Can You Switch From a Medicare Advantage Plan to Original Medicare?
Key takeaways:
You can switch from a Medicare Advantage (MA) plan to original Medicare during two periods each year: Medicare Advantage open enrollment (January 1 to March 31) and Medicare open enrollment (October 15 to December 7).
Leaving your MA plan for original Medicare could expand your provider options and may reduce your out-of-pocket expenses.
But there are multiple factors to consider. Many MA plans include Part D prescription medication coverage, while original Medicare requires you to purchase a standalone Part D plan. Though, with original Medicare, you may be able to buy a Medicare supplement insurance (Medigap) plan to help cover your out-of-pocket costs.
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Medicare passed a tipping point between traditional coverage and alternative private plans known as Medicare Advantage (MA) in 2024. A Centers for Medicare & Medicaid Services (CMS) analysis of nearly 67 million people enrolled in Medicare as of November 2023 showed that original Medicare retained a slight majority: 51% were enrolled in traditional coverage, versus 49% in MA.
Medicare Advantage gained its numeric edge in January 2024. As of July 2024 — the latest CMS figures available — the percentage split was 50-50 for the 67.7 million enrolled, but 34.2 million were covered by MA and 33.5 million had original Medicare.
Millions of people consider, choose, and switch Medicare plans every year. The three Cs — cost, coverage, and choice — are reasons why some people disenroll from their MA plan and join original Medicare. A study published in 2023 found that the group with the highest rate of switching from MA to original Medicare were enrollees with more health needs and high costs.
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Many MA plans offer additional perks beyond what’s covered by original Medicare (Part A and/or Part B), such as vision, dental, and hearing care benefits. But MA plans typically limit enrollees to in-network provider and hospital networks. So some MA enrollees choose original Medicare for broader care options, potential savings on out-of-pocket costs, and the option to have Medicare supplement insurance (Medigap).
Can you switch from Medicare Advantage to original Medicare?
Yes, you can switch from Medicare Advantage (MA) to original Medicare, but typically only at certain times of the year. One of these is Medicare open enrollment, which runs from October 15 to December 7 and is open to all current and first-time Medicare enrollees. The other is Medicare Advantage open enrollment, which runs from January 1 to March 31 and is only open to current MA enrollees.
You also may become eligible for a special enrollment period if you experience a qualifying life event. If so, you would be able to switch from MA to original Medicare outside of the open enrollment periods.
How do you switch from a Medicare Advantage plan to original Medicare?
Switching from Medicare Advantage (MA) to original Medicare is straightforward. The first step is to cancel your MA plan. To do this, you can either:
Call 1-800-MEDICARE (1-800-633-4227) and ask an agent to help you disenroll from your plan and to enroll in original Medicare. Agents are available 24/7, except during a few federal holidays.
Call your MA plan and ask to cancel your enrollment. Then, call 1-800-MEDICARE (1-800-633-4227) for help joining original Medicare.
If you need help, you can reach out to the State Health Insurance Assistance Program (SHIP) in your area for free assistance from trained, unbiased benefits counselors who can guide you on Medicare issues.
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What are the benefits of changing from Medicare Advantage to original Medicare?
Having original Medicare could make your healthcare more affordable. Original Medicare may also meet your coverage needs better than your Medicare Advantage (MA) plan. Here are some reasons why:
Wider provider networks: Original Medicare is accepted by most physicians in the U.S. But MA plans require you to access care within their networks, which are local and can change at any time during the year. For certain people, such as residents of rural areas, finding in-network care can be especially challenging.
Medigap: Medigap insurance can be used to cover original Medicare’s out-of-pocket costs. Though, you are not guaranteed eligibility for a Medigap policy if you switch to original Medicare. Medical underwriting allows Medigap insurers to deny you coverage or, even if you’re accepted, charge you more.
Less financial risk: Compared to an MA plan, you could end up paying less out-of-pocket with original Medicare. Some MA plans have an additional premium beyond what you pay for Medicare Part B. And while MA plans have an annual out-of-pocket maximum, the average MA enrollee doesn’t access enough care or spend enough to reach that maximum.
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What factors should you consider before changing plans?
Before making a switch, evaluate your healthcare and coverage needs, as well as your financial situation. For most people, prescription medication benefits are important to consider. Medicare Part D is often included in Medicare Advantage (MA) plans but not in original Medicare. So you may want to make sure that you can find an affordable standalone Part D plan that covers your needed medications before you opt for original Medicare.
Here are some other questions to consider:
Will your health needs be served better by having access to a wider range of healthcare professionals and facilities?
Does your MA plan have benefits you don’t use or don’t want?
Does your MA plan no longer offer benefits that you need?
What are the differences in premiums and out-of-pocket costs?
Can I get a Medigap plan after I switch to original Medicare?
You may be able to purchase a Medigap plan once you switch to original Medicare, but it’s not guaranteed. So do your research. If you apply outside of your initial 6-month Medigap open enrollment period, consider whether you’ll have guaranteed issue rights or a trial right to be accepted by a plan of your choice that covers your preexisting conditions without charging you more.
You should also be prepared for the medical underwriting process, which can include answering eligibility questions, leading to higher premiums or coverage denial.
The bottom line
Switching from a Medicare Advantage (MA) plan to original Medicare may be the right choice for you. But it’s important to consider your healthcare needs, finances, and desired coverage before making this change. You can make the switch during Medicare open enrollment in the fall, during Medicare Advantage open enrollment at the beginning of the year, or during a special enrollment period if you qualify.
If you opt for original Medicare, you may also be able to buy a Medigap plan to help cover your out-of-pocket costs. If you need help reviewing your options, you can call Medicare’s toll-free number or contact a State Health Insurance Assistance Program (SHIP) counselor in your area.
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References
Biniek, J. F., et al. (2023). Medicare Advantage enrollment, plan availability and premiums in rural areas. KFF.
Data.CMS.gov. (n.d.). Medicare enrollment dashboard. Centers for Medicare & Medicaid Services.
Eisenberg, R. (2024). How to use Medicare Advantage open enrollment to switch plans or move into traditional Medicare. Fortune.
Medicare.gov. (n.d.). Special enrollment periods.
Ochieng, N., et al. (2023). How many physicians have opted out of the Medicare program? KFF.
Ochieng, N., et al. (2023). Medicare Advantage in 2023: Premiums, out-of-pocket limits, cost sharing, supplemental benefits, prior authorization, and star ratings. KFF.
Xu, L., et al. (2023). Medicare switching: Patterns of enrollment growth in Medicare Advantage, 2006-22. Health Affairs.
