement and the costs were far greater than I thought they would be. My former Medicare supplement covered almost all out-of-pocket costs. Is it possible to switch from this Medicare Advantage plan back to Medicare and my former supplement? I’m a resident of Florida.

A: You may run into problems if you try to buy a Medigap supplement outside of certain protected enrollment periods. Unlike Obamacare where insurers are prohibited from refusing to sell you coverage or charging you more based on age or pre-existing health conditions, there is no such universal coverage guarantee for Medicare supplement policies.

Generally, the best time to enroll is when you first become eligible for Medicare at age 65. Since you are well past that age, there’s no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements, except under certain circumstances. The following list applies nationally, but your state may have other times you can buy a supplement:

  • You had group health insurance (through either current or previous employment), you lost it through no fault of your own, and you qualify for a special enrollment period.
  • If you joined a Medicare Advantage plan when you first became eligible for Medicare and dis-enrolled within 12 months.
  • If your previous Medigap policy, Medicare Advantage plan, or PACE program ends its coverage or commits fraud.

If an insurance company does agree to sell you a policy you will probably pay higher monthly premiums and you may need to wait six months before your Medigap policy will cover pre-existing conditions, which undoubtedly would put you at risk financially. Some states allow people to buy a Medigap policy during other times so it is important that you contact a State Health Insurance Assistance Program (SHIP) counselor for help. Many of these programs work through local senior services departments and area agencies on aging.

SHIP counselors provide free, in depth, one-on-one insurance counseling and assistance to Medicare beneficiaries. Your counselor can explain what you are allowed to do in your state, and can also help you compare ALL your Medicare coverage options to help you find good quality coverage at the most affordable cost to you.

While you might not be able to get your old Medigap plan back, you may be able to find a better Medicare Advantage plans with lower costs and better benefits. Contact a counselor NOW during the Medicare fall Open Enrollment period, October 15 through December 7.