Maybe Medicare Advantage’s extra perks – vision, hearing, and dental – sounded great at first, but now you’re missing the wider doctor choices of Original Medicare.

No network restrictions and predictable Medigap options to cover gaps…if Medicare Advantage feels like the 8-track player you no longer want, let’s rewind to the classics.

Can I drop my Medicare Advantage plan and go back to Original Medicare?

Yes, you can drop your Medicare Advantage (MA) plan and revert to Original Medicare. But this decision shouldn’t be made lightly. It’s essential to understand the enrollment periods when such changes can be made and any implications or penalties you might face.

Is there a penalty to switch from Medicare Advantage to Original Medicare?

Alright, so you’re thinking about making the switch and now you’re wondering, “Is there a catch?” Penalties can be a bummer, so let’s look into it:

• No penalty

Switching from Medicare Advantage (MA) back to Original Medicare in itself doesn’t incur a penalty. Phew! But there are some related moves and details you should be aware of.

• Prescription Drug plans (Part D) – the tricky part

If you drop your MA plan and don’t have drug coverage from another source, and then you decide to get a Part D plan later, there might be a Part D Late Enrollment Penalty.

Here’s how to dodge it: If your MA plan has drug coverage and you switch back to Original Medicare, make sure you enroll in a Part D plan right away or ensure you have other creditable drug coverage.

• Gap in coverage

If there’s a gap of 63 days or more during which you don’t have creditable drug coverage after leaving your MA plan, the Late Enrollment Penalty for Part D could kick in when you eventually enroll.

• How’s the penalty calculated?

Without getting too “mathy” here: it’s about 1% of the national base beneficiary premium times the number of full months you didn’t have coverage. This amount gets added to your monthly Part D premium.

• What about Medigap?

Medigap (also known as Medicare Supplement)  is a separate private insurance policy to help pay costs Original Medicare doesn’t cover. If you’ve been on MA for a while and now want Medigap after returning to Original Medicare, timing is crucial. If you wait longer than 6 months after you first signed up to Part B  you will be subject to underwriting which means insurers might charge you more or deny coverage based on your health.

When can I make the switch?

Knowing when you can hop from Medicare Advantage back to Original Medicare can help you plan ahead. Let’s clear up the calendar confusion.

Medicare Annual Enrollment Period (AEP)

Dates: October 15th to December 7th each year.

What you can do: During this time, you can swap from Medicare Advantage to Original Medicare (or vice versa). Plus, if you choose to go back to Original Medicare, you can also enroll in a Part D plan to ensure you’ve got prescription drug coverage.

Coverage start date: If you switch during AEP, your new coverage begins on January 1st of the following year.

Medicare Advantage Open Enrollment Period (OEP)

Dates: January 1st to March 31st.

If you’re in a Medicare Advantage plan, this period is your second chance. You can switch to a different MA plan (excluding Medical Savings Accounts, cost plans, and PACE) or go back to Original Medicare. If you choose the latter, sign up for a stand-alone prescription drug plan (PDP) too, unless you have creditable drug coverage from another source.

Coverage start date: If you make changes during this period, the new coverage will generally start on the first day of the month following the month you enrolled. So, if you switch in February, your new coverage would start March 1st.

Special Enrollment Periods (SEPs)

Life can be unpredictable. SEPs are all about those unexpected moments. If you move, lose your current coverage, or your plan changes its contract with Medicare, you might qualify for a SEP.

The perks: SEPs allow you to make changes outside the typical enrollment periods. The exact timing and length of your SEP can vary based on the situation.

Coverage Start Date: The start date for SEPs can vary, but usually, it’s the first day of the month after you make the switch. For some situations, like moving, it might be even sooner.

Medigap timing

Coverage start date: Generally, once you’re approved for a Medigap policy and you pay the premium, your coverage starts immediately.

However, if you’re switching from Medicare Advantage to Original Medicare and applying for Medigap outside of your open enrollment period, the insurer might make you wait up to six months if you have pre-existing conditions. It’s always a good idea to check with the insurance company about the start date.

How to switch from Medicare Advantage to Original Medicare

Thinking of switching back? Here’s a concise step-by-step guide to transition from Medicare Advantage to Original Medicare:

Contact your provider or Medicare directly

• To switch from a Medicare Advantage plan to Original Medicare, you’ll need to reach out to either your plan provider or Medicare itself.
• You can reach Medicare any time at their helpline: 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. They’re available 24/7.

Check your timing

Ensure you’re within the Annual Enrollment Period (October 15th – December 7th) or the Medicare Advantage Open Enrollment Period (January 1st – March 31st). Special Enrollment Periods apply for specific situations.

Research and enroll in Part D

If you need prescription coverage, use Medicare’s Plan Finder to pick a Part D plan. Enrolling in it will automatically shift you from MA to Original Medicare.

Consider Medigap

For extra coverage, look into Medigap policies. They can help with costs not covered by Original Medicare.

Inform your MA plan

Give them a heads-up that you’re leaving, even if it’s not mandatory.

Verify with your doctors

Ensure your doctors accept Original Medicare to avoid any disruptions in care.

Handle new payments

Set up premium payments for your new Part D or Medigap, if there’s a charge.

Keep documents handy

Store any new ID cards or policy information you receive in a safe place.

Seek assistance if confused

Use resources like Medicare’s helpline or Hella Health’s blog for guidance.

Your health, your choice

Your health is your most invaluable asset, and ensuring that you have the best possible coverage tailored to your needs is paramount.

Every journey through Medicare is unique, and while switching from Medicare Advantage back to Original Medicare might be the right move for some, it’s essential to weigh all options and consult experts if needed.

After all, it’s not just about healthcare; it’s about ensuring peace of mind in your golden years. Stay informed, stay proactive, and most importantly, prioritize your well-being above all.