JustCare

Category: Your Coverage Options

  • Humana threatens to close some Medicare Advantage plans and reduce extra benefits in others

    Humana threatens to close some Medicare Advantage plans and reduce extra benefits in others

    Suzanne Blake reports for Newsweek on the consequences of Humana closing some of its Medicare Advantage plans in 2025 and claiming it will reduce benefits in other Medicare Advantage plans in order to increase profits. Warning: Enrolling in Medicare Advantage will always mean never being able to rely on getting care and coverage from the physicians and hospitals you want to use and having out-of-pocket costs as high as $8,850 this year for in-network care and more if you go out of network.

    Today, Humana covers six million Medicare enrollees through its Medicare Advantage plans. Humana offers Medicare Advantage plans in all 50 states. Its greatest penetration is in the Southeast. Florida has nearly three quarters of a million Humana Medicare Advantage enrollees. North Carolina has more than 450,000. Georgia has 336,000, Texas has 289,000 and Illinois has 250,000.

    Some people believe that many enrollees in Medicare Advantage won’t get dental, vision, or hearing benefits any longer. Truth is that though insurers tend to offer these benefits, most Medicare Advantage plan enrollees do not appear to use them. The benefits are usually quite limited, offering little coverage, difficult to access because in-network providers are few and far between, and require high out-of-pocket costs.

    Humana is claiming that Medicare is not paying it enough to deliver Medicare Advantage. Truth is that Medicare is spending $83 billion more on enrollees in Medicare Advantage than it does on enrollees in Traditional Medicare. Those payments are unsustainable.

    The government is giving insurers a $16 billion raise next year on top of the overpayments. Humana simply must wants to squeeze even more money out of Medicare Advantage.

    UnitedHealth also is looking to see more profits from Medicare Advantage. It can do so by denying and delaying care, but it can only do so much of that. Traditional Medicare, government-administered benefits, is far more cost-effective and also makes it much easier than Medicare Advantage to get care, anywhere in the US. But, traditional Medicare lacks an out-of-pocket limit, meaning that to protect themselves financially, people need supplemental coverage, either Medicaid or Medigap, that fills gaps in traditional Medicare.

    Here’s more from Just Care:

  • Medicare Advantage: Hospice care is a juggle

    Medicare Advantage: Hospice care is a juggle

    Insurers clearly have not figured out how to profit from the Medicare hospice benefit, which offers comfort care for people who are terminally ill. Caitlin Owens reports for Axios that a government trial to include the Medicare hospice benefit in Medicare Advantage is ending six years sooner than planned because insurers and hospice agencies alike cannot make the benefit work to their liking. The Centers for Medicare and Medicaid Services, CMS, which oversees Medicare, claims the pilot was not a failure. What would you call it?

    Right now, if you are enrolled in a Medicare Advantage plan and elect the Medicare hospice benefit–choose to forgo curative treatments for your condition in favor of palliative care–traditional Medicare covers the hospice services, even though you are still enrolled in a Medicare Advantage plan. [N.B. Unfortunately, the hospice benefit is only truly available to people who have someone to take care of them at home and ensure their safety when the hospice aides are not there. The hospice benefit does not provide 24 hour care.]

    Juggling between traditional Medicare for your hospice care and Medicare Advantage for all unrelated health care services can be a bear. And, it can be a big bear for the more than 800,000 people enrolled in Medicare Advantage who elected hospice in 2022–about half the Medicare Advantage enrollees who died in 2022.

    In 2021, the Center for Medicare and Medicaid Innovation (CMMI) launched a pilot to permit insurers offering Medicare Advantage to coordinate hospice care for their enrollees directly. The question is whether Medicare Advantage plans can make getting hospice services easier for their enrollees, bring down costs, and improve quality of care. The pilot was scheduled to run through 2030.

    The Medicare Advantage hospice experiment will now end in 2026. Neither UnitedHealth Group nor Elevance, two of the biggest insurance companies offering Medicare Advantage, who had been part of the pilot, wanted to continue participating. Only 13 insurers were participating.

    For the most part, hospices agencies were pleased that the insurers pulled out. Insurers were not paying them adequately and their administrative burdens were significant. But, without a hospice benefit, Medicare Advantage cannot provide seamless care at the end of life; it makes Medicare Advantage accountability and enrollee costs all the more complicated for hospice enrollees.

    Here’s more from Just Care:

  • Medicare Part D plans can make it hard to get prescription drugs

    Medicare Part D plans can make it hard to get prescription drugs

    As you might already know, Medicare Part D plans can make it hard to get the prescription drugs you need. That’s not to say you shouldn’t have Part D coverage because it could protect you from out-of-control prescription drug bills. But, you still might spend less paying for your drugs out of pocket with a discount coupon from GoodRx or through Costco mail order or from a verified pharmacy abroad.

    First, the good news. Beginning next year, your out-of-pocket costs for drugs that Medicare Part D covers will be capped at $2,000 a year. The Inflation Reduction Act, one of President Biden’s big accomplishments is responsible for that limit as well as negotiated drug prices for some of the highest cost drugs in Medicare.

    But, corporate health insurers offering Part D like to make money, so they are finding ways to shift more costs on to their enrollees.Part D insurers are making it hard for their enrollees to fill certain prescriptions. Either these insurers are not covering certain medicines altogether or they are forcing people to go through multiple hoops before they will pay for certain drugs, according to a recent Health Affairs study.

    For the most part, if a Part D plan does not cover a drug, then that drug is not subject to the $2,000 out-of-pocket cap.

    How do Medicare Part D insurers limit their prescription drug spending and/or boost their revenue?

    1. They don’t include certain drugs on their formulary; they now don’t cover 30 percent of drugs, up from 21 percent 13 years ago. Apparently, they are now not covering come drugs that treat cancers and autoimmune disorders.
    2. They promote brand-name drugs for which they get large rebates from pharmaceutical manufacturers and make copays for generic substitutes more expensive or simply don’t cover generics.
    3. They restrict access to drugs through prior authorization requirements. In 2020, they restricted access to 44 percent of them.
    4. They require the use of generics and won’t cover brand-name alternatives.

    Why does the government permit these restrictions?

    Here’s more from Just Care:

  • Medicare Advantage: Expect lots of care denials

    Medicare Advantage: Expect lots of care denials

    If you’re in a Medicare Advantage plan or any other corporate health insurance plan and need costly care, you can expect a denial from your insurer about once every seven times you seek treatment, reports Jeff Lagasse for HealthcareFinanceNews. A new national survey by Premier found that insurers deny almost 15 percent of claims for reimbursement, including claims for care that the insurers had authorized. And, insurers offering Medicare Advantage plans require prior authorization about 25 percent of the time.

    Insurers sometimes do not pay hospitals, health systems and nursing homes, even after they have okayed delivery of care. To be clear, insurers can deny payment with impunity, allowing them to hold onto assets. They challenge providers to appeal their decisions, a tactic that serves insurers’ bottom lines well.

    Insurers end up paying more than half of the claims that they deny initially. However, they only do so if providers are willing and able to go through a time-consuming and costly appeal process. For the providers, it is usually worth appealing since insurer denials are generally for costly charges.

    Health care providers spend nearly $20 billion each year appealing insurance corporation denials. That breaks down to $43.84 per claim on about three billion claims. Providers incur additional costs from the need for more clinical work–$13.29 for an inpatient stay and $51.20 for inpatient surgery, according to  American Medical Association estimates.

    Even when providers prevail on appeal, they generally can wait as long as six months after treating patients to get paid. Not surprisingly, many hospitals are hurting. In stark contrast, UnitedHealth and Cigna have around 25 percent more cash on hand today than they did five years ago.

    People with corporate health insurance not yet eligible for Medicare might not get the care they need for fear of having to pay out of pocket for it. About half say that they couldn’t pay a $1,000 hospital bill in 30 days time, according to a Commonwealth Fund report. Forty-six percent say they skip or delay needed care because they can’t afford to pay for it.

    People with Medicare should never be responsible for bills Medicare or their Medicare Advantage plans don’t pay. But, their doctors and hospitals might not provide them needed care, concerned that they won’t be paid for it.

    Premier’s survey found that people in Medicare Advantage plans needing skilled nursing facility care are especially likely to face denials. Insurers deny about one in five provider requests for discharge from a hospital to a skilled nursing facility.

    CMS needs to collect data on MA insurer payment delays and denials. Inappropriate delays and denials violate insurers’ contractual obligations.

    Here’s more from Just Care:

  • Need skilled nursing care? Medicare Advantage insurers often won’t cover it

    Need skilled nursing care? Medicare Advantage insurers often won’t cover it

    Insurers offering Medicare Advantage plans are causing nursing homes to lose money at a rapid pace, reports Amy Stulick for Skilled Nursing News. These insurers are not only paying Medicare-nursing homes less than the traditional Medicare rate, they are too often not covering enrollees’ care in nursing homes, even when they are required to do so. If our government does not step in to insist that insurers pay nursing homes the Medicare rate, there may be no skilled nursing facility care available to Medicare patients.

    Today, Medicare covers care in skilled nursing facilities in limited situations. To qualify for Medicare skilled nursing care, patients must need daily skilled nursing or therapy services and receive these services in a Medicare-certified skilled nurse facility. Moreover, they must be hospitalized for at least three days in the 30 days prior to admission to a skilled nursing facility. So long as they qualify, Medicare covers up to 100 days of care per benefit period.

    But, insurers offering Medicare Advantage plans don’t like to spend the money they receive to cover Medicare services. Every service they do not cover is money in their pockets. So, people in Medicare Advantage plans often do not get nursing home care or get very limited nursing home care or get poor quality nursing home care.

    Marc Zimmet, the president of Zimmet Healthcare says that nursing homes are losing $274.9 million for every one percent increase in Medicare Advantage enrollment. Traditional Medicare pays about 87 percent more ($841) for nursing home care than insurers offering Medicare Advantage ($448). Not surprisingly, Medicare Advantage enrollees not only get less nursing home care than traditional Medicare enrollees, they are forced to use lower quality nursing homes.

    People enrolled in Medicare Advantage need to recognize that they are taking a big risk with their health. They can’t count on getting high quality physician and hospital care; they can’t count on continuity of care; they can’t count on getting needed care. Yes, it is true that some people do perfectly well in Medicare Advantage; it’s also true that hundreds of thousands, if not millions, experience serious deterioration of their health and tens of thousands die needlessly. With Medicare Advantage, you are always playing the odds; you could end up in a killer plan.

    Here’s more from Just Care:

  • Next frontier: Eye exams using artificial intelligence

    Next frontier: Eye exams using artificial intelligence

    Photos from a retinal camera allow an artificial intelligence (AI) algorithm to perform eye exams and quickly diagnose diabetic retinopathy, a condition that could lead to blindness, reports Hannah Norman for California Health Line. Diagnoses are immediate, and no doctor is involved.

    Diabetic retinopathy is the principal cause of blindness for adults under 65 and a health condition that millions of Americans with diabetes are at risk of getting. Today, some 9.6 million Americans have diabetic retinopathy.

    People with type 2 diabetes typically spend a lot of time and money getting tested for retinopathy. They must see an eye doctor, have their eyes dilated and then can easily wait seven days for a diagnosis. And, it is recommended that they do so each year or, at least, every other year.

    To date, the FDA has approved lots of medical devices that work through AI.

    What is diabetic retinopathy? It stems from injury to blood vessels in the retina from high blood sugar. People with diabetes can stave off diabetic retinopathy when they manage their condition. And, doctors can treat diabetic retinopathy. But, screenings allow for early treatment.

    How easy is it to you an AI system to detect diabetic retinopathy? It takes only a few hours of training.

    What happens during the AI diagnosis? Patients look into a special camera so that a technician can photograph their eyes. Generally, there is no need to dilate the patients’ eyes.

    What are the risks of using AI to diagnose diabetic retinopathy? At the moment, using AI will only detect diabetic retinopathy. It will not detect other eye conditions that an eye doctor might detect. For example, it won’t detect choroidal melanoma.

    What are the benefits of using AI to diagnose diabetic retinopathy? Using AI to diagnose diabetic retinopathy is faster and less costly than going to the eye doctor. With AI, people are also far more likely to go for a follow-up visit after diagnosis than if they went to the eye doctor, according to one recent study. Researchers attribute the increased likelihood of follow-up to the fact that patients get a diagnosis right away.

    Does Medicare cover this AI test? Medicare covers this AI eye test, albeit at a very low rate–$45.36.  Corporate health insurers have an average negotiated rate of $127.81 for the test.

    The technology is still in its infancy. But, based on what we know right now, it is more than likely to take off big time before long. And, of course, researchers are looking to expand the reach of AI to detect glaucoma and other eye diseases.

    Here’s more from Just Care:

  • 2024: Programs that lower your health care costs if you have Medicare

    2024: Programs that lower your health care costs if you have Medicare

    Medicare only covers about half of a typical person’s health care costs, leaving people with average annual out-of-pocket costs of $7,000. So, even with Medicare, many people struggle to afford premiums, deductibles and other costs. Some people qualify for Medicaid, which fills most of the gaps in Medicare. But, if you do not qualify for Medicaid, there are other programs that lower your health care costs. Click here or contact your local State Health Insurance Assistance Program (SHIP) to find out if you are eligible for any of these programs and how to apply.

    1. Medicare Savings Programs. Depending on your income, Medicare Savings Programs, administered by Medicaid, help pay for Medicare premiums and coinsurance, even if you don’t qualify for Medicaid. There are three programs, Qualified Medicare Beneficiary (QMB), Specified-Low Income Medicare Beneficiary (SLMB) and Qualified Individual (QI). Income and asset limits, and how they are counted, are listed below for 2024, but vary somewhat by state. You might still qualify for these programs in your state even if your income or assets are higher than the federal amounts listed below. States sometimes exclude certain income and assets when determining your eligibility. You should apply through your state Medicaid office.

    • Qualified Medicare Beneficiary (QMB)—100 percent of federal poverty level (FPL) + $20. If you have QMB, you should not have out-of-pocket costs for Medicare-approved services in traditional Medicare or for in-network services in a Medicare Advantage plan. It should cover premiums, deductibles, coinsurance and copays for Medicare-covered services.
      • Income limit monthly depends upon where you live but is around
        • $1,275 for individuals
        • $1,724 for couples
      • Asset limit
        • Individuals: $9,430
        • Couples: $14,130
    • Specified Low-income Medicare Beneficiary (SLMB)—120 percent of FPL + $20. SLMB helps pay your Medicare Part B premium, if you have Part A and Part B.
      • Income limit monthly depends upon where you live but is around
        • $1,526 for individuals
        • $2.064 for couples
      • Asset limit
        • Individuals: $9,430
        • Couples: $14,130
    • Qualifying Individual (QI)—135 percent of FPL +$20, helps pay your Medicare Part B premium if you have Medicare Part A and Part B.
      • Income limit monthly depends upon where you live but is around
        • $1,715 for individuals
        • $2,320 for couples
      • Asset limit
        • Individuals: $9,430
        • Couples: $14,600

    Several valuable items are not counted as income and assets. No matter what state you live in, the first $20 of your income and the first $65 of your monthly wages are not counted as income. In addition, half of your monthly wages, after the first $65 is not counted, nor are food stamps. Some of your assets are also not counted, including your primary home, if you own it, your car, your wedding and engagement rings, a burial plot and $1,500 in burial funds, your life insurance with a cash value less than $1,500, and your furniture, household and personal items. Your bank accounts, stocks and bonds are counted.

    Tip: If your income is low but too high to qualify you for Medicaid, it is worth looking into whether you qualify for any of these programs. According to MACPAC, an independent agency that advises Congress on Medicaid policy, less than a half the people over 65 who qualify for the Qualified Medicare Beneficiary program (48%) are enrolled. And, an even smaller share of people over 65 who qualify for the Specified Low-Income Medicare Beneficiary program (28%) are enrolled. About one in seven people over 65 (15%) who qualify for the QI program are enrolled.

    2. Extra Help with Medicare Part D prescription drug coverage: You will automatically qualify for the Extra Help program, which is administered by Medicaid, if you qualify for Medicaid or any of the above low-income programs or receive Supplemental Security Income benefits. You can also apply for Extra Help independently. Extra Help pays for some or all of the cost of your Part D drug coverage and is estimated to be worth around $5,100 a year. The amount of help with cost-sharing depends on the level of your income and assets. In 2024, you may qualify if you have up to $22,590 in annual income ($30,660 for a married couple) and up to $17,220 in assets ($34,360 for a married couple). With Extra Help your drug costs are no more than $4.50 for each generic/$11.20 for each brand-name covered drug. If your total drugs costs–what you and your health plan pay) go above $8,000 this year, you’ll pay nothing more. And, depending upon your income, you may pay only part of your Medicare drug plan premiums and deductibles. (Some states have State Pharmaceutical Assistance Programs that provide even more assistance.)

    3. Federally Qualified Health Centers (FQHCs) and other programs run by the Human Resources and Services Administration: FQHCs are located across the country and provide a wide range of services to underserved populations and areas on a sliding-fee scale. They might waive the Medicare deductible and coinsurance, depending upon your income.

    4. Hill-Burton programs offer free or reduced care at Hill-Burton facilities in 38 states. Hill-Burton does not cover services fully covered by Medicare or Medicaid. Eligibility depends on your family size and income.

    5. Veterans’ Administration: If you are a vet, the Veterans’ Administration (VA) offers low-cost services and prescription drugs directly. And, you can have VA coverage as well as Medicare.

    Keep in mind that you may be eligible for Medicaid based on your income after paying for some health care costs. To contact your state Medicaid office, click here.

    Here’s more from Just Care:

  • Will FDA approval of Wegovy to treat heart conditions mean more people with Medicare can fill a weight-loss prescription?

    Will FDA approval of Wegovy to treat heart conditions mean more people with Medicare can fill a weight-loss prescription?

    The FDA recently approved Wegovy, a weight-loss drug, to treat overweight people with heart conditions. Will that mean that more people with Medicare will get their weight-loss drugs covered? Maya Goldman reports for Axios on what the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, as well as the insurers offering Medicare Part D prescription drug coverage, are considering.

    At the moment, CMS has not decided whether Medicare will cover Wegovy as a treatment for overweight people with heart conditions. To date, Medicare has not covered any weight-loss drugs simply for the purpose of helping people lose weight. But, Medicare does cover weight-loss drugs as a treatment for people with diabetes.

    Medicare, by law, covers only treatments for medically reasonable and necessary services. CMS does not consider treatment for weight loss as reasonable and necessary. Treatment for a heart condition, much like treatment for diabetes, is very different.

    About 40 percent of people with Medicare have heart conditions. That’s more than 24 million people. And, likely a sizeable number of them are overweight. So, Medicare might end up covering Wegovy for them.

    Of note: Wegovy costs about $1,200 a month. Covering it for even four million more people will likely cause Medicare spending to balloon. Fortunately, people with Medicare should not see their costs balloon. Beginning in 2025, people’s annual out-of-pocket costs for covered prescription drugs will be capped at $2,000.

    For now, insurers offering Medicare Part D prescription drug coverage are waiting for CMS to rule on the conditions under which Medicare will cover Wegovy. Part D insurers could, of course, decide to cover Wegovy without waiting for CMS, but that would cost them a bundle. Their Medicare payments for this year are already set.

    Here’s more from Just Care:

  • Five concerning policy outcomes of Medicare Advantage program

    Five concerning policy outcomes of Medicare Advantage program

    We frequently think about aspects of Medicare and MA in isolation from their effects on our healthcare system. But when we step back, we see the following Medicare Advantage policy outcomes that we would never choose to accomplish on a stand-alone basis.

    1. Medicare Advantage program incentivizes insurer competition around attracting healthy people and avoiding people with costly conditions—with networks that avoid top specialists and specialty hospitals, with coverage protocols that delay and deny care inappropriately—increasing costs for providers and patients in the system and maximizing profits for insurers.
    2. Medicare Advantage program is effectively unaccountable, operating largely on trust, with no real-time oversight or meaningful enforcement, which prevents people from knowing which MA plans will provide high value care if they have cancer or heart disease and which to avoid, forcing them to gamble when they choose an MA plan and leading more than 10,000 people to die needlessly each year when they choose the wrong MA plan.
    3. Medicare Advantage program misleads people, particularly those with low incomes, into believing that they will get the same benefits as people in traditional Medicare with an out-of-pocket cap, when insurers can game Medicare coverage requirements so as not to deliver the same benefits. In fact, mounting evidence indicates insurers too often inappropriately deny critical care and provider payments, threatening the health and financial security of the most vulnerable enrollees with complex conditions.
    4. Medicare Advantage program uses a payment system that insurers can game to achieve 23 percent more per enrollee than the government spends on enrollees in traditional Medicare, driving up Medicare spending and Medicare premiums by $260 billion in the 10 years ending in 2033, and threatening the Medicare program. And, while MA offers a valuable out-of-pocket cap to people with low incomes and “extra” benefits, unlike TM, when they get sick, they are often faced with financial and administrative barriers to care wealthier people in TM do not face, which aggravate health inequities.
    5. Medicare Advantage program is financially unsustainable over the middle to long term and, left to its own devices, likely will lead to the withering away of traditional Medicare, the end of Medicare negotiated rates as providers acquire more leverage over insurers, greater financial and administrative barriers to care and much higher costs for enrollees with costly conditions.

    Here’s what MA policy should be designed to do:

    • MA policy should incentivize MA plans to compete to deliver high value care to the people with complex and costly conditions.
    • MA policy should bar bad actors from participating in the program; at the very least, it should identify the bad actors so that people can avoid enrolling in them.
    • MA policy should ensure that MA enrollees get the same benefits as people in Traditional Medicare and that providers are paid appropriately for the care they deliver.
    • MA policy should ensure that insurer administrative costs and profits total no more than 15 percent more than insurers spend on care.
    • MA policy should not allow the MA program to cost any more per enrollee than Traditional Medicare.

    Here’s more from Just Care:

  • How to switch to Traditional Medicare from Medicare Advantage?

    How to switch to Traditional Medicare from Medicare Advantage?

    For years, I’ve been advising people to enroll in Traditional Medicare for easy access to medically reasonable and necessary care. And, I continue to believe that anyone who can afford the upfront costs of Traditional Medicare with supplemental coverage should enroll in Traditional Medicare. Medicare Advantage plans save you money, so long as you’re healthy; but your health care coverage should cover the care you need when you’re sick and you can’t count on a Medicare Advantage plan to do that. So, one Just Care reader asks, how easy is it to switch from a Medicare Advantage plan to Traditional Medicare?

    First things first: Twice a year, during the annual Medicare Open Enrollment period between October 15 and December 7 and during the Medicare Advantage Open Enrollment period between January 1 and March 31, you have the right to disenroll from Medicare Advantage and switch to Traditional Medicare. The issue becomes getting supplemental coverage to fill gaps in traditional Medicare if you don’t have Medicaid or retiree coverage that fills those gaps.

    Here are the benefits of enrolling in Traditional Medicare, along with the challenges of doing so, and your rights.

    The benefits of enrolling in Traditional Medicare:

    • You will have easy access to the medical and hospital care you deserve, without the need for prior authorization or a referral from your doctor to a specialist; you won’t need to go through hoops to get care, nor will you face care delays or denials of care your treating physician says you need.
    • You and your doctor decide the care you need, not an insurance company that profits from denying you care.
    • You will be covered for care from virtually any doctor or hospital in the US; you will not be limited to coverage from a narrow group of physicians in your community.
    • With supplemental coverage, either through Medicaid, your former employer or union or a Medigap plan that you buy in the individual market, you are likely to have almost all your care covered without having to pay out of pocket for that care.

    The challenges of switching to Traditional Medicare:

    • With certain exceptions, if you want to sign up for Traditional Medicare after you’ve been in a Medicare Advantage plan for more than a year, you have no guaranteed right to buy supplemental coverage in all but four states, New York, Massachusetts, Connecticut and Maine. And, because Traditional Medicare has no out-of-pocket limit, you could have higher out-of-pocket costs in Traditional Medicare than you would in a Medicare Advantage plan, which tends to limit your out-of-pocket expenses for medical services to an average of $5,000 for in-network care but could cap those costs as high as $8,700 in 2024.
    • Even if your Medicare Advantage plan is not covering the care you need from the providers you need to see, you can only switch to Traditional Medicare during the Medicare Open Enrollment Period between October 15 and December 7, effective January 1 of the following year and during the Medicare Advantage Open Enrollment Period between January 1 and March 30, effective the month after you disenroll from your Medicare Advantage plan.
    • If you are able to switch to Traditional Medicare and you don’t have Medicaid or a union or employer retiree plan to provide supplemental coverage, supplemental coverage could cost a lot, easily $200 a month or more. Medigap Plans K and L tend to be lower cost and cap your out-of-pocket expenses.

    Your rights to buy a Medigap without medical underwriting or a waiting period:

    • When you first enroll in Medicare, you have a guaranteed right to buy Medigap coverage to fill gaps in Traditional Medicare during a six month open enrollment period beginning the month you turn 65.
    • If you enrolled in a Medicare Advantage plan when you were first eligible for Medicare and disenroll within 12 months, you have a guaranteed right to buy Medigap coverage.
    • If you move out of your Medicare Advantage plan’s service area, you have a right to switch to Traditional Medicare and a guaranteed right to buy Medigap coverage.
    • If you had supplemental coverage from your employer or union and that coverage ends, you have a guaranteed right to buy Medigap coverage.
    • If your Medicare Advantage plan ends its coverage or commits fraud, you have a guaranteed right to buy Medigap coverage.

    Insurers still might sell you Medigap coverage even if none of the above federal rights apply to your situation:

    You still might be able to buy a Medigap policy in your state if you want to switch from a Medicare Advantage plan to Traditional Medicare and none of the above guaranteed federal rights to buy Medigap apply. Contact your State Health Insurance assistance Program or SHIP for free help. Or call your state department of insurance to see if you can buy a policy. Some Medigap plans have out-of-pocket limits like Medicare Advantage and cost much less than more comprehensive Medigap plans.

    Here’s more from Just Care: