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How To Switch Back to Medicare From Advantage Plans
It’s easy to avoid costly mistakes with the right planning.
Choosing between Original Medicare and Medicare Advantage plans is difficult. Many Medicare beneficiaries agonize over the decision. You lose the benefits of one plan for the benefits of another. For example, switching to Medicare Advantage means forgoing your Medigap policy.
These decisions can cause a lot of stress. But, just because you switch to a Medicare Advantage plan, doesn’t mean you lose out on Medigap forever. In fact, you get quite a few safety measures to ensure you can always get the right insurance plan for you.
In this article, we will go over those safety measures. And we’ll show you the right way to switch back to Original Medicare from a Medicare Advantage plan.
Don’t forget: it’s easy to save money on Medicare with the Insurify Medicare comparison tool. Discover plans, compare your options, and find the Medicare plan that’s right for you. Try it now!
What’s the Difference Between Original Medicare and Medicare Advantage?
Original Medicare is a health plan administered by the federal government. It’s also known as Medicare Part A and Medicare Part B,. With Original Medicare, you work with any doctor or healthcare provider accepting Medicare. And you don’t need referrals to see a specialist, so long as that specialist accepts Medicare.
You can also add a Medigap policy to your health plan. Medigap is also known as Medicare Supplement Insurance.
Medicare Part C, or Medicare Advantage, works in a different way. With Medicare Advantage, you get health insurance through a private health insurance company. That health plan must follow guidelines from the Centers for Medicare & Medicaid Services (CMS). It must offer at least the same coverage as Original Medicare.
With Medicare Advantage, you work with doctors and providers within your healthcare network. You may need a Primary Care Physician (PCP) to recommend you to see a specialist. And you may need to follow other network guidelines.
However, most Medicare Advantage plans offer additional benefits. That means coverage and services not available to Original Medicare beneficiaries.
You can’t have both Medicare Advantage and Medigap. With either plan, you can add Medicare Part D so long as you don’t already have prescription coverage.
Can You Switch Back To Medicare From Medicare Advantage?
Yes. You can switch back during the Fall annual election period (AEP). You can switch back sooner if you qualify for a special enrollment period (more on this below).
What’s Medigap and What’s the Big Deal About Losing Medigap?
Medigap is like buying extended coverage for Original Medicare. Medigap helps you cover out-of- pocket costs of coinsurance, copays, and deductibles. There are several types of Medigap policies to choose from:
* Please note that Medigap Plans C and F are no longer available to new Medicare beneficiaries. If you already have either Medigap plan and you leave the plan, you will not be able to re-enroll.
When you first enroll in Medicare, you get a signup period called “guaranteed issue rights.” This means you can enroll in a Medigap plan without medical underwriting.
Medical underwriting is the process of figuring out a person’s health insurance premium. It’s based on several factors, including their health. It also means that a healthcare insurer can deny coverage to people who don’t meet health standards.
Outside of your initial enrollment period, you’re not offered “guaranteed issue rights.” That means you’d be subject to medical underwriting. For people with pre-existing conditions, this means more expensive monthly premiums. Even denial of coverage.
Luckily, when you decide to try Medicare Advantage for the first time, you’re given trial rights. These give you time to decide if you like your new health insurance. If you don’t like your plan, you can switch back to Original Medicare and keep your guaranteed coverage.
Let’s explore that further.
Understanding Your Trial Rights
The first time you enroll in Medicare Advantage you’ll be granted Medigap trial rights. That’s true whether it’s during your initial enrollment period or later. Your Medicare Advantage trial rights extend over is a 12-month window. The window begins the first month of your Medicare Advantage coverage.
During that window, you can drop Medicare Advantage and return to Original Medicare. You may also re-enroll in your Medigap plan so long as it’s still available. But you’ll need to wait for certain times of the year to switch plans.
Want to disenroll from Medicare Advantage and re-enroll in Original Medicare? You’ll need to wait for an Open Enrollment Period. These periods are:
Medicare Advantage Open Enrollment from January 1 to March 31 annually, or
However, you can make the switch outside of these periods if you qualify for a Special Enrollment Period ( SEP ).
Medicare Advantage Trial Rights and Special Enrollment Period
If you decide to switch back to Original Medicare, you can do so without penalty. But only if disenrollment occurs during your Medicare Advantage trial period.
Usually, beneficiaries must wait for an Open Enrollment Period. But, if you qualify for a Special Enrollment Period, you can enroll outside of Open Enrollment. Eligibility for a Special Enrollment Period (SEP) includes the following events:
You’ve moved to an area that makes new plan options available to you or is outside of the service area of your plan.
You’ve moved into or out of an institution such as a skilled nursing facility.
You’ve been released from jail or prison.
You’ve returned to the United States after living abroad.
You’ve lost Medicaid coverage, employer coverage, union coverage, or COBRA.
You’re now eligible for Medicaid, Extra Help, or other government assistance programs.
New plan options are made available to you through an employer.
You’ve voluntarily or involuntarily lost your Part D prescription drug coverage.
Your plan provider has lost its ability to contract with Medicare.
You are now eligible for a Special Needs Plan or are no longer eligible for a Special Needs Plan.
As a note: sometimes the Special Enrollment Period is called the “Special Election Period.”
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CYA: Dos and Don’ts of Plan Switching
Do be clear about the start and end dates of your trial period. Mark these dates on your calendar. It’s also a good idea to put reminders on your calendar like, “ Annual Election Period starts in one month”.
Do make time to review your satisfaction with your policy. We recommend reflecting on your policy once every quarter. At the very least, mark a review date on your calendar. It should be at least one month before each Open Enrollment Period begins. On the review date(s), take the time to write about your experience. Record everything that will help you decide if the Medicare Advantage plan is right for you.
Do keep a journal of your good and bad experiences with your new health plan.
Don’t rely on someone else to remind you about the end of your trial period.
Don’t assume your Medigap plan will be there waiting. Plan options change often, and you can’t always rely on a plan being available to you. Before you drop your Medigap, determine if you’ll have the option to re-enroll if you decide to switch back.
FAQ: Returning to Original Medicare
During the Medicare Advantage Open Enrollment Period, you can switch Medicare Advantage plans. That period runs from January 1 to March 31 every year. You can swap a Medicare Advantage plan without prescription drug coverage for one with drug coverage. Or change your stand-alone Medicare Prescription Drug plan.
You can also swap your Medicare Advantage plan for an Original Medicare plan. Finally, you can enroll in a Medicare Prescription Drug plan. But only if you’re enrolled in Medicare Advantage.
You cannot swap your Original Medicare plan for a Medicare Advantage plan. And, if you’re enrolled in Original Medicare, you cannot enroll in a Part D prescription drug plan. Nor swap your Medicare Prescription Drug coverage.
There are advantages and disadvantages to both Original Medicare and Medicare Advantage. And whatever you decide, you will be making a trade of one opportunity for another.
For example, you may be able to find a Medicare Advantage plan with a $0 premium. But the plan's network is much smaller than the network for Original Medicare.
Ultimately, you get to decide which trade-off is right for you.
If you move outside of your plan’s service area, you will be eligible for a special election period. It will begin the first day of the month you move and ends two months after the month you move.
During that time, you can choose to enroll in a different Medicare Advantage plan. You can also switch back to Original Medicare. If this event occurs during your trial rights, you keep your “guaranteed issue rights.”
Medicare Supplement Plan F is no longer available to new Medicare beneficiaries. If you enrolled in Medigap Plan F before January 2020, you can keep your plan. If you disenroll from your plan, but, you won’t be allowed to re-enroll.
If your Medigap plan is no longer available when you switch back, you’ll have to choose a different Medigap plan.
Conclusion: Your Medicare Program Should Work for You
It’s hard to know if Original Medicare with Medigap or a Medicare Advantage plan is better for you. The key to getting Medicare coverage right is to know the rules and follow them. Trying a Medicare Advantage plan has been the right call for millions. But that doesn’t mean it has to be right for you. So when you decide to switch plans, set up a time to your satisfaction. You don’t want to scramble to change back if you decide at the last minute. And you want to keep the protection to switch back without medical underwriting. Enrolling in a Medicare Advantage plan can be a great option for you. So long as you make a plan to avoid these plan-switching pitfalls.
And don’t forget that the Insurify Medicare comparison tool is always here to help you find the best Medicare plan at the best price. With just your ZIP code, you can uncover plan options and compare them side-by-side. Try it today!
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JJ StarrInsurance Writer
J.J. Starr is a health and finance writer with a background in banking, lending, and financial advising. She holds a Series 6, FINRA, and life insurance licensure and a master's degree from New York University. Through her writing, she strives to use her decade of experience to help consumers make sound financial choices. Connect with J.J. on LinkedIn.