Medicare Advantage Enrollment: Impact on Switching to Original Medicare and Medigap

Medicare Advantage (MA) plans and original Medicare with Medigap present distinct choices for beneficiaries, particularly concerning plan flexibility and subsequent enrollment opportunities. Medicare Advantage plans, offered by private insurers and serving as alternatives to original Medicare, generally provide bundled services, including hospital, medical, and often prescription drug coverage, with added benefits like dental and vision care.

These plans are typically network-based and may introduce care access restrictions and pre-authorization requirements. Conversely, original Medicare offers broader provider access but has coverage gaps that Medigap policies help fill. Crucially, enrolling initially in Medicare Advantage impacts the availability and cost of Medigap coverage later due to underwriting requirements.

This "Medicare Advantage trap" means that beneficiaries who switch from an MA plan to original Medicare after the initial enrollment period may face denial or higher premiums for Medigap plans, except in four states—Connecticut, Massachusetts, Maine, and New York—where insurer denial based on preexisting conditions is prohibited. Prospective enrollees should weigh cost savings against potential limitations and future flexibility when choosing between MA plans and original Medicare with supplementary coverage.