10/19/2025
Medicare Open enrollment began October 15th , so this is the time of year I get lots of questions. Question that has predominated this week āCan I move back to Medicare?ā ( from an advantage plan). The answer is Yes!.. but ā¦.We only get a ā1 TIMEā Medigap supplement Insurance fixed rate opportunity that does NOT consider your health status. So this rate will be low and will not go up as it does not reflect your health issues. THISā1 TIMEā offer is ONLY at your initial sign up for Medicare and offer ends forever after 6 months ⦠so that would mean if you are beginning Medicare for the first time in January then this offer ends July 1st. If you STAY on traditional Medicare and keep this low rate Medigap supplement then you will STAY at this low rate even as your health declines as you age. OK ⦠but what happens if you ever convert your Medicare to an Advantage Plan⦠you will loose this fixed low rate Medigap forever. Yes you can change back to traditional Medicare and purchase a Medigap plan BUT you will now be subject to underwriting⦠Meaning they can raise your premiums because of your health issues. So this is what happens ALOT⦠a person is doing fine with their advantage plan as long as they are healthy and require very little health care/ low health care costs. Then something happens and they have a new illness, disease, accident, or like all of us as we age we get multiple high cost health issues. The person then realizes that the upfront savings they thought they would love with the Advantage Plan ended up being a lot of copays, hospital cost, rehab cost, durable medical cost, and flat denials of care needs by their insurance. They now want to change back ā¦. But now they canāt afford to purchase the Medigap because they have medical problems that create high premiums. Now they are in real trouble⦠they canāt afford to change AND they canāt afford to pay for what the Advantage Plan denies. And I as their physician CANāT help. All I can do is educate. And a warning⦠the Advantage Plan Reps can call you or your elderly relative and change them off Medicare with a simple phone call. This is a very very scary problem for those Medicare patients that have dementia. Happened to one of my patients a few weeks ago. (And I just want to say I get paid the exact same whether my patient is Medicare or Advantage⦠so my concern is for my patients). Always advocating , Dr. Peyton