Think of Medicare Advantage plans as the all-in-one bundle – covering your basic Medicare needs, tossing in prescription drugs, and sprinkling in extras like dental, vision, and even gym memberships. Plus, they offer a safety net with an annual out-of-pocket limit.

Tempted to switch from Original Medicare to Medicare Advantage? Let’s dive in.

Is switching from Original Medicare to Medicare Advantage possible?

Absolutely! If you’re enrolled in Original Medicare (Part A and Part B), you have the chance to switch to a Medicare Advantage plan. But timing matters.

Why should you consider the switch?

Medicare Advantage might be a good fit if:

• You want an all-in-one plan. Often, these plans bundle in prescription drug coverage.
• You’re seeking extra perks like dental, vision, or gym memberships.
• You prefer having an annual out-of-pocket maximum. This means there’s a limit to what you’ll spend each year. Once you hit that ceiling, the Medicare Advantage plan covers 100% of your costs. It’s a safety net that Original Medicare doesn’t provide.

However, it’s essential to weigh the benefits against the potential drawbacks:

• With Medicare Advantage, you’re limited to a network of providers. Some Medicare Advantage plans, like HMOs, even require referrals to see specialists. So, if you’ve got a favorite doctor outside of that network, this might not be the move for you.
• If you had a Medigap plan before switching and then decided to return to Original Medicare, getting back your Medigap plan might not be a sure shot. Under federal guidelines, there are specific periods to buy Medigap. Your state may have additional options. Consult your State Health Insurance Assistance Program (SHIP) for local Medigap rules.
• Medical Advantage does not provide nationwide coverage. You are limited to a specific region or network, unless in an emergency.
• If you join a Medicare Advantage Plan that doesn’t include Part D, in most cases, you’ll be unable to join a separate Medicare Prescription Drug Plan (Part D). 

When can you switch from Original Medicare to Medicare Advantage?

There are specific times when you can make this switch:

Annual Enrollment Period (AEP) also known as Open Enrollment

When can you switch? Every year from October 15 to December 7.

When does coverage start? The new plan will kick in on January 1 of the following year.

Special Enrollment Periods (SEPs)

When can you switch? They’re based on certain life events.

When does coverage start? Typically, the first of the month following your enrollment, but it can vary based on the specific qualifying event.

Being in the know about these dates ensures you’re never caught off guard. Stay informed and transition smoothly.

How to switch from Original Medicare to Medicare Advantage?

Alright, so you’re leaning toward making the switch. Let’s break down the journey, step by step, so you know exactly what’s in store:

Do your homework

Start with an online Medicare plan finder; you can use medicare.gov or this Medicare Plan Finder. The latter tool helps you compare available plans in your area not only based on your medications and pharmacies but also doctors and helps you focus on the extra benefits that you care about the most to simplify and narrow your search.

Understand the costs

Beyond the monthly premium, dig into any deductibles, co-pays, and coinsurance.

For starters, here’s a quick breakdown of the costs for 2024:

	Original Medicare	Medicare Advantage
Monthly Premiums	Part A: $0 if you or your spouse have paid your Medicare taxes while working; $278 or $505 in 2023 if you haven’t. Part B: $174.7	The average premium is $18.50
Deductibles	Part A: $1,632 for each benefit period Part B: $226	Varies by plan
Coinsurance	Part A: Days 1-60: $0 for each benefit period Days 61-90: $408 per day of each benefit period Days 91-beyond: $816 per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime) Beyond lifetime reserve days: all costs Part B: 20% of the Medicare-approved amount for: Most doctor services (incl. while you’re a hospital inpatient) Outpatient therapy Durable Medical Equipment (DME)	Varies by plan
Out-of-Pocket Maximum	No Max Out-of-Pocket	In-network maximum: Up to $8,850 Combined in and out-of-network maximum: Up to $13,300

Source: Hella Health, Easy Medicare Intro, CMS

Each plan will have a ‘Summary of Benefits’. This document will be your best friend, outlining all potential costs.

Check the network

Medicare Advantage plans often have specific provider networks.

Ensure your preferred doctors, specialists, and hospitals are in the plan’s network. If you love your current doctor(s), you’ll want to stick with them.

Enroll in your chosen plan

Time to make it official.

You can enroll:

• online directly through a comparison plan tool;
• online through the provider’s website;
• on the phone by calling Medicare helpline at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048;
• or through the Medicare website.

As soon as you enroll in a Medicare Advantage plan, you’ll be automatically dis-enrolled from Original Medicare.

If you have a stand-alone Part D prescription drug plan or another private Medicare plan, you need to reach out directly to the plan provider to dis-enroll. It’s easy—just call the number on the back of your insurance member ID card.

Confirm, confirm, confirm

Don’t be left wondering.

You should receive a confirmation from your new Medicare Advantage plan. This could be a letter, email, or even a welcome package.

If you’ve got any meds, chat with your new plan about transitioning your prescriptions. Some might require new authorizations or even changes, so it’s good to be in the know.

Once enrolled, you should receive an acknowledgment. If you don’t hear anything within a week or so, give them a call to check your enrollment status.

Welcome your new card

Out with the old, in with the new. Once everything’s sorted, you’ll get a new membership card. Store your Original Medicare card in a safe place, and use the new plan card for all your medical services.

Time to act

Switching plans is a big decision. Some people have made Medicare mistakes in the past. So, double-check prescription coverage, ensure your doctors are in-network, and be clear on all out-of-pocket costs.

Remember, whether you stick with Original Medicare or shift to Medicare Advantage, the goal is to find what serves you best. And hey, if you ever feel the need for another “upgrade,” you’ve got options and the know-how to make the change. Check the calendar, when you can switch.