Choosing between Original Medicare and Medicare Advantage is a critical decision for many Medicare beneficiaries. Both options offer health coverage for seniors, but they differ in structure, coverage, and cost management. As your healthcare needs evolve, you might find that your initial choice no longer suits you. Fortunately, you can switch between Medicare Advantage and Original Medicare under specific conditions. 

Table of Contents: 

• Understanding Original Medicare and Medicare Advantage 

• Enrollment Periods and When You Can Switch Between Medicare Advantage and Original Medicare? 

• Steps to Switch from Medicare Advantage to Original Medicare 

• Conclusion 

Understanding Original Medicare and Medicare Advantage 

1. Original Medicare (Part A and Part B): 

• Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health services. 

• Part B covers outpatient care, doctor’s visits, preventive services, and medical supplies. 

With Original Medicare, you can visit any doctor or hospital that accepts Medicare without being limited to a specific network. However, you may still face out-of-pocket costs, such as premiums, deductibles, and coinsurance. 

2. Medicare Advantage (Part C): 

Medicare Advantage (Part C) plans are offered by private insurance companies and combine the benefits of Part A, Part B, and often Part D (prescription drug coverage) into one plan. Some Medicare Advantage plans offer additional benefits  like dental, vision, and wellness programs. 

Medicare Advantage plans may have a more limited network of providers, and you may require referrals for specialist care, depending on the plan. These plans usually include a set of monthly premiums (in addition to the Part B premium) and often have lower out-of-pocket costs compared to  Original Medicare. 

Enrollment Periods and When You Can Switch Between Medicare Advantage and Original Medicare? 

The opportunity to switch between Medicare Advantage and Original Medicare is available during specific enrollment periods. The easiest way to move from Medicare Advantage to Original Medicare is during one of two annual periods that allow anyone to leave Medicare Advantage with no questions asked. The second way to leave your Medicare Advantage plan is if you have had it for less than one year. You are entitled to a “trial right.” Understanding these periods is crucial to making a seamless transition. 

1. Initial Enrollment Period (IEP) 

IEP is when you first become eligible for Medicare. You have a seven-month window to enroll in either Original Medicare or a Medicare Advantage plan. This period includes three months before your 65th birthday, the month of your 65th birthday, and three months after. During this time, you can choose between the two types of plans.

2. Annual Enrollment Period (AEP) 

The Annual Enrollment Period (AEP), also known as the Open Enrollment Period, runs from October 15 to December 7 each year. During AEP, you can make changes to your coverage: 

• Switch from Original Medicare to a Medicare Advantage plan. 

• Switch from Medicare Advantage to Original Medicare. 

• Add or drop Part D prescription drug coverage (if you have Original Medicare). 

• Change your Medicare Advantage plan. 

• Changes made during AEP take effect on January 1 of the following year. 

Medicare Advantage Open Enrollment Period (MA OEP) 

If you are already enrolled in a Medicare Advantage plan, you have another opportunity to switch during the Medicare Advantage Open Enrollment Period (MA OEP). This period runs from January 1 to March 31 each year. During MA OEP, you can: 

• Switch from one Medicare Advantage plan to another. 

• Switch from a Medicare Advantage plan back to Original Medicare. 

• If you switch back to Original Medicare, you can also join a Part D prescription drug plan if you want prescription drug coverage. 

If you disenroll from a plan during the month, your changes will be effective on the first of the following month.  

However, MA OEP is not the time to join a Medicare Advantage plan if you are not already enrolled in one. You must already have a Medicare Advantage plan to make a change. 

Special Enrollment Periods (SEPs) 

There are certain situations where you can switch between Medicare Advantage and Original Medicare outside of the standard enrollment periods. These are called Special Enrollment Periods (SEPs), and they are triggered by specific life events, such as: 

• Moving out of your plan’s service area. 

• Losing other creditable prescription drug coverage. 

• Involuntary loss of your Medicare Advantage plan. 

• You can also qualify for an SEP if you qualify for Medicaid or Extra Help. 

• SEPs allow you to make changes to your coverage without having to wait for the next AEP. 

Steps to Switch from Medicare Advantage to Original Medicare 

If you decide that Medicare Advantage no longer suits your needs and you would like to switch back to Original Medicare, here is what you need to do: 

Step 1: Make the Decision: Understand why you want to switch. Are you unhappy with the restrictions or network limitations of your Medicare Advantage plan? Do you prefer the flexibility of Original Medicare? Take the time to weigh the pros and cons of each option to ensure that switching is the right decision. 

Step 2: Review Your Coverage Needs: Determine whether you need prescription drug coverage (Part D), and whether you will need to purchase a Medigap policy to help cover out-of-pocket costs.  Medigap plans are helpful for covering the gaps in Medicare’s coverage including the co-pays, deductibles, and coinsurance. But if you have missed your Medigap Open Enrollment Period, an insurer could deny you coverage due to your health history.   

Step 3: Enroll in Original Medicare (Part A and Part B): If you are not already enrolled in Original Medicare, you will need to sign up for Part A and Part B through the Social Security Administration (SSA) or by visiting their website. Your coverage will begin on the first day of the month after you switch. 

Step 4: Consider Medigap or Part D Plans: If you want additional coverage, consider applying for a Medigap policy or a Part D prescription drug plan. You can apply for a Medigap policy during the six-month Medigap Open Enrollment Period, which begins the first month you are 65 or older and enrolled in Part B. You can also choose a Part D plan for prescription drug coverage if needed. 

Step 5: Cancel Your Medicare Advantage Plan: Contact your Medicare Advantage provider and inform them of your decision to switch back to Original Medicare. Make sure to coordinate the cancellation so that there are no gaps in your coverage. 

Conclusion 

Switching between Medicare Advantage and Original Medicare is possible during specific enrollment periods.  Carefully assess your healthcare needs and costs before making the transition. 

 By understanding the enrollment periods, coverage options, and steps involved, you can make an informed decision about which Medicare option is right for you. 

To know more about these options, contact Sarva Care on 804 302 4185.