Key Takeaways

• Transitioning clients from Medigap to Medicare Advantage requires transparent conversations that outline what changes they can expect in terms of coverage, costs, and provider access.

• By setting clear expectations beforehand, you strengthen client trust, reduce dissatisfaction, and position yourself as a reliable professional resource.

Why This Transition Conversation Matters

When a client decides to move from Medigap coverage to Medicare Advantage, they are making a shift that will impact how they access care, what they pay out of pocket, and how flexible their provider options remain. Your role as an independent licensed agent is not only to present plan information but also to ensure your clients understand the reality of what this change means for their healthcare experience.

If expectations are not set clearly in advance, clients may feel blindsided later by provider limitations, prior authorizations, or copay structures they did not anticipate. By preparing them upfront, you create a smoother transition and preserve the trust you have worked hard to build.

Laying Out the Structural Differences

The first step is making sure clients recognize that Medicare Advantage and Medigap operate under different structures.

• Medigap supplements Original Medicare. It reduces out-of-pocket expenses, offering predictability for those who prefer flexibility in seeing providers nationwide.

• Medicare Advantage replaces Original Medicare. It is an all-in-one plan with built-in cost-sharing rules, networks, and extra benefits that Medigap does not provide.

Your responsibility is to make clients aware that this is not a minor change but a reconfiguration of how they receive and manage care.

Timelines and Enrollment Windows

Clients often underestimate the importance of enrollment timing. As of 2025, there are specific opportunities to make this transition:

• Annual Enrollment Period (October 15 to December 7): The most common window for switching to Medicare Advantage.

• Open Enrollment Period (January 1 to March 31): Allows one switch from Medicare Advantage to another, but not back to Medigap without underwriting in many cases.

• Special Enrollment Periods: Triggered by events like moving or losing other coverage.

Stress to your clients that timing matters. If they leave Medigap and later regret it, getting back into Medigap may not be straightforward due to underwriting and possible higher premiums.

Cost Realities Clients Need to Hear

Clients often switch because they hear about the added benefits Medicare Advantage may provide. What they may not realize is how cost-sharing differs.

• Predictability with Medigap: Most out-of-pocket costs are covered after premiums.

• Variable with Medicare Advantage: Clients face copayments, coinsurance, and out-of-pocket maximums that reset annually.

Explain how the annual out-of-pocket maximum in Medicare Advantage protects them against catastrophic costs, but day-to-day expenses may feel more unpredictable compared to Medigap.

Provider Networks and Access

One of the most sensitive areas in this transition is provider access. With Medigap, the client can see any provider that accepts Medicare. With Medicare Advantage, the network rules apply.

• In-network versus out-of-network: Stress that out-of-network costs can be significantly higher or not covered at all.

• Referrals and prior authorizations: Many Medicare Advantage plans require these, whereas Original Medicare with Medigap typically does not.

The key is to frame provider network restrictions as a trade-off clients need to weigh carefully, not as a hidden drawback.

Extra Benefits: Setting Balanced Expectations

Medicare Advantage often includes additional benefits like routine dental, vision, or hearing coverage. While these may appeal to clients, make sure you frame them correctly:

• Benefits are not always as broad as standalone policies.

• Availability and coverage vary by plan and region.

• They should be viewed as a supplement, not the core reason for switching.

Help clients see extra benefits as added conveniences, not the deciding factor in choosing Medicare Advantage.

Addressing Common Client Concerns

When discussing this transition, prepare for these frequent concerns:

1. “Will I be able to see my current doctor?”

   • Answer by confirming network status before enrollment and explaining referral rules.

2. “What happens if I travel?”

   • Medigap allows nationwide access. Medicare Advantage may limit care outside local networks, except in emergencies.

3. “Can I go back to Medigap if I don’t like it?”

   • Explain the possibility of underwriting and that guaranteed issue rights are limited to specific situations.

Your transparency here is what strengthens your credibility.

Guiding Clients Through Comparisons

When you walk clients through the side-by-side differences, focus on these categories:

1. Monthly Costs: Premiums versus potential out-of-pocket variability.

2. Access to Care: Freedom of provider choice versus managed care networks.

3. Financial Protection: Out-of-pocket maximums versus Medigap’s predictability.

4. Additional Perks: Extra benefits that may fill gaps but differ in scope.

Lay this out in clear, structured language so clients understand the trade-offs, not just the surface-level appeal.

Practical Communication Strategies for Agents

As an agent, how you communicate is just as important as what you communicate. Consider these strategies:

• Use plain language: Avoid jargon that confuses clients.

• Anticipate questions: Prepare answers for common client doubts.

• Frame choices neutrally: Present both Medigap and Medicare Advantage as viable, but different, paths.

• Encourage future planning: Discuss how health changes or relocation might affect the suitability of Medicare Advantage.

These strategies ensure that clients feel you are guiding them, not pushing them.

Long-Term Planning Factors

You should also highlight the long-term considerations your clients need to think about:

• Health stability: Clients in good health may prefer Medicare Advantage now but may face challenges returning to Medigap later.

• Relocation risks: Moving to another area may change available Medicare Advantage plans.

• Changing priorities: What appeals in 2025 may not align with needs in 2030.

Encouraging clients to think about not only today’s needs but also tomorrow’s realities positions you as a trusted advisor.

Avoiding Common Pitfalls in Transition Discussions

Many agents inadvertently create frustration by overlooking key issues. Avoid these mistakes:

• Focusing only on extra benefits without addressing network restrictions.

• Skipping the importance of timing and enrollment rules.

• Underestimating how much clients value provider freedom.

• Presenting Medicare Advantage as a one-size-fits-all solution.

By steering clear of these pitfalls, you maintain professionalism and client trust.

Bringing It All Together for Client Confidence

Transitioning from Medigap to Medicare Advantage is not just about paperwork. It is about managing expectations, ensuring clarity, and protecting client trust. When you set the foundation clearly, your clients walk away understanding what they are gaining, what they are giving up, and why the choice makes sense for their personal circumstances.

When you position yourself as the professional who lays out the full picture, you strengthen client loyalty and reinforce your reputation as a reliable resource.

Partnering With Us for Professional Support

Helping clients navigate these complex transitions is what sets you apart as an agent. At BedrockMD, we provide the resources, training, and tools that empower you to deliver conversations that clients remember positively. By joining us, you can access technology, ongoing support, and marketing systems designed to help professionals like you grow your business with confidence.

We are here to make sure you never have to approach these conversations alone. Sign up with BedrockMD today and let us help you guide your clients with clarity and professionalism.