Switching from Medicare Advantage to Original Medicare: Enrollment Period and Plan Change Options

Medicare Advantage Plans provide Medicare benefits through private health insurance companies. While they offer benefits like capped out-of-pocket costs and included prescription drug coverage, Medicare Advantage isn’t right for everyone. You may decide to switch back to Original Medicare if you want more provider choice, lower costs, or are moving outside your plan’s service area. Fortunately, you have options to switch from Medicare Advantage back to Original Medicare.

When Can You Make Changes to Medicare Advantage Enrollment?

There are certain times of the year when you can make changes to your Medicare Advantage Plan:

Medicare Advantage Open Enrollment Period: From January 1 to March 31 each year, you can switch Medicare Advantage Plans or drop your Medicare Advantage Plan and return to Original Medicare. This change will take effect the first of the month after the plan gets your enrollment request.
Medicare Advantage Disenrollment Period: From January 1 to February 14 each year, Medicare Advantage members can leave their plan and switch to Original Medicare. Coverage will begin the first day of the month after the plan gets your disenrollment request.
Initial Enrollment Period: When you first become eligible for Medicare at age 65, you have a seven-month initial enrollment window to sign up for Medicare Advantage or Original Medicare.
Special Enrollment Period: If you lose your employer health coverage, move outside your plan’s service area, or qualify for Extra Help with prescription drugs, you may qualify for a Special Enrollment Period to switch Medicare Advantage Plans or drop your plan.

How Do I Switch from Medicare Advantage Back to Original Medicare?

Find out if you’re eligible to make a change. Refer to the enrollment periods above to see if it’s time for you to switch plans.
Decide on a Medicare Part D prescription drug plan. Since most Medicare Advantage Plans include drug coverage, you’ll need to enroll in a standalone Part D Plan if you want prescription coverage.
Inform your Medicare Advantage Plan you want to disenroll. Call their customer service or fill out a disenrollment form.
Enroll in Original Medicare. Once your Medicare Advantage Plan disenrollment goes through, you’ll automatically be returned to Original Medicare Parts A and B.
Purchase supplemental coverage. Many people enroll in a Medigap Plan to help pay Medicare deductibles, copays and coinsurance charges.
Send paperwork before the month you want your new coverage to begin. All enrollments and disenrollments take effect the first day of the following month.

Reasons to Switch from Medicare Advantage to Original Medicare

There are several scenarios where switching from Medicare Advantage to Original Medicare may make sense:

You want freedom of provider choice. With Original Medicare, you can see any doctor or hospital in the U.S. that accepts Medicare. Medicare Advantage networks are more restricted.
You’re moving outside the plan’s service area. Medicare Advantage Plans are regional. Original Medicare lets you see any Medicare provider across the country.
Your drugs aren’t covered. If you need a medication not on your Medicare Advantage drug formulary, Original Medicare with Part D may provide better coverage.
You have high out-of-pocket costs. Between copays, deductibles and coinsurance, Medicare Advantage costs can add up. Medigap Plans help limit costs in Original Medicare.
You’re traveling a lot. Most Medicare Advantage Plans only cover emergency and urgent care outside the network. With Original Medicare, any provider nationwide will accept your coverage.
Your doctor leaves the network. Since networks fluctuate, your providers may leave your Medicare Advantage Plan. Switching to Original Medicare can ensure continued access.

Is Switching Back to Original Medicare the Right Move?

Here are some key factors to consider as you make this decision:

Review Medicare Advantage Plan costs. Will your premiums, deductibles and other out-of-pocket costs be lower in Original Medicare + Medigap?
Compare coverage for your medications. Make sure moving to Original Medicare won’t limit access to any of your prescription drugs.
Check if your healthcare providers accept Medicare. Some providers choose not to accept Medicare’s payment rates. See if your doctors participate in Medicare before switching.
Consider additional benefits. Do the extra benefits offered by your Medicare Advantage Plan, like dental, vision or hearing coverage, outweigh the advantages of Original Medicare for your situation?
Ask about special needs plans. If you have a chronic condition, you may lose customized Medicare Advantage benefits designed for your condition when you switch to Original Medicare.

How Can You Get Help Deciding?

The decision between Medicare Advantage and Original Medicare depends on your unique healthcare needs and preferences. It’s smart to consult with a Medicare advisor before making changes to get personalized help comparing costs, coverage and provider networks as you weigh your options. Speaking with an expert can provide the guidance needed to determine if switching from Medicare Advantage back to Original Medicare is the right call.

FAQs

Can you get kicked off a Medicare Advantage Plan?

Yes, you can be disenrolled from a Medicare Advantage Plan for various reasons, such as not paying the plan premiums, moving out of the plan’s service area, or if the plan terminates its contract with Medicare. You also have the right to voluntarily disenroll during certain enrollment periods.

How can I enroll in a Medicare Advantage Plan?

You can enroll in a Medicare Advantage Plan during the Initial Enrollment Period (when you first become eligible for Medicare), the Annual Open Enrollment Period (from October 15 to December 7 each year), or during special enrollment periods for specific qualifying events, such as moving to a new area with different plan options or qualifying for Medicaid.

What is the difference between Medicare Advantage and traditional Medicare?

A: Medicare Advantage Plans, also known as Part C, are offered by private insurance companies approved by Medicare and provide the same coverage as Medicare Part A and Part B, often with additional benefits such as prescription drug coverage. In contrast, traditional Medicare is the government-run fee-for-service program consisting of Part A (hospital insurance) and Part B (medical insurance).

Can I switch from one Medicare Advantage Plan to another?

Yes, you can switch from one Medicare Advantage Plan to another or switch back to Original Medicare during the Annual Open Enrollment Period or during a Special Enrollment Period if you meet certain qualifying criteria, such as moving to an area where different plan options are available.

What happens if I lose my Medicare Advantage Plan?

If you lose your Medicare Advantage Plan due to reasons such as the plan terminating its contract with Medicare or moving out of the plan’s service area, you have the opportunity to enroll in a new Medicare Advantage Plan during specific enrollment periods or return to Original Medicare and, if needed, enroll in a standalone Medicare Part D prescription drug plan.

Can I go back to Original Medicare from a Medicare Advantage Plan?

Yes, you have the right to voluntarily disenroll from a Medicare Advantage Plan during certain enrollment periods and return to Original Medicare. Additionally, you can also enroll in a Medicare Supplement insurance (Medigap) policy to provide additional coverage alongside Original Medicare.

What is the Medicare Part B enrollment period?

The Medicare Part B enrollment period is the time during which you can sign up for Medicare Part B, which usually occurs when you are first eligible for Medicare or during the General Enrollment Period from January 1 to March 31 each year if you didn’t sign up when you were first eligible. It is important to enroll in Medicare Part B when you’re first eligible to avoid late enrollment penalties.

What should I do if I want to switch from my Medicare Advantage Plan to a new plan?

If you want to switch from your current Medicare Advantage Plan to a new plan, you can do so during the Annual Open Enrollment Period from October 15 to December 7 each year. Additionally, you may also be eligible to switch during a Special Enrollment Period for qualifying events, such as moving to a new area with different plan options.

What is the role of the Centers for Medicare and Medicaid Services in Medicare Advantage Plans?

The Centers for Medicare and Medicaid Services (CMS) regulates and oversees Medicare Advantage Plans, ensuring that they comply with the rules and requirements set forth by Medicare. CMS also provides information and resources to help Medicare beneficiaries understand their coverage options and rights.

Can people with Medicare also qualify for Medicaid?

Yes, some people with Medicare may also qualify for Medicaid, which is a joint federal and state program that helps with medical costs for people with limited income and resources. Depending on your income and assets, you may qualify for both Medicare and Medicaid, also known as dual eligibility, and receive assistance with Medicare premiums, deductibles, and cost-sharing.

Can You Get Kicked Off A Medicare Advantage Plan?