Key takeaways
If you have a Medicare Advantage Plan, you can switch back to Original Medicare during certain times of the year, or under special situations if you are already past your Initial Enrollment Period.
Use the Annual Enrollment period (October 15 through December 7) or during the Medicare Advantage Open Enrollment Period (January 1 – March 31) to disenroll from your Medicare Advantage plan and automatically re-enroll in Original Medicare.
You will need to enroll in a stand alone Medicare Part D plan for prescription drug coverage.
Caution: enrolling in a Stand-Alone Part D prescription drug plan automatically disenrolls you form your Medicare Advantage Plan.
You can apply for a Medicare supplement any day of the year. But in most states, acceptance is not guaranteed after your first six months on Medicare Part B.
Understanding Medicare Advantage Plans
Medicare Advantage plans are an alternative to traditional Medicare, offering additional benefits and services not covered by Original Medicare. A Medicare Advantage plan is offered by private insurance companies approved by Medicare and are designed to provide comprehensive health coverage. Medicare Advantage plans often include prescription drug coverage, dental, vision, and hearing benefits, as well as fitness programs and wellness services. When you enroll in a Medicare Advantage plan, you are still enrolled in Medicare, but your Medicare benefits are administered by the private insurance company.
Does An Advantage Plan Cancel My Original Medicare?
A Medicare Advantage plan replaces traditional Medicare. When you enroll in a Medicare Advantage plan, you are essentially opting to receive your Medicare benefits through the private insurance company that offers the plan, which is referred to as Medicare Advantage coverage.
You will use the Medicare Advantage plan network of doctors and hospitals to receive care. You must also follow your Medicare Advantage Plan’s rules, or they will deny coverage.
You must still pay your Medicare Part B premium so that if or when you leave your Medicare Advantage Plan, your traditional Medicare coverage will automatically restart.
Do I Pay the Part B Premium With an Advantage Plan?
If you enroll in a Medicare Advantage plan, you must still to pay your Medicare Part B premium and any IRMAA surcharge to the government, in addition to any premium required by the Medicare Advantage plan and any bundled drug coverage.
Is There a Penalty for Switching Back to Original Medicare?
There is no penalty for switching back to Original Medicare from a Medicare Advantage plan. During Special Enrollment Periods, you can also make changes to your Medicare drug coverage without facing any penalties. You have the right to switch back to Original Medicare during specific enrollment periods without facing any financial penalty.
The major annual enrollment period where you can switch to original Medicare coverage or switch Medicare advantage plans is the annual election period from October 15 through December 07 of every year. There is also the Medicare Advaantage open enrollment period from January 01 through March 31 of every year where you can switch from a Medicare Advantage Plan back to Original Medicare or make one switch from a Medicare Advantage plan to another Medicare Advantage Plan.
If you switch to original medicare you can also apply for Part D drug coverage during that period.
Enrollment Periods for Switching
There are several enrollment periods, outside of your initial enrollment period, during which you can switch from one Medicare Advantage plan to another or switch from Medicare Advantage to Original Medicare. The Annual Election Period (AEP) takes place from October 15 to December 7, allowing you to make changes to your Medicare coverage, with new coverage starting on January 1.
The Medicare Advantage Open Enrollment Period (MA OEP) occurs from January 1 to March 31, allowing Medicare Advantage plan holders to switch to another Medicare Advantage plan or to Original Medicare with or without a Part D plan. Additionally, Special Enrollment Periods (SEPs) may be available due to life events such as moving, losing other coverage, or exceptional situations like natural disasters or emergencies.
The Medicare Advantage open enrollment period is the newest and most under used Medicare advantage open enrollment period. Sometimes it is used when a person finds their current drug coverage is not adequate and the need a new prescription drug plan.
Special Circumstances for Switching
There are several special circumstances that may allow you to switch from Medicare Advantage to Original Medicare or switch to a different or new Medicare Advantage plan. If you have a Medicare Advantage plan and move out of your plan’s service area, you may be eligible for a Special Enrollment Period.
When you move out of your Part D drug coverage service area you can also apply for new Part D drug coverage using your new zip code. This gives you a prescription drug plan designed for your new location.
If you lose your Medicaid eligibility, you can switch to Original Medicare up to three months from the date you lose Medicaid eligibility or the date you’re notified, whichever is later. Additionally, if you enroll in coverage from your union, employer, or a Program of All-Inclusive Care for the Elderly (PACE) plan, you may be able to leave Medicare Advantage and enroll in certain types of private plans.
Can I switch from Medicare Advantage to Medigap without underwriting?
In most states, after your first 180-days on Medicare Part B, enrolling in a Medicare supplement will require passing medical underwriting. When switching to a Medigap policy, you may also need to consider enrolling in a separate prescription drug plan to cover your medication needs.
Medicare Advantage Plan Changes
If your current Medicare Advantage plan makes changes that significantly affect your coverage, benefits, provider network, or if there are changes to the plan’s service area, you might have a special enrollment period to switch to a Medigap policy without medical underwriting. Keep in mind your choice of Medicare supplement plans will be limited. Still, Medicare supplement health insurance is often superior coverage and allows for you to improve on your Medicare plan.
Plan Discontinuation
If your Medicare Advantage plan’s service area changes, or if the plan is canceled you will be eligible for a special enrollment period. The Special Enrollment Period gives you options to choose a different Medicare Advantage Plan or choose from select Guarantee Issue Medicare supplement plans.
This same Special Enrollment period can apply if you lose Part D drug coverage. This can happen with a stand-alone Part D drug coverage plan.
How Long Does it Take to Switch Back to Original Medicare?
The change from an Advantage plan back to Original Medicare is seamless and virtually immidiate. When switching back to Original Medicare, consider whether your new plan includes prescription drug coverage to ensure you have comprehensive benefits. The moment one health insurance policy ends, the other health insurance policy starts.
Medicare Plan Comparison
When comparing Medicare plans, it’s essential to consider several factors, including coverage, cost, and provider network. Medicare Advantage plans often have lower premiums than Original Medicare, but may have higher out-of-pocket costs. Additionally, Medicare Advantage plans may have limited provider networks, which may not include your current healthcare providers. Original Medicare, on the other hand, offers more flexibility in terms of provider choice, but may require additional coverage for prescription drugs and other services. When switching from Medicare Advantage to Original Medicare, you may need to consider purchasing additional coverage, such as a Medicare Supplement plan or a stand-alone Part D plan, to fill in the gaps in your coverage.
What Happens When I Disenroll from a Medicare Advantage Plan?
When you disenroll from a Medicare Advantage plan, you are effectively canceling your enrollment in that plan and returning to Original Medicare (Parts A and B). If you decide to switch Medicare Advantage plans instead of returning to Original Medicare, make sure to review the new plan’s benefits and network.
When you switch back to original Medicare, you might need to consider other coverage options to fill in the gaps, if any (you’ll lose coverage for dental, vision, etc).
Make sure to notify your health providers about the change. If you received a new Medicare card when you enrolled in the Medicare Advantage plan, you’ll want to continue using the same card for your Original Medicare coverage.
Can I switch from a Medigap Plan to an Advantage Plan?
Because switching from a Medicare supplement to an Advantage plan does not require medical underwriting, it can be done during any year you are on Medicare. Any enrollment period where Medicare beneficiaries can switch from one Medicare Advantage plan to a different Medicare Advantage plan you can also switch back to Original Medicare without consequence.
Contact us today so we can help you with this request! Our award-winning team is happy to answer any other questions you may have. Make sure to take advantage of the upcoming open enrollment periods. Switch back to original Medicare and take control over your health decisions back!
