If you’re currently enrolled in a Medicare Advantage Plan, you may be wondering if it’s difficult to leave and go back to Original Medicare. The good news is that switching from Medicare Advantage to Original Medicare is a relatively straightforward process.
However, there are some important timing requirements and steps to take depending on your situation. With a bit of planning, you can successfully transition back to Original Medicare coverage.
Moving from Medicare Advantage to Original Medicare coverage
Medicare Advantage Plans are offered by private insurance companies as an alternative way to receive your Medicare benefits. If you decide Medicare Advantage isn’t right for you, you have options to return to Original Medicare, which includes Part A (hospital coverage) and Medicare Part B (outpatient care coverage).
Here are some key things to keep in mind about making the switch:
- You must meet certain timeframes for when you can disenroll from Medicare Advantage and pick up or get enrolled in Medicare(original).
- You’ll need to sign up for a separate Medicare Part D prescription drug plan if your Advantage Plan included drug coverage.
- Consider adding a Medigap policy if you want help paying Original Medicare out-of-pocket costs.
- Be aware you may need to change healthcare providers if your doctors aren’t covered under Original Medicare.
As long as you carefully follow the proper steps, transitioning coverage options can go smoothly.
When Can You Switch from Medicare Advantage Back to Original Medicare?
In most cases, you can only leave a Medicare Advantage Plan and return to Original Medicare during certain designated times of year:
- Medicare Advantage Open Enrollment Period – January 1 to March 31 each year. Coverage begins the first of the following month.
- Medicare Annual Enrollment Period – October 15 to December 7 each year. Coverage starts January 1.
Outside of these enrollment windows, your ability to make changes is more limited. However, there are some exceptions that allow switching Medicare Advantage Plans or going back to Original Medicare, including:
- Within your first year of joining a Medicare Advantage Plan, you can leave and switch back to Original Medicare during a “trial period.”
- If you’re moving out of your plan’s service area, you can switch plans in the two months before your move through two months after.
- Certain life events like losing employer coverage permit Special Enrollment Periods to make plan changes.
So while the general windows to switch are set annually, you may have options even off-season depending on your unique situation.
How Do You Disenroll from Medicare Advantage and Return to Original Medicare?
To leave your Medicare Advantage Plan, you must officially complete the disenrollment process. Here are the steps:
- Contact your Medicare Advantage insurer – Let them know you want to disenroll from their Medicare Advantage Plan. They may require you to fill out forms.
- Call 1-800-MEDICARE – Inform Medicare you are leaving your Medicare Advantage Plan and moving back to Original Medicare.
- Visit your local Social Security office – Bring your Medicare Advantage disenrollment forms as proof. They can process your request to return to Original Medicare.
Once your disenrollment is complete, your Original Medicare coverage will begin the first day of the following month. You’ll pay the standard Part B premium just like others with Original Medicare.
Should You Sign Up for a Medicare Part D Plan?
If your Medicare Advantage Plan included prescription drug coverage, you’ll need to enroll in a stand-alone Part D Plan when you switch back to Original Medicare. Here are some tips:
- Use the Medicare Plan Finder to compare Part D Plans in your area. Consider premiums, covered medications, and pharmacy access.
- Sign up before your Medicare Advantage enrollment ends to avoid gaps in medication coverage.
- Look for Part D Plans with national pharmacy chains in their network to allow picking up prescriptions when traveling.
- Check if you qualify for Extra Help paying Part D costs if you have limited income and resources.
Take time to select the right Part D Plan for your prescription needs and budget.
Considering a Medigap Plan for Additional Coverage
Original Medicare leaves you responsible for deductibles, copays, and coinsurance amounts for Part A and Part B services. To help fill these coverage gaps, you may want to enroll in a Medigap policy. Here are some pointers:
- Shop and compare rates during your Medigap Open Enrollment Period when insurers must cover you regardless of health status.
- Focus on benefits over price alone – a higher premium may provide better coverage value long-term.
- Know that you cannot have both Medigap and Medicare Advantage coverage – it’s one or the other.
- Be aware Medigap Plans do not cover vision, dental, hearing aids or prescription drugs. You need additional plans for those.
Medigap can provide financial protections from high Original Medicare out-of-pocket expenses. Determine if it aligns with your healthcare needs.
Will You Need to Change Doctors When You Switch to Original Medicare?
One potential drawback of leaving a Medicare Advantage Plan is that you may have to find new healthcare providers who accept Original Medicare’s coverage terms. Before disenrolling, ask your doctors:
- Do they accept Medicare assignment? This means they agree to Medicare’s approved amounts as payment in full for covered services.
- Are they still willing to treat you if you have Original Medicare? Some providers limit their practice to Medicare Advantage members only.
- Will referrals to specialists be impacted if they were arranged by your Medicare Advantage Plan previously?
Know that with Original Medicare you can see any provider nationwide that accepts Medicare beneficiaries. But confirm your physicians will continue caring for you post-switch to avoid disruptions.
Reasons Why Switching from Medicare Advantage to Original Medicare Makes Sense
There are a variety of reasons why returning to Original Medicare could be a smart choice, including:
More flexibility in providers – You aren’t limited to narrow Medicare Advantage networks and can see any doctor accepting Medicare patients.
Lower costs for frequent services – Original Medicare’s cost-sharing amounts can be cheaper than some plans’ high copays for things like labs or specialist visits.
Moving to a different area – Your current plan may not offer coverage where you’re relocating, making Original Medicare a simpler option.
Marketplace changes – Medicare Advantage Plan benefits, formularies, and costs can change yearly. Their network providers can also change.
Traveling frequently – Original Medicare is accepted nationwide, while Medicare Advantage restricts out-of-network coverage.
Think about your personal situation and healthcare needs when deciding if going back to Original Medicare could be beneficial.
Mistakes to Avoid When Switching from Medicare Advantage to Original Medicare
Changing coverage always involves some risks of administrative issues or gaps in care. Avoid these common mistakes when moving from Medicare Advantage back to Original Medicare:
- Waiting too long into the fall Medicare Open Enrollment Period to decide, leaving insufficient time to enroll in Medigap and Part D Plans. Start the process early.
- Not having all your prescriptions, dosages, frequencies, and pharmacy information handy when comparing Part D Plans. Incomplete information can lead to the wrong plan choice.
- Assuming your doctors will automatically accept you as a Medicare patient. Get confirmation to prevent unwanted surprises.
- Letting your Medicare Advantage coverage terminate before your Original Medicare and supplemental plans are effective. Double check dates to prevent any lapse.
With attentive planning and research, you can transition coverage without missteps.
We’re Here to Help
You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at American Entitlements a Call at (469) 814-0289. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.
Is it hard to switch from Medicare Advantage plan to Original Medicare?
Switching from a Medicare Advantage Plan to Original Medicare is not necessarily difficult, but it does require some understanding and careful consideration. It is important to review your current plan and compare it to the coverage provided by Original Medicare to determine if the switch is right for you.
What is the Medicare open enrollment period?
The open enrollment period is a specific time frame during which individuals can make changes to their Medicare coverage. It typically occurs annually from October 15th to December 7th. During this period, you can switch from a Medicare Advantage Plan to Original Medicare or vice versa.
Can I switch my Medicare Plan outside of the open enrollment period?
Generally, you can only make changes to your Medicare coverage during the open enrollment period. However, there are certain circumstances, such as qualifying for a Special Enrollment Period (SEP), that may allow you to make changes outside of the usual enrollment period.
What are the advantages of Medicare Advantage Plans?
Medicare Advantage Plans, also known as Medicare Part C, offer additional benefits and coverage beyond what is provided by Original Medicare. These plans often include prescription drug coverage and may offer additional services such as dental, vision, and hearing coverage.
Can I enroll in or change Medicare Plans at any time?
No, you cannot enroll in or change Medicare Plans at any time. There are specific enrollment periods, such as the initial enrollment period and the open enrollment period, during which you can make changes to your Medicare coverage.
How can I switch from Original Medicare to a Medicare Advantage Plan?
To switch from Original Medicare to a Medicare Advantage Plan, you will need to contact the Medicare Advantage Plan you wish to enroll in and follow their enrollment process. It is important to note that not all plans are available in all areas, so you may need to research available options.
Can I drop my Medicare Advantage Plan and switch back to Original Medicare?
Yes, you have the option to drop your Medicare Advantage Plan and switch back to Original Medicare. However, it is recommended that you carefully consider the coverage and benefits provided by both options before making a decision.
Can I switch from one Medicare Advantage Plan to another?
Yes, you have the option to switch from one Medicare Advantage Plan to another during the open enrollment period. It is important to review the coverage and benefits offered by the new plan to determine if it meets your needs.
Can I switch from a Medicare Advantage Plan to a Medicare Supplement Insurance Plan?
Yes, you can switch from a Medicare Advantage Plan to a Medicare Supplement Insurance Plan. However, it is important to carefully compare the coverage and costs associated with each option before making a decision.
Can I switch from a Medicare Advantage Plan to Original Medicare without penalty?
Generally, there are no penalties for switching from a Medicare Advantage Plan to Original Medicare. However, it is important to review the terms and conditions of your specific plan to ensure that you understand any potential penalties or limitations.