Medicare provides health insurance to American seniors as well as adults who have a qualifying disability or medical condition. Beneficiaries can choose between Original Medicare and a Medicare Advantage (MA) plan. But can you go back to Original Medicare from an Advantage plan? The short answer is, Yes. The longer answer is, Yes, but you must act during specific times. This post explains your options. Show
What Is Original Medicare?Original Medicare includes two parts:
Original Medicare does not include prescription drug coverage, vision, dental, or hearing aids. What Is Medicare Advantage?Medicare Part C, more commonly known as Medicare Advantage, is similar to the group health insurance plans that many people have through an employer. At a minimum, every Medicare Advantage plan must provide the same coverage as Original Medicare. However, they are not limited to this coverage. And in fact, most Medicare Advantage plans offer additional benefits. Medicare Advantage Prescription Drug plans (MA-PD) include your Medicare Parts A, B, and D benefits. These all-in-one plans account for around 90 percent of all MA plan offerings. The vast majority of Advantage plans also cover routine vision and dental care, fitness benefits, and hearing aids. Private insurance companies provide Medicare Advantage plans, which is why coverage and costs vary. Can You Return to Original Medicare After Joining an Advantage Plan?Yes, you may return to Original Medicare after you join an Advantage plan. But you may only do so during specific enrollment periods. The Medicare Annual Enrollment PeriodThe Medicare Annual Enrollment Period (AEP) lasts from October 15 through December 7. During Annual Enrollment, you may:
Changes you make during Annual Enrollment take effect on January 1. The Medicare Advantage Open Enrollment PeriodThe Medicare Advantage Open Enrollment Period (OEP) occurs every year from January 1 through March 31. It is limited to current Medicare Advantage enrollees. During OEP, your options are:
If making that change means that you lose your prescription drug coverage, you may also join a standalone Medicare Part D plan. Special Enrollment PeriodsMedicare provides Special Enrollment Periods (SEP) to people who experience certain life events. Common special circumstances include:
There are more than two dozen qualifying special circumstances. How long you have to act varies according to which SEP you qualify for. Find the full details on Medicare.gov. Can You Join a Medigap Plan After Leaving Medicare Advantage?Medicare Supplement Insurance, more commonly known as Medigap, helps pay some of your out-of-pocket costs under Original Medicare. You cannot have both Medigap and a Medicare Advantage plan. If you plan to stay with Medicare Parts A and B, we nearly always recommend applying for a Supplement plan during your Medigap Open Enrollment Period, which begins once you are aged 65 or older AND have Medicare Part B. Your Medigap OEP is one of the few times your application will not undergo medical underwriting thanks to guaranteed issue rights. Medical underwriting is how the insurance company determines (1) whether to sell you a Medigap policy and (2) what to charge for it. Guaranteed issue rights mean that you cannot be denied a Medicare Supplement policy nor charged a higher premium – even if you have preexisting medical conditions. If you leave an Advantage plan to return to Original Medicare, the only way to avoid medical underwriting is if this was both the first time you had Part C AND you make the switch back to Original Medicare within 12 months. Some states offer a bit more flexibility when it comes to joining a Medigap plan. And two – New York and Connecticut – don't allow medical underwriting at all. For details on your state's Medicare Supplement guidelines, check your State Health Insurance Assistance Program (SHIP). How to Choose Between Original Medicare and Medicare AdvantageThere are pros and cons to both Original Medicare and Medicare Advantage. The right choice depends on your unique situation. Consider the following:
Comparing your Medicare plan options is easy with our Find a Plan tool. Just enter your location and coverage start date to review Medicare Advantage, Part D, and Medigap plans in your area. Can I switch back to original Medicare?Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. Your coverage under traditional Medicare will begin January 1 of the following year.
What are the negatives of a Medicare Advantage plan?Disadvantages of Medicare Advantage. Limited service providers. If you choose one of the more popular Medicare Advantage plan types, such as an HMO plan, you may be limited in the providers you can see. ... . Complex plan offerings. ... . Additional costs for coverage. ... . State-specific coverage.. When can you switch from Medicare Advantage to a Medicare supplement?Once you've left your Medicare Advantage plan and enrolled in Original Medicare, you are generally eligible to apply for a Medicare Supplement insurance plan. Note, however, that in most cases, when you switch from Medicare Advantage to Original Medicare, you lose your “guaranteed-issue” rights for Medigap.
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