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.
What is Original Medicare?
Original Medicare, often referred to as “Traditional Medicare,” is the foundational health insurance program provided by the U.S. government for eligible individuals aged 65 and older, as well as certain younger individuals with disabilities. When you apply for Medicare during your Initial or Open Enrollment Period you start with Original Medicare.
Your Medicare plan consists of two main parts: Part A (hospital insurance) and Part B (medical insurance).
FYI: they are often confused, but Medicaid coverage is not the same as the Medicare program.
What’s a Medicare Advantage Plan?
A Medicare Advantage plan (Part C) is a private health insurance option approved by Medicare. It replaces the Original Medicare (Parts A and B) and sometimes includes drug coverage, vision, dental, and hearing services.
Should I Switch Back to Original Medicare?
We have many helpful videos and posts on this topic but here are some key points:
Original Medicare allows Medicare beneficiaries to see any doctor or specialist who accepts Medicare, without network restrictions. This gives you a broader choice of healthcare providers. It’s also more accommodating for those who travel often within the US.
Original Medicare coverage is standardized, simple, and straightforward. You know what to expect in terms of costs for different services.
Pre-authorizations are not required. There is no need to wait for a referral or authorization to see a specialist or for certain procedures. Medical decisions are between you and your doctor.
If you opt for Original Medicare, you can also purchase a Medicare Supplement Insurance (Medigap) to help cover out-of-pocket costs. You can lower your annual maximum out-of-pocket for medical bills down to under $300 per year.
In our “Medicare Secrets of Who and Why” video I detail the demographics of who usually chooses a Medicare Advantage Plan, who chooses a Medicare supplement, and why.
When Can I Switch to Original Medicare?
You can switch to Original Medicare if you are currently enrolled in a Medicare Advantage plan (Medicare Part C) during select annual enrollment periods.
The most common time to switch from a Medicare Advantage plan (Part C) to
Original Medicare is during the Annual Election Period (AEP), also known as the Annual Election Period which occurs from October 15 to December 7 each year. If you choose, you can also switch Medicare Advantage Plans during this period or switch from Original Medicare to an Advantage Plan. All changes take effect on the following January 01.
You are also eligible to make one change during the Medicare Advantage Open Enrollment Period (Jan 1-March 31). You can drop your Medicare Advantage Plan and go back to Medicare Parts A & B.
If your Part C plan included a prescription drug plan and you’re switching back to Original Medicare, you will need to enroll in a stand alone Medicare Part D prescription drug plan to ensure you have drug coverage for prescription drugs.
Special Circumstances
There are certain special circumstances that can result in your ability to change back to Original Medicare outside the standard enrollment periods. This includes moving to a new address out of your plan’s service area or losing insurance coverage. If you lose your health coverage through no fault of your own, Medicare usually allows for a Special Enrollment Period to get a new Medicare Plan.
Why Are Medicare Advantage Plans Bad?
It’s not so much that all Medicare Advantage Plans are bad, it’s that none of the Advantage plans are as good as Traditional Medicare plus a supplement.
Medicare Advantage Plans must cover all the same benefit categories as Original Medicare, but add a maximum annual out of pocket limit to your expenses. In return, the for profit insurance company managing your plan must place restrictions on your coverage in order to make a profit. It is those restrictions that shock people and place their health at risk when they need healthcare the most.
Benefits and coverage between Medicare Advantage plans vary widely and change annually, including their drug formularies. The benefits and features of every Advantage Plan change each calendar year. The plan might alter its coverage, network, or costs, potentially affecting the care and providers you’re accustomed to. Because Medicare Advantage coverage changes each year, it’s difficult to plan for or budget your health care costs during retirement.
There are approximately 4,000 different Medicare Advantage Plan throughout the U.S. Each with its own cost structure, maximum out-of-pocket and network.
Does An Advantage Plan Cancel My Original Medicare?
Medicare Advantage plans replace 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.
You will use the Medicare Advantage plan’s network of doctors and hospitals to receive care. You must also follow your 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 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.
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. You have the right to switch back to Original Medicare during specific enrollment periods without facing any financial penalty.
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.
Medicare Advantage Plan Changes
If your Medicare Advantage plan makes changes that significantly affect your coverage, benefits, or provider network, you might have a special enrollment period to switch to a Medigap policy without medical underwriting.
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.
How Long Does it Take to Switch Back to Original Medicare?
The change from an Advantage plan back to Original Medicare is seamless. The moment one ends, the other starts.
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).
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 another, 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!
Matthew Claassen
Matthew Claassen, CMT and CEO of Medigap Seminars Insurance Agency. Medigap Seminars is an award winning premier national Medicare Insurance Brokerage, ranked among the top in the U.S.A. Matthew is considered a leading national expert on Medicare and Social Security. Mr. Claassen is a distinguished member of the Forbes Business council, an invitation only organization of business leaders and entrepreneurs. He and his team have received awards from many of the countries largest insurance companies including Mutual of Omaha, Aetna, Humana, Cigna, United American, United Healthcare and others. His videos have become the most popular Medicare educational videos on YouTube with millions of views. As a financial analyst Matthew lead a team of researchers to win the 2009 Best Equity Research & Strategy Award from The Technical analysis magazine.
