If you’re an older adult, it can be confusing to understand and choose from the various healthcare options available. For example, you might wonder if you can switch from Medicare Advantage to Original Medicare, how to switch from Medicare Advantage to Medicare, and what that process entails. Rest assured that you can switch from one coverage plan to another, though certain factors at play will determine your ability to do so.
In this blog, we will answer all your questions so that by the end, you’ll have clarity around whether or not switching plans make sense for your healthcare needs! So read on to learn more about the topic.
What is the difference between Original Medicare and Medicare Advantage?
Original Medicare is the combination of Medicare Plan A and Plan B. Medicare Plan A provides coverage for hospital and nursing home costs. In contrast, Plan B acts as medical insurance and covers the cost of outpatient services. The Original Medicare does not cover certain expenses, including prescription drugs, hearing aids, dental care, vision, etc.
On the other hand, Medicare Advantage, also known as Medicare Plan C, is a bundled plan that combines the Original Medicare Plan A, B, and some additional benefits. That includes prescription drugs, hearing aids, dental, and vision care. Medicare-approved private companies provide this plan.
The main difference between Medicare and Medicare Advantage is that, under Original Medicare, you can go to any hospital or physician of your choice and receive care but under the Advantage plan, you can only choose from a selected option of doctors or providers to receive coverage.
The table below highlights the difference between Original Medicare vs Medicare Advantage:
Inpatient hospital care and outpatient medical services except prescription drugs, dental care, hearing aids, etc.
Inpatient hospital care and outpatient medical services and prescription drugs, dental care, hearing aids, etc.
Choice of provider
Any choice of doctors, hospitals, providers.
Selected number of doctors, hospitals, providers.
Network and service area
Whole United States.
The plan’s specific network and service area.
Not required to see a specialist.
Required to see a specialist.
Does not cover.
Does not cover.
Can you switch from Medicare Advantage to Medicare?
Yes, you can switch from Medicare Advantage to Original Medicare. However, there are important steps and considerations you should take before making the transition. First of all, it is necessary to keep in mind that there are specific timing windows during which you can make this switch.
It is also important to remember that switching from a Medicare Advantage Plan back to Original Medicare does not automatically enroll you into a Prescription Drug Plan (Part D) or a Medigap policy. So, to continue enjoying Medicare Part D coverage, you must join a stand-alone prescription drug plan.
How to switch from Medicare Advantage to Original Medicare?
So, now that you know it is possible switching from Medicare Advantage to Medicare, how to make that transition? What are the time frames and criteria? Well, all of this may seem a bit overwhelming, but no need to worry! We are just about to explain the process to you as simply as we can.
There are basically three different enrolment periods to switch between Medicare plans:
The open enrolment period
Medicare’s open enrolment period is the best time to switch plans or make changes to an existing one as it saves you from paying extra money. Every year, the federal government allows Medicare Advantage beneficiaries to switch plans. The time period for the open enrolment is January 1 – March 31 each year.
During the open enrolment period, you can:
- Switch to Medicare from the Advantage plan and vice-versa
- Add, drop, or modify Medicare drug coverage
The annual enrolment period
During the annual enrolment period, which occurs between October 15 and December 7th each year, Medicare Advantage plan beneficiaries can switch from their existing plan to Original Medicare. When switching from a Medicare Advantage plan to Original Medicare, there are several key steps you will need to take in order to ensure everything goes smoothly. You can do so by:
- Contacting your current Medicare Advantage provider directly and request a termination form.
- Calling 1-800-MEDICARE and request for proceeding the disenrollment process through phone.
- Visiting your local Social Security office to get a disenrollment form and submit.
The special enrolment period
The special enrolment period is when Medicare Advantage plan beneficiaries can switch back to the Original Medicare outside of the normal enrollment windows. However, to qualify for a special enrollment period, individuals must meet specific criteria, which include:
- You are moving to another location
- You lost your current coverage
- You have the opportunity to get other coverage
- Your plan is about to lose its contract with Medicare
- You became eligible for Medicaid
- You no longer qualify for a Special Needs Plan (SNP)
Pros and cons of Medicare Advantage plans vs Original Medicare
Medicare Advantage and Original Medicare have their own advantages and disadvantages. That must be weighed carefully before making a choice. Below are some pros and cons of Medicare Advantage plans vs. Original Medicare.
- Lower premiums than private insurance plans.
- Offers a wide range of coverage for medically necessary services throughout the USA.
- Can choose their own doctors or healthcare providers.
- No referrals required to see a specialist doctor.
- Doesn’t cover all medical costs including prescription drugs, dental care, hearing aids, etc.
- Does not cover long-term nursing home care or custodial care after a certain period of time spent in a facility.
- Potentially lower out-of-pocket expenses
- Coverage for services not covered by Original Medicare
- Provides additional coverage for prescription drugs
- Limited access to providers outside of the plan’s network
- Requires referrals to see a specialist
- Restrictions on choice of doctors or hospitals
- It is possible to switch from Medicare Advantage to Original Medicare.
- There are three periods to change Medicare plans – open enrolment period, annual enrolment period, and special enrolment period.
- Medicare Advantage and Original Medicare have some pros and cons, so it is recommended to research before making changes.
Now that you know the answer to the question, “Can you switch from Medicare Advantage to Original Medicare?” It’s time to take action. If you’re unhappy with your current plan or want to explore your options, switching to Original Medicare during one of their specified enrolment periods may be the best choice.
We hope this blog post has helped answer any questions you may have had. If you’re still unsure or would like more information, please call us. We would be happy to answer any remaining queries. In the meantime, you may have a look at some of our related articles on Medicare and Medicaid:
- Can you switch from an Advantage plan to a Medicare Supplement?
Yes, it is possible to switch from an Advantage plan to a Medicare Supplement plan. However, when switching plans, review your current coverage under your Advantage plan and compare it with what the Medicare Supplement offers so you don’t have to incur additional out-of-pocket costs.
- Why are people leaving Medicare Advantage plans?
There could be various reasons why people are leaving Medicare Advantage plans. The most common one has been the network restriction. In some cases, healthcare costs have risen due to changes in providers or coverage limits have been reduced. Others may find that their current plan does not provide enough flexibility in terms of choosing from different doctors or specialists. In addition, Advantage plans typically require higher monthly premiums than traditional Medicare.
- How can I switch from Original Medicare to Medicare Advantage?
If you’re currently enrolled in Original Medicare (Part A and Part B) and you’re wondering how switch to a Medicare Advantage plan, then you should take the following steps:
- research the different Advantage plans that are available in your area
- compare coverage levels, out-of-pocket expenses, and provider networks
- once you’ve chosen a plan, complete an enrollment form and submit it to the plan provider during one of the Medicare open enrollment periods.
- What Medicare Advantage plan has the highest rating in 2023?
Medicare Advantage plan ratings may vary by area and plans may change over time, but at this time, some of the top-rated Medicare Advantage plans in 2023 include: