travislanefinancia
- Oct 21, 2023
- 7 min read

Is It Hard to Switch From Medicare Advantage to Original Medicare?

Updated: Oct 28, 2023

When you first enroll in Medicare, you have a choice between getting your coverage through Original Medicare or a Medicare Advantage Plan. But what if later on you want to change from Medicare Advantage to Original Medicare? Is it a difficult process?

Switching from Medicare Advantage back to Original Medicare can be done, but it's important to understand the rules around when and how you can make this change. Read on to learn more about:

Why someone may want to switch from Medicare Advantage to Original Medicare
The steps involved in making the change
Enrollment periods that allow you to switch
Things to consider before making the switch

Knowing what to expect can help ensure you can successfully transition from a Medicare Advantage Plan back to Original Medicare if that better meets your needs down the road.

Why Would Someone Want to Switch from Medicare Advantage to Original Medicare?

There are a few key reasons someone enrolled in a Medicare Advantage Plan may later decide they want to change to Original Medicare instead:

Limited Provider Network

Medicare Advantage Plans have network restrictions that may make it difficult to see the providers or specialists you want. Original Medicare lets you see any doctor nationwide that accepts Medicare.

High Out-of-Pocket Costs

The copays, deductibles, and coinsurance with Medicare Advantage can lead to unpredictable costs. Original Medicare with a Medigap Plan offers more cost protection.

Lack of Coverage When Traveling

Medicare Advantage Plans generally only cover emergency and urgent care outside of the plan's service area. Original Medicare plus Medigap provides nationwide coverage.

Declining Health

If your health changes, the larger network and flexibility of Original Medicare may suit your needs better than a Medicare Advantage Plan's restrictions.

While there are benefits to Medicare Advantage Plans, the network limitations and cost sharing may eventually make Original Medicare a better option for some beneficiaries.

How Do You Switch from Medicare Advantage to Original Medicare?

If you've decided Original Medicare is a better fit for your situation, how do you go about switching from your Medicare Advantage Plan? Here are the key steps:

1. Review Enrollment Periods

You can only make changes to your coverage during designated Medicare enrollment periods. We'll cover these in more detail shortly.

2. Inform Your Medicare Advantage Plan

Contact your Medicare Advantage Plan to disenroll. You can do this by calling their member services number or filling out a disenrollment form.

3. Enroll in Original Medicare

To switch to Original Medicare, you need to sign up for both Medicare Part A and Part B. Make sure coverage will start when your Medicare Advantage Plan ends.

4. Get Supplemental Coverage

Consider enrolling in a Medicare Part D prescription drug plan and/or a Medicare Supplement (Medigap Plan) for additional coverage.

5. Send in Paperwork

Submit all enrollment paperwork before deadlines. You should get confirmation that your plan switch was successful.

The earlier in your current plan's cycle you request to switch, the better to avoid gaps in coverage when transitioning.

When Can You Switch from Medicare Advantage to Original Medicare?

Medicare has strict enrollment guidelines dictating when you can switch between Medicare Advantage and Original Medicare:

Medicare Advantage Open Enrollment Period

January 1 to March 31 each year
Switch to Original Medicare or a different Medicare Advantage Plan

Medicare Annual Enrollment Period

October 15 to December 7 each year
Switch from Medicare Advantage to Original Medicare for January 1 coverage

Medigap Open Enrollment Period

6 month period when you turn 65 and enroll in Medicare Part B
Chance to buy a Medigap policy when transitioning from Medicare Advantage

Special Enrollment Period

Qualifying life events like moving allow temporary chance to switch plans

Be strategic and make changes during these designated windows to avoid delays or gaps in coverage.

Can You Get Medigap Coverage After Leaving Medicare Advantage?

One common question when switching to Original Medicare is whether you can get a Medigap policy. Here's how it works:

After your initial Medigap Open Enrollment Period when newly enrolling in Medicare, insurers can deny you a Medigap Plan or charge higher premiums based on health history.
But some states offer additional Medigap enrollment rights when switching from Medicare Advantage.
These protections allow you to purchase certain Medigap policies without medical underwriting when returning to Original Medicare.
Check if your state has Medigap protections for people moving from Medicare Advantage back to Original Medicare.

Having a way to get a Medigap Plan after leaving Medicare Advantage makes it easier to reduce out-of-pocket costs under Original Medicare.

Things to Consider Before Switching from Medicare Advantage

Before you make the change to Original Medicare, some key considerations include:

Cost

Will Original Medicare with supplements cost less than your Medicare Advantage out-of-pocket expenses?

Coverage

Does your Medicare Advantage Plan cover key benefits like vision, dental, hearing aids you want? These aren't covered under Original Medicare.

Providers

Are your preferred doctors, hospitals, and pharmacies in-network with your Medicare Advantage Plan? With Original Medicare you can see any provider that accepts Medicare.

Prescriptions

Check that your Medicare Part D Plan will cover your prescription medications if you switch. Formularies and pricing can vary.

Health Needs

Will your healthcare needs and usage result in lower costs under Original Medicare vs. your current Medicare Advantage Plan?

Doing a thorough comparison of costs, coverage, and providers will ensure switching to Original Medicare is the right move for your health and budget.

Is It Difficult to Switch from Medicare Advantage Back to Original Medicare?

The bottom line is that yes, it is possible to switch from a Medicare Advantage Plan back to Original Medicare. But there are some hurdles to understand:

You can only make changes during designated enrollment periods
Delays in paperwork could mean gaps in healthcare coverage
Pre-existing conditions may prevent you from getting a Medigap Plan
Your doctor or medications may no longer be covered under Original Medicare
Overall costs may be higher, depending on your healthcare needs

However, in many cases the flexibility and expanded coverage offered by Original Medicare outweighs these challenges. Thorough planning and preparation can help make the transition back to Original Medicare smooth.

Key Takeaways on Switching from Medicare Advantage to Original Medicare

Switching from a Medicare Advantage Plan to Original Medicare is permitted but requires careful consideration:

Evaluate if your providers, prescriptions, and costs will be covered as expected under Original Medicare.
Use enrollment periods like Medicare Open Enrollment to change plans.
Understand rules in your state on qualifying for supplemental Medigap coverage.
Weigh benefits like predictable costs vs. plan restrictions.
With proper planning, you can successfully transition from Medicare Advantage to Original Medicare.

Knowing the process, timeline, and factors like costs and coverage involved will make any switch back to Original Medicare go more smoothly.

FAQs

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

Switching from Medicare Advantage to Original Medicare is generally straightforward. However, it's essential to understand the enrollment periods and requirements for making this change to ensure a smooth transition.

What is the Open Enrollment Period for Medicare?

The Open Enrollment Period for Medicare, also known as the Annual Enrollment Period, occurs from October 15th to December 7th each year. During this time, Medicare beneficiaries can make changes to their Medicare Plans insurance paln, switch between Medicare Advantage and Original Medicare, or add or drop Medicare Part D (prescription drug) coverage.

Can I switch from my current Medicare Plan to another Medicare Advantage Plan during the Medicare Open Enrollment Period?

Absolutely. The Open Enrollment Period allows Medicare beneficiaries to switch to Medicare Advantage Plan to another Medicare Advantage Plan. It's an excellent opportunity to review your coverage options and choose a plan that better suits your healthcare needs and preferences.

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

Yes, you can switch from Original Medicare to a Medicare Advantage Plan during the Open Enrollment Period. This period allows you to reevaluate your healthcare needs and explore different Medicare Plan options, including Medicare Advantage Plans.

Can I switch from a Medicare Advantage Plan to Original Medicare outside the Open Enrollment Period?

While the Open Enrollment Period is the most convenient time to switch from a Medicare Advantage Plan to Original Medicare, certain special circumstances may allow you to make this change outside of the enrollment period. These circumstances include moving out of your plan's service area or qualifying for a Special Enrollment Period.

Can I drop my Medicare Advantage Plan and switch back to Original Medicare anytime?

Generally, you can drop your Medicare Advantage Plan and switch back to Original Medicare during the Open Enrollment Period or other qualifying periods. However, to ensure a smoother transition and avoid any coverage gaps, it's advisable to make these changes during designated enrollment periods.

If I switch from Original Medicare to a Medicare Advantage Plan, can I switch back to Original Medicare later?

Yes, you have the flexibility to switch from a Medicare Advantage Plan back to Original Medicare. However, it's important to be aware of the specific enrollment periods and requirements to make this change to ensure a seamless transition in your coverage.

Can I change my Medicare Part D (prescription drug) coverage during the Open Enrollment Period?

Yes, the Open Enrollment Period allows Medicare beneficiaries to make changes to their Medicare Part D (prescription drug) coverage. You can switch to a different Part D Plan or add Part D coverage if you previously didn't have it.

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

Yes, some circumstances may qualify you for a Special Enrollment Period, allowing you to make changes to your Medicare coverage outside of the Open Enrollment Period. Examples of qualifying circumstances include moving out of your plan's service area, losing other creditable coverage, or receiving assistance to pay for your Medicare costs.

Are there any costs associated with switching Medicare coverage?

Switching Medicare coverage itself does not have direct costs associated with it. However, different Medicare Plans may have different premiums, deductibles, copayments, and other out-of-pocket expenses. It's important to review the costs and coverage details of the plans you are considering before making any changes.