Lindsay is a freelance personal finance writer currently pursuing her Series 65 license. She enjoys helping readers learn money management skills that improve their lives.
5+ years in insurance and personal finance content
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If you’re currently on a Medicare Advantage (MA) plan, you can switch to an Original Medicare plan during specific enrollment periods — typically a few months before and after the end of the year. You’ll need to contact your current plan administrator to cancel your plan during one of these enrollment periods and arrange to start coverage under Original Medicare.[1]
Switching back to Original Medicare is a complex decision, and you have many things to consider to make sure you’ve taken care of your health. Here’s what you need to know about Original Medicare and Medicare Advantage and how to switch back to Original Medicare if you decide it’s right for you.
Understand the differences between Original Medicare and Medicare Advantage plans
You have two main options when it comes to Medicare coverage: Original Medicare or Medicare Advantage (also known as Part C), each of which has its pros and cons. They both work in different ways — and that can affect your healthcare options and how much you have to pay.
Here are the biggest differences between the two:[2][3]
Part A: $0 if you or a spouse worked at least 10 years
Part B: $175, unless you have a high income
Part D: Varies by plan and income, but ranges $0–$2004
Original Medicare Part B premium, plus any additional premiums for the specific Medicare Advantage plan (which varies by insurer). Only 27% of plans charged an additional premium in 2023 — typically around $57.5
Varies by plan type, typically includes fixed costs for office visits
Out-of-pocket limit for costs?
No
Yes, varies by plan type. In 2023, the average limits were:
HMOs: $4,033
PPOS: $8,605 for in-network care; $9,643 for out-of-network care
Where you can use it
Any healthcare provider in the U.S. that accepts Medicare (99% of all doctors in 2023)
Varies by plan type:
HMOs: Only doctors within the HMO
PPOs: Any doctor that accepts your plan, although in-network doctors are cheaper
Referral needed to see a specialist?
No
HMOs: Yes
PPOs: No
Reasons to go back to Original Medicare
In 2021, 53% of enrollees chose Original Medicare, while 47% opted for a Medicare Advantage plan.[4] MA plans are popular because they frequently offer more benefits for no additional cost and have caps in place for how much you’ll spend.
But in some cases, you might want or need to switch back to Original Medicare:
Original Medicare may be cheaper, like if you don’t need prescription drug coverage.
You won’t have to get a referral to see a specialist with Original Medicare like some Medicare Advantage plans require.
Private insurance companies offering Medicare Advantage may choose to end their contracts with Medicare, forcing you to choose a new plan.
You’ll have access to more doctors with Original Medicare, as opposed to specific physicians within your plan’s network under a Medicare Advantage plan.
If you’re currently on a Medicare Advantage plan and you’d like to switch, you can only do so during specific enrollment periods offered at certain times of the year. Luckily, these periods cover a broad swath of the calendar:[5]
Dates
When Changes Take Effect
Who Qualifies
Initial enrollment period
Three months after you first get Medicare
First day of the month after the plan receives your request
People newly eligible to receive Medicare benefits
Medicare open enrollment period
Oct. 15–Dec. 7
Jan. 1 of the following year
Anyone with Medicare
Medicare Advantage open enrollment period
Jan. 1–March 31
First day of the month after the plan receives your request
Only people who already have a Medicare Advantage plan
Special enrollment period
Varies depending on the event
First day of the month after the plan receives your request
People who’ve undergone certain events, like moving to a new home or losing coverage
How to switch back to Original Medicare
If you’re not happy with your current Medicare plan, it’s not very difficult to switch back to traditional Medicare — provided you’re currently in the right open enrollment period. Before you switch, it’s a good idea to go through a few steps to make sure it’s the right decision:
Check the date. You can only switch from your current plan during certain times of the year, so this is an important first step to see if you’re even eligible to proceed.
Assess your coverage needs. Good health insurance decisionsstart by considering what services you’re most likely to need, especially if you have chronic conditions like diabetes, a family history of certain diseases, or need specific prescription drugs.
Consider your finances. Compare your known costs (premiums and out-of-pocket costs for care you know you’ll need) under your current plan, compared to traditional Medicare. Consider whether you’ll be able to pay for additional care, if needed.
Compare plan options. Just because your current plan isn’t working out doesn’t mean that a different Medicare Advantage plan won’t. Any time you switch coverage, it’s important to compare all your options to see what’s available.
Cancel your current policy. Reach out to your insurer’s customer service team and notify them that you’re canceling your plan.
Set up new coverage. You can sign up for Original Medicare on theMedicare website, by calling 1 (800) MEDICARE, or by getting extra help from a local counselor through your State Health Insurance Program (SHIP).
Three out of four Medicare Advantage plans offer prescription drug coverage at no extra cost, but that’s not the case with Original Medicare. When you switch back, you’ll need to choose whether to purchase a separate Medicare drug plan or not. Otherwise, you may not have coverage for any drugs your healthcare provider prescribes for you.
Private insurance companies administer Medicare Part D plans, just like your current MA plan. (Medicare itself only operates the Part A and Part B coverages for hospital stays and medical care.) You’ll be able to decline or choose a new Medicare drug plan at the same time you reach out to Medicare to request a switch back to Original Medicare.
Keep in Mind
Although Medicare requires insurers to cover broad classes of medications, some plans may cover more individual drugs than others. If you have any prescription drugs that you know you need, it’s a good idea to verify you have coverage for them before signing up for a new drug plan. You can compare the costs and coverage options for different plans on Medicare’s website.
Switching to Original Medicare From an Advantage Plan FAQs
You have a number of factors to consider if you’re thinking about going back to Original Medicare. Here’s what’s top of mind for most retirees.
Can you switch back to Original Medicare at any time?
No. You’ll need to wait for an annual enrollment period, except for specific times like when you lose coverage or if you’ve only recently started receiving Medicare coverage.
Is there a penalty for switching?
No. There’s no penalty for switching to a new Medicare Advantage plan or back to Original Medicare. Medicare only charges late penalties if you don’t sign up for Medicare for the first time during your initial enrollment period.[6]
Can you rejoin a Medicare Advantage plan after disenrolling?
Usually. As long as the insurance company is still contracted with Medicare to offer health plans in your area, you can rejoin your old policy during an eligible enrollment period.
What’s the difference between Original Medicare and an Advantage plan?
The Centers for Medicare & Medicaid Services (CMS) runs Original Medicare, and it offers hospital and medical coverage (with the option for prescription drug coverage from private companies). Private insurers administer Medicare Advantage plans, and they offer the same benefits (and more).
What are the advantages and disadvantages of going back to Original Medicare from an Advantage plan?
Original Medicare offers access to more doctors and healthcare facilities in exchange for taking on a greater financial risk. Advantage plans typically offer more benefits and have more protection against runaway healthcare costs in exchange for access to a more limited pool of doctors.
Sources
Kaiser Family Foundation. "How and when can I switch from Medicare Advantage to traditional Medicare?."
Lindsay VanSomeren is a freelance personal finance writer living in Suquamish, WA. Her work has appeared with FICO, Credit Karma, The Balance, and more. She enjoys helping people learn how to manage their money better so they can live the life they want.
5+ years in insurance and personal finance content
Ashley is a seasoned personal finance editor who’s produced a variety of digital content, including insurance, credit cards, mortgages, and consumer lending products.
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