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Tired of the limited provider network with your Medicare Advantage plan? Or maybe you’ve had enough of the endless pre-approvals?
Whatever’s driving your decision to switch back to Original Medicare, it’s a legitimate one.
But before you make the leap, there are some things you should know. Switching back isn’t as complicated as it might seem, but you do need to pay attention to the details.
From coverage dates to prescription drug plans, the process comes with its own set of considerations and some potential bumps in the road—especially when it comes to extra coverage like Part D or Medigap.
So, let’s break down what you need to do to make the switch as smooth as possible, and avoid any surprises along the way.
Ready?
1. Can You Switch from Medicare Advantage to Original Medicare?
Yes, you can. But only during specific enrollment periods (more about them later)—or if life throws you a curveball that qualifies you for a Special Enrollment Period, in which case you can switch plans outside of the regular enrollment windows.
A SEP kicks in when:
- Your plan leaves your area, or you move out of its service zone
- You’re admitted to institutional care (you can switch monthly while there and up to two months after discharge)
- You gain or lose Medicaid eligibility
But just because you can switch doesn’t mean you should—at least, not without weighing the pros and cons.
Some people stick with Medicare Advantage for the extra benefits. Others? They prefer the broader provider network and fewer restrictions of Original Medicare.
Need help deciding? Check out Medicare Advantage vs. Medicare to see which one fits your needs best.
2. Deadline For Switching Medicare Plans
There are designated enrollment periods you have to follow if you want to switch from your Medicare Advantage plan to the Medicare Original. If you miss them, you’ll be stuck with your current Medicare plan for another year.
Here’s when you can make a switch:
- During Medicare Annual Enrollment Period (AEP), which lasts from October 15–December 7.
- During Medicare Advantage Open Enrollment Period (MA OEP), which lasts from January 1–March 31, 2025.
Important: You can only make one change during MA OEP, so choose wisely.
3. Steps to Switching Medicare Plans
The first thing you need to do is decide when you want to make the switch. Will it be during AEP or MA OEP?
These are your main windows for making the switch, so mark the dates.
Then, grab your Medicare card, oh—and any other important documents like your current plan details and contact information. With this in hand, call the number on your insurance card or on the paperwork they sent you.
Let them know you want to disenroll from your Medicare Advantage plan.
After that, call 1-800-MEDICARE and tell them about the switch you want to make.
In case you prefer face-to-face help, you can also head to your local Social Security office, in which case just make sure to bring your ID and ask them to assist with disenrolling from your current plan.
Keep in mind that Original Medicare doesn’t cover everything either, so you might want to consider a Medigap policy for extra coverage. Also, since Original Medicare doesn’t cover prescriptions, you’ll likely need a Part D plan too.
Pretty simple, right?
4. Implications of Switching Medicare Plans
Ready to make the switch? There are a few last things to keep in mind.
Number one: When does your new coverage actually kick in?
Well, if you’re switching during the Medicare Annual Election Period, your coverage will start on January 1 of the following year.
But if you’re switching during the Medicare Advantage Open Enrollment Period, your new coverage will start the first day of the month after you request the change.
Now, let’s talk about special situations where things get a little different.
For instance, if you’re moving out of your service area, you can switch plans without penalty up to two months after leaving or informing your plan. On the other hand, if you’re in rehab or a skilled nursing facility, you can change your plan monthly while you’re there or up to two months after discharge.
Lastly, if you become eligible for Medicaid, you can switch anytime during certain periods or whenever your eligibility changes.
You should also think about how this change might affect your doctors.
With Original Medicare, your network might be different, so make sure your healthcare providers are still covered under your new plan. Also, Original Medicare might have a bigger network, but you’ll probably need extra coverage (like Medigap) to avoid paying higher out-of-pocket costs.
5. Are There Any Penalties for Switching Medicare Plans?
While there aren’t really penalties for the switch itself (yay!), there are some things you’ll want to keep an eye on.
For starters: Late enrollment penalties for Part D.
Namely, if you had prescription drug coverage through your Medicare Advantage plan and now want to switch to Original Medicare, you’ll need a separate Part D plan for prescriptions. And if you don’t enroll in Part D right away, you could face a late enrollment penalty when you do sign up.
This penalty means you’ll pay extra on top of your monthly premium for as long as you have Part D. Ouch.
Also, if you’ve been in a Medicare Advantage plan for over 12 months, expect it to be harder to get a Medigap policy. Some states have protections, but in many cases, Medigap enrollment can be tougher after being in Advantage for a while.
This could mean higher costs or even refusal if you’re not careful.
Conclusion
Switching from Medicare Advantage back to Original Medicare can give you more flexibility and fewer restrictions, but it’s important to weigh all the factors before making that change.
While there are no penalties for switching during the right enrollment periods, there are other considerations like prescription drug coverage, Medigap policies, and network differences that could impact your decision.
Before you take the plunge, take the time to compare plans thoroughly. Look at your healthcare needs, the costs, and the coverage options that best suit your lifestyle. The right choice will depend on what’s most important to you—whether it’s provider flexibility, cost savings, or comprehensive coverage.