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. Show
Changing from Medicare Advantage to Original MedicareChanging 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:
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 PeriodsYou 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.
Medicare Advantage Open Enrollment PeriodThis 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 RightSince 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:
Changing Medicare Plans: Special CircumstancesIn 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 MoveIf 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.
If You’re Admitted to Institutional CareIf 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.
If You Become Eligible for MedicaidOnce you become eligible for Medicaid benefits, then you can drop your Medicare Advantage plan and switch to Original Medicare.
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 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.
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.
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 StepsConsider 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. Can you switch to Medicare Advantage at any time?No, you can't switch Medicare Advantage plans whenever you want. But you do have options if you're unhappy with your plan. You can jump to another plan or drop your Medicare Advantage plan and change to original Medicare during certain times each year.
Does getting a Medicare Advantage Plan make you lose original Medicare?If you join a Medicare Advantage Plan, you'll still have Medicare but you'll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare. Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Can I switch from a Medicare supplement to an Advantage plan?Yes. Not only you can switch from Medigap to Medicare Advantage (MA), but depending on your situation, this may be a smart move for Medicare-eligible seniors.
Can you switch back to Medicare after being on a Medicare Advantage Plan?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.
|