Medicare Advantage plans also may require you to get approval before they cover some services or medications.


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Although most Medicare Advantage enrollees are in plans with a $0 premium, getting medical care costs money, and Medicare Advantage plans can have an annual out-of-pocket maximum as high as $8,850 in 2024.


Joanne Giardini-Russell, owner of the insurance agency Giardini Medicare in Michigan, recalled a client who had a Medicare Advantage plan and got cancer.


“He was hitting his max out-of-pocket year after year,” she said. “And then throw in prior authorizations, which he wasn’t a fan of.”


When you can change plans


If you have Medicare Advantage and you want to switch plans or go back to Original Medicare, there are two annual opportunities: Medicare’s fall open enrollment from Oct. 15 to Dec. 7 and Medicare Advantage open enrollment from Jan. 1 to March 31.


However, if you want to return to Original Medicare and you have health issues, you may not qualify for Medigap, which helps keep Original Medicare affordable. In most states, after Medigap’s initial enrollment period — in which you can buy any plan from any insurer, regardless of health status — companies can decline to cover you.


Medicare Advantage was meant to curb federal healthcare spending. It’s costing more instead


“Everybody thinks the open enrollment in the fall is going to save them,” Giardini-Russell said, remembering a client with a Medicare Advantage plan who couldn’t qualify for Medigap because of a heart condition.


“She said, ‘I thought in November, you could just change during open enrollment,’” Giardini-Russell said. “She didn’t have any way to get out.”


What are the exceptions?


There are two “trial rights” scenarios in which someone with Medicare Advantage can switch back to a Medigap plan without a medical exam:


If you start with a Medicare Advantage plan when you first qualify for Medicare, you have 12 months to go back to Original Medicare with any Medigap plan.

If you have a Medigap plan and drop it to try a Medicare Advantage plan for the first time, you have 12 months to return to Original Medicare and the Medigap plan you dropped, as long as the company still sells it.


If you work with an insurance agent, they might also know which Medigap company would approve you based on your health.




Author: KATE ASHFORD

Source: © 2025, Los Angeles Times

Retrieved from: latimes.com

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