If you’re thinking about changing Medicare plans, you’ll always have the option to switch from Medicare Advantage to Original Medicare and vice versa. However, you may not be able to change your coverage right away. Let’s talk about how and when you can do so.
Changing from Medicare Advantage to Original Medicare
Changing from Medicare Advantage to Original Medicare is a very simple process once you’re ready and eligible to switch. There are three ways you can make the change:
- Visit your local Social Security Office and ask to be disenrolled from Medicare Advantage;
- Call 1-800-MEDICARE (1-800-633-4227) and process your disenrollment over the phone; or
- Contact your Medicare Advantage insurer directly and request a disenrollment form.
When Can I Switch to Original Medicare?
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’ve had it for less than one year (that is: you’re entitled to a “trial right”).
Medicare Annual Election (“Medicare Open Enrollment”) and Medicare Advantage Open Enrollment Periods
You can break up with your Medicare Advantage plan from October 15 through December 7, and again from January 1 through March 31, in favor of Original Medicare.
Medicare Annual Election Period (AEP)
Also known as Medicare open enrollment, AEP lasts from October 15 through December 7. If you choose to change from one Medicare Advantage plan to a different one, or if you want to completely disenroll from your Medicare Advantage plan during this time, the cancellation will take effect on January 1.
- You can also enroll in a Medicare Part D prescription drug plan during this time.
Medicare Advantage Open Enrollment Period
This special opportunity to leave Medicare Advantage lasts from January 1 through March 31 each year.
If you disenroll during January, your changes will be effective on February 1.
If you disenroll during February, your changes will be effective on March 1.
If you disenroll during March, your changes will be effective on April 1.
Can You Enroll in Medigap?
If you’re switching from Medicare Advantage to Original Medicare, you can also purchase a plan Medicare Supplement plan. This kind of plan, also known as a Medigap policy, pays for gaps in Medicare’s coverage.
For instance, Medicare Part B pays 80% of covered costs after you pay your annual deductible. A Medigap policy would pay the remaining 20% due. But if you’ve missed your Medigap Open Enrollment Period, an insurer could deny you coverage due to your health history.
Your Trial Right
Since Medicare Advantage is plenty different from Original Medicare, you’re entitled to a risk-free trial during your first year in the Medicare Advantage program. At any point during your first year in a Medicare Advantage plan, you can switch back to Original Medicare without penalty for the following reasons:
- If you left Medigap for Medicare Advantage, your trial right allows you to switch back to your Medigap policy. You cannot become eligible for guaranteed-issued Medigap by switching to Medicare Advantage and back if you did not previously have Medigap.
- If your Medicare Advantage plan included Part D coverage, your trial right allows you to enroll in standalone Part D coverage without penalty.
- If it isn’t your first time in a Medicare Advantage plan, you’re not eligible to switch to Original Medicare using a trial right.
Changing Medicare Plans: Special Circumstances
In case this doesn’t give you enough of a chance to leave Medicare Advantage in a timely fashion, you may be eligible for a number of special disenrollment circumstances as well.
If You Move
If you move away from your Medicare Advantage plan’s service area, you can re-enroll in Original Medicare without penalty. This works even if other Medicare Advantage plans are available at your new address.
- You can switch from a Medicare Advantage plan to Original Medicare the month before you move out of your plan’s service area. This opportunity lasts for two full months after the month you move.
- If you wait to tell your Medicare Advantage plan about your move, then you can switch to Original Medicare for up to two full months after the month that you inform your plan.
- If you don’t inform your Medicare Advantage plan that you’ve left their service area, then you’ll be enrolled in Original Medicare once your plan learns of this and disenrolls you.
If You’re Admitted to Institutional Care
If you’re admitted to any type of long-term care setting, you can switch your plan up to once per month during your stay, if you wanted to leave Medicare Advantage for Original Medicare. Facilities that qualify as institutional care include: 1.) long-term hospitals, 2.) skilled nursing facilities (SNFs), 3.) rehabilitation hospitals and units, 4.) psychiatric hospitals and units, 5.) care facilities for the intellectually disabled, and 6.) and swing bed hospitals.
- You can move from Medicare Advantage to Original Medicare for up to two months after being discharged.
If You Become Eligible for Medicaid
Once you become eligible for Medicaid benefits, then you can drop your Medicare Advantage plan and switch to Original Medicare.
- While you’re covered under Medicare and Medicaid, you can change that coverage once a quarter during the first three quarters of the year (and the annual election period continues to be available during the last quarter of the year).
If You Lose Your Medicaid Eligibility:
If you’re covered by both Medicare and Medicaid and then you lose eligibility for Medicaid, you can switch from Medicare Advantage to Original Medicare up to three months from the date you lose Medicaid eligibility, or the date you’re notified, whichever is later.
- If you’re told in advance that you’ll lose your Medicaid coverage for the following year, you can switch to Original Medicare between January 1–March 31.
If You Can Enroll in Coverage from Your Union, Employer, or a Program of All-Inclusive Care for the Elderly (PACE) Plan:
You’re free to leave Medicare Advantage and enroll in certain types of private plans. If your employer or union offers a plan that you find more appealing than Medicare Advantage, you can disenroll without penalty.
- You can switch from Medicare Advantage to other coverage whenever the rules of your union, employer, or PACE plan allow for it.
If You Enroll in Drug Coverage That’s Equivalent to Medicare Part D (or You Already Have That Coverage)
If you enroll in TRICARE, VA coverage, or another plan that offers comprehensive prescription drug benefits – and you have a Medicare Advantage plan that includes prescription drug coverage (also called MAPD) – then you can leave your Medicare Advantage plan and return to Original Medicare.
- You’ll want to check with your prescription drug plan to make sure that it provides you with credible drug coverage.
- You can do this at any time, but your ability to enroll in the alternative creditable drug coverage may be limited by that plan’s rules.
If You Made a Mistake in Your Coverage Choices as a Result of an Error from a Federal Employee:
In rare circumstances, Medicare may send you a letter admitting that a mistake was made when you were given assistance with selecting a plan. Once you receive that letter, you have two months in which you may leave your Medicare Advantage plan and enroll in Original Medicare.
Once I Disenroll from Medicare Advantage, Am I Automatically Enrolled in Original Medicare?
You shouldn’t have to take any extra steps once you disenroll in Medicare Advantage. If you were enrolled in Medicare Advantage, you would have already continued paying your Original Medicare premiums anyway.
You may encounter issues, though, when leaving Medicare Advantage. If you voluntarily drop your Medicare Advantage coverage, you may run into difficulty when signing up for Medicare Part D prescription drug coverage or a Medigap supplemental insurance plan.
Taking the Next Steps
Consider which disenrollment option is easiest for you. The important thing is that you’re informed about your decision. Once you know what you’re getting into, there are a number of options for you to positively influence your health plan outcomes.