Is it Hard to Switch from Medicare Advantage to Original Medicare?

Making changes to your Medicare coverage can seem daunting, especially if you want to switch from a Medicare Advantage Plan back to Original Medicare. Every year during Medicare’s open enrollment period from October 15 to December 7, you have the opportunity to make changes to your Medicare health and drug plans for coverage starting January 1.

So is it difficult to drop your Medicare Advantage Plan and switch back to Original Medicare? What steps do you need to take? What factors should you consider before switching? This guide will walk you through everything you need to know about making the change from Medicare Advantage to Original Medicare.

What is Medicare Advantage?

First, let’s review the key differences between Original Medicare and Medicare Advantage.

Original Medicare consists of Part A, which covers hospital insurance, and Part B, which covers medical insurance. With Original Medicare, you can see any doctor or hospital that accepts Medicare nationwide. You may also want to purchase a Medigap Plan to help pay for out-of-pocket costs in Original Medicare like deductibles and coinsurance.

Medicare Advantage (also known as Medicare Part C) are health plans from private insurance companies that contract with Medicare to provide your Part A and Part B benefits. Medicare Advantage Plans must cover the same services as Original Medicare, but they can do so with different rules, costs, and coverage restrictions.

The key distinguishing features of Medicare Advantage Plans include:

• Built-in prescription drug coverage
• Out-of-pocket spending limits
• Extra benefits like dental, vision, hearing, and more
• Provider networks – you generally need to see in-network doctors

Many people enroll in Medicare Advantage for the extra coverage and coordinated approach to care. Medicare pays the plan a fixed monthly payment for your care.

When Can You Switch from Medicare Advantage to Original Medicare?

Medicare has specific enrollment periods that determine when you can make changes to your coverage. The main time you can switch from Medicare Advantage to Original Medicare is during the annual open enrollment period from October 15 to December 7.

Your new coverage will take effect on January 1 of the following year after you make changes during open enrollment. Outside of this period, you can only switch back to Original Medicare if you qualify for a Special Enrollment Period due to specific circumstances like moving.

So if you want to change Medicare Advantage to Original Medicare for 2023, you’ll need to make that switch during the 2022 open enrollment period.

Here are some other Medicare enrollment period tips:

• When you first enroll in Medicare at age 65, you have an initial enrollment period to pick Original Medicare or a Medicare Advantage Plan
• If you’re enrolling in a Medicare Advantage Plan for the first time, you can change plans or switch back to Original Medicare within the first 3 months you have the plan
• You can only make changes once during open enrollment and the plan change becomes effective January 1

Sticking to these enrollment period rules is important, because in most cases you can’t switch out of your Medicare Advantage Plan outside these windows.

How Do You Switch from Medicare Advantage to Original Medicare?

The process to switch from Medicare Advantage to Original Medicare involves two key steps:

1. Disenroll from your Medicare Advantage Plan – Contact your plan or 1-800-MEDICARE to disenroll effective at the end of the year. This will automatically put you back in Original Medicare if you don’t enroll in a new Medicare Advantage Plan.
2. Enroll in a standalone Part D drug plan – Original Medicare does not cover prescription drugs, so you’ll need to purchase a separate Part D Plan. Make sure to enroll in drug coverage to avoid paying a penalty.

You may also want to consider purchasing a Medigap policy if you want help covering Original Medicare out-of-pocket costs.

To disenroll from your Medicare Advantage Plan, call the plan, call 1-800-MEDICARE, or submit a written disenrollment request. Let them know you want to switch to Original Medicare for January 1 coverage.

You can search and enroll in new Part D and Medigap Plans on Medicare.gov or the plan websites during open enrollment. These new coverage’s will start when your Medicare Advantage Plan ends on December 31.

Should You Switch from Medicare Advantage to Original Medicare?

Before making the change to Original Medicare, ask yourself these key questions:

• Are you happy with your Medicare Advantage Plan’s coverage, costs, and care access? If so, you may want to stick with your Medicare Advantage Plan.
• Do you want access to any doctors or hospitals nationwide? With Original Medicare, you can see any provider throughout the U.S. who accepts Medicare. Medicare Advantage Plans have network restrictions.
• Do you need Medigap supplemental coverage? You can’t purchase a Medigap policy if you have a Medicare Advantage Plan – Medigap is only available to those enrolled in Original Medicare.
• Do you travel frequently? Original Medicare covers you at standard rates anywhere in the country, while Medicare Advantage Plans often have different costs when you see out-of-network providers.
• Are you paying for additional benefits you don’t need? Medicare Advantage Plans offer dental, vision, hearing, gym memberships and more. If you don’t use these extra perks, you may save money with Original Medicare plus a Medigap.
• What are your prescription needs? Make sure to compare Part D costs for any medications you take before switching. Medicare Advantage Plans include drug coverage.

Take some time to weigh the pros and cons before switching from Medicare Advantage to Original Medicare to decide what option truly offers you the most value.

Pros of Switching to Original Medicare

There are advantages you’ll get when you switch from Medicare Advantage to Original Medicare, including:

Freedom to choose any provider who accepts Medicare – You aren’t limited to a Medicare Advantage network and can see any doctor or hospital across the U.S. that welcomes Medicare patients. This gives you greater access to specialists and care facilities.

Ability to get Medigap coverage – Medigap Plans help pay for costs like Medicare deductibles and coinsurance amounts. This can lower your out-of-pocket expenses in Original Medicare.

No need for referrals to see specialists – With Original Medicare, you don’t need permission from a primary care doctor to see specialists and other providers.

Standardized coverage wherever you travel – When you visit other states, Original Medicare works the same with the same coverage rates nationwide. Medicare Advantage may have different costs when you see out-of-network providers.

May have lower costs – Without the extra benefits offered by Medicare Advantage Plans, your premiums, deductibles and other costs may be lower with Original Medicare plus a Medigap policy.

Switching to Original Medicare offers greater freedom and flexibility for those who want access to healthcare nationwide or need standardized coverage for frequent travel.

Cons of Switching to Original Medicare

However, there are some potential drawbacks to switching from Medicare Advantage to Original Medicare, including:

No annual out-of-pocket limit – Original Medicare does not cap your annual medical costs. Some Medicare Advantage Plans have a yearly limit on your out-of-pocket spending for covered care.

You need to buy separate drug and Medigap Plans – Medicare Advantage offers all-in-one coverage, while you’ll need to purchase standalone drug and Medigap policies if you want this coverage in Original Medicare.

May have higher costs – Even with Medigap coverage, you could pay more out of pocket for some services compared to in-network costs in a Medicare Advantage Plan.

Lose extra benefits – Many Medicare Advantage Plans include dental, vision, hearing and other extra perks that aren’t covered by Original Medicare.

Need to find new providers – Since you can’t see your Medicare Advantage network providers once you switch plans, you’ll need to establish care with new healthcare providers that accept Medicare.

Before switching to Original Medicare, make sure you understand and prepare for the increased coordination and potential costs required to manage your care and coverage.

What Happens to My Coverage if I Switch?

When making the change from Medicare Advantage to Original Medicare, here’s an overview of what will happen:

• Your Medicare Advantage Plan ends – The plan will terminate when your coverage switches on January 1. The plan cannot limit your ability to switch to Original Medicare during open enrollment.
• You’ll be enrolled in Part A and Part B – Since you already have Medicare, your coverage under Original Medicare will automatically start once your Medicare Advantage Plan ends. You don’t have to re-apply.
• You can use your red, white, and blue Medicare card – This card shows you have Original Medicare coverage that you can use to get care from any Medicare-accepting provider nationwide.
• You’ll need to get a separate Part D Plan – To have drug coverage, you must enroll in a standalone Part D prescription drug plan. Make sure to choose a plan by December 7.
• Consider enrolling in Medigap – Medigap policies help fill Medicare coverage gaps, but you have a limited time to enroll without medical underwriting.
• You’ll need to pay new premiums – Your Medicare Part B premium will return to the standard rate. You’ll also pay your new Part D and Medigap premiums (if you enroll in this additional coverage).
• Care access will expand nationwide – You’ll have the freedom to choose healthcare providers throughout the country who accept Medicare assignment.

The switch back to Original Medicare means saying goodbye to the all-in-one structure of Medicare Advantage for greater choice and flexibility. Make sure you’re comfortable with this trade-off before making the change.

Key Takeaways

• You can switch from Medicare Advantage to Original Medicare during Medicare’s open enrollment period from October 15 to December 7 each year.
• To make the change, you must disenroll from your Medicare Advantage Plan and enroll in standalone Part D prescription drug coverage.
• Consider whether the freedom to choose any provider nationwide or lower costs make Original Medicare the better choice for your needs.
• Be prepared to take on more coordination and potentially higher expenses without the all-in-one structure of Medicare Advantage.
• Follow all enrollment period requirements to successfully transition to Original Medicare for January 1 coverage.

Switching from Medicare Advantage to Original Medicare takes some effort but provides greater flexibility and nationwide care access. By understanding the steps, coverage implications, and key considerations, you can determine if returning to Original Medicare is right for your health and budget needs. Consult with a Medicare specialist to walk through your options before making any changes.

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FAQS

Is it hard to switch from Medicare Advantage to Original Medicare?

Switching from Medicare Advantage to Original Medicare is not difficult. You can do it during certain enrollment periods.

What is the Open Enrollment Period?

The Open Enrollment Period is a time when you can make changes to your Medicare coverage. It usually occurs every year from October 15 to December 7.

Can I switch my Medicare Plan during the Open Enrollment Period?

Yes, you can switch your Medicare Plan, including switching from Medicare Advantage to Original Medicare, during the Medicare Advantage Open Enrollment Period.

What does Medicare Open Enrollment mean?

Medicare Open Enrollment refers to the annual period when you can make changes to your Medicare coverage. It allows you to switch plans, add or drop coverage, and make other changes to your Medicare benefits.

Can I switch from Original Medicare to Medicare Advantage during the Open Enrollment Period?

Yes, you can switch from Original Medicare to a different Medicare Advantage Plan during the Open Enrollment Period.

How do I enroll in or change my Medicare Plan?

To enroll in or change your Medicare Plan, you can do so during the Open Enrollment Period by contacting Medicare directly or through the Medicare website.

Can I switch from one Medicare Advantage Plan to another?

Yes, you can switch from one Medicare Advantage Plan to another during the Open Enrollment Period.

Can I switch from a Medicare Advantage Plan to Original Medicare?

Yes, you can switch from a Medicare Advantage Plan to Original Medicare during the Open Enrollment Period.

Can I switch from Original Medicare to a Medicare Advantage Plan?

Yes, you can switch from Original Medicare to a Medicare Advantage Plan during the Open Enrollment Period.

Can I switch my Medicare coverage outside of the Medicare Open Enrollment Period?

Generally, you can only switch your Medicare coverage outside of the Open Enrollment Period if you qualify for a Special Enrollment Period, which is typically triggered by certain life events or circumstances.