How Do You Switch from Medicare Advantage to Original Medicare Plan?

Medicare Advantage Plans, also known as Medicare Part C, are health plans offered by private insurance companies that contract with Medicare. If you've enrolled in a Medicare Advantage Plan but decide you would rather have Original Medicare, you can switch back. Here we'll discuss when and how you can make the change to traditional Medicare coverage.

When Can You Switch Back to Original Medicare?

There are certain times each year when you can disenroll from a Medicare Advantage Plan and move back to Original Medicare:

·        Annual Election Period (October 15 – December 7): This fall open enrollment period allows anyone with Medicare Advantage to switch Medicare for coverage starting January 1.

·        Medicare Advantage Open Enrollment Period (January 1 – March 31): During the first quarter each year, Medicare Advantage enrollees can move to Original Medicare or switch to another Medicare Advantage Plan. Coverage begins the first day of the following month.

·        Initial Enrollment Period: People new to Medicare Advantage can change Medicare within the first year of joining their initial plan.

·        Certain Circumstantial Special Enrollment Periods: These allow disenrolling from Medicare Advantage outside normal windows if certain life events occur, like moving.

Knowing these enrollment period rules helps ensure you make changes at times that won't cause gaps in your healthcare coverage or late penalties.

How Do I Process the Change to Original Medicare?

The steps to switch from Medicare Advantage depend slightly on whether you want to join Original Medicare only or enroll in a stand-alone Part D prescription drug plan too:

To change to Original Medicare only:

·        Contact your Medicare Advantage Plan to disenroll. You can do this online, over the phone, or by mailing a signed letter.

·        The plan will notify Medicare of your disenrollment request. This will automatically enroll you in Original Medicare Parts A and B.

·        Consider purchasing a Medigap policy once on Original Medicare to supplement and cover cost-sharing amounts.

To change to Original Medicare plus Part D:

·        First pick a stand-alone Part D prescription drug plan to enroll in. These are available to all Medicare beneficiaries. Ensure your medications will be covered under the Part D Plan you select.

·        Inform your Medicare Advantage Plan that you are disenrolling and want Original Medicare coverage.

·        Enroll in the Part D Plan of your choosing. You have up to three months after leaving Medicare Advantage to join a Part D Plan without penalty.

That's all it takes to process the change administratively! The plan and Medicare will handle disenrolling you from Medicare Advantage and returning you to Original Medicare Parts A and B.

What are the Coverage Implications?

When you switch from Medicare Advantage to Original Medicare, there are some key coverage differences to be aware of:

·        Providers: Original Medicare covers any healthcare provider nationwide who accepts Medicare. Medicare Advantage Plans have restricted provider networks.

·        Referrals: With Original Medicare you can see any specialist without needing referrals. Some Medicare Advantage Plans require referrals.

·        Prescriptions: You'll need to enroll in a stand-alone Part D Plan for drug coverage under Original Medicare. Medicare Advantage includes Part D.

·        Costs: Original Medicare has higher cost-sharing that you can supplement with a Medigap Plan. Medicare Advantage relies on copays and coinsurance.

·        Extra benefits: Services like dental and vision are covered by some Medicare Advantage Plans but not under Original Medicare.

It's important to account for these differences to ensure you have full coverage in place once the change takes effect. Speaking to an insurance counselor can help identify any gaps to fill.

Things to Know About Switching Back

Here are some important points to keep in mind when switching from Medicare Advantage to Original Medicare:

·        You may need to purchase a Medigap Plan upon returning to Original Medicare to supplement your coverage.

·        Your guaranteed right to buy a Medigap policy only applies for 63 days after leaving Medicare Advantage. Make sure to apply within this window.

·        Medigap Plans provide nationwide coverage with Original Medicare, whereas Medicare Advantage restricts you to in-network providers.

·        You cannot remain enrolled only in Medicare Part B. You must keep both Part A and Part B to have coverage.

·        Carefully choose your new Part D drug plan if your Medicare Advantage Plan included prescription drugs. Formulary details differ between plans.

·        Some providers like specialists may only accept patients with Original Medicare coverage. Check before making the switch.

With a good understanding of the process, coverage implications, and things to watch out for, you can smoothly transition from a Medicare Advantage Plan back to Original Medicare when needed. Reach out to Medicare directly as well as State Health Insurance Assistance Program counselors for personalized help with making plan changes.

Reasons Some Switch Back to Original Medicare

There are a few common reasons Medicare beneficiaries choose to leave Medicare Advantage and return to Original Medicare:

Broader Provider Choice

Original Medicare allows you to see any doctor or hospital nationwide that accepts Medicare. Medicare Advantage networks are usually restricted to a subset of providers, which some find limiting.

Avoid Referrals for Specialists

Many Medicare Advantage Plans require you to get pre-approval from a primary care doctor before seeing specialists. Under Original Medicare, you can see any specialist who accepts Medicare without referrals.

Lower Prescription Costs

While Medicare Advantage Plans include prescription drug coverage, they have formularies that may not include specific medications you need or that have high cost sharing. Stand-alone Part D Plans may offer better coverage for your drugs.

Medigap Coverage

Original Medicare has gaps in coverage that Medigap Plans pay for, like coinsurance. These plans provide financial protection but can't be used with Medicare Advantage.

Travel Coverage

Original Medicare covers you nationwide so long as providers accept Medicare. Medicare Advantage may only cover non-emergency care within a plan's service area or network.

Conclusion

Switching from a Medicare Advantage Plan back to Original Medicare is an option for beneficiaries each year during open enrollment periods, or for those new to a plan within their first year of joining. Making the change involves working with both your Medicare Advantage insurer and Medicare directly to disenroll and re-enroll you in Original Medicare. Understanding how this process works, when you can make changes, and the resulting coverage implications allows you to smoothly transition back to Original Medicare if doing so better meets your needs.

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 Bourgeois Insurance a Call at (985) 803-8999. 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.

FAQS

Can I switch from a Medicare Advantage Plan to Traditional Medicare during the open enrollment period?

 Yes, you can switch from a Medicare Advantage Plan to Original Medicare during the open enrollment period.

What is the open enrollment period?

 The open enrollment period is a specific time frame each year during which you can make changes to your Medicare coverage.

Can I change my Medicare Plan during the open enrollment period?

 Yes, you can change your Medicare Plan during the open enrollment period.

Can I switch from one Medicare Plan to another during the open enrollment period?

 Yes, you can switch from one Medicare Plan to another during the open enrollment period.

Can I switch from a Medicare Advantage Plan to Switch  to Original Medicare Coverage during the Medicare open enrollment period?

 Yes, you can switch from a Medicare Advantage Plan to Original Medicare during the Medicare open enrollment period.

Can I switch from Medicare Advantage Plan to a different Medicare Advantage Plan during the open enrollment period?

 Yes, you can switch from a Medicare Advantage Plan to a different Medicare Advantage Plan during the open enrollment period.

Can Change Medicare Plan 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.

Can I switch from one Medicare Advantage Plan to another after the open enrollment period?

 You may be able to switch from one Medicare Advantage Plan to another outside of the open enrollment period, depending on certain circumstances.

Can I drop my Medicare Advantage Plan and go back to Original Medicare during the open enrollment period?

 Yes, you can drop your Medicare Advantage Plan and go back to Original Medicare during the open enrollment period.

Can I enroll in or change my Medicare drug plan during the open enrollment period?

 Yes, you can enroll in or change your Medicare drug plan during the open enrollment period.

Can I switch back to Original Medicare if I'm enrolled in a Medicare Advantage Plan?

Yes, if you're enrolled in a Medicare Advantage Plan, you can switch back to Original Medicare during the Medicare Open Enrollment Period each year from October 15th to December 7th. Outside of this enrollment window, you generally cannot switch plans unless you qualify for certain exceptions like if you've had a change in your permanent home address.