Can you switch between Original Medicare and Medicare Advantage?

If you currently have Medicare, you can switch to Medicare Advantage (Part C) from Original Medicare (Parts A & B), or vice versa, during the Medicare Annual Enrollment Period. If you want to make a switch though, it may also require some additional decisions. The specific choices you need to make depend on which kind of coverage you’re switching to and from.

In this situation, you have Original Medicare and want to switch to a Medicare Advantage plan. You may also currently have a stand-alone Part D prescription drug plan.

Most Medicare Advantage plans are all-in-one plans. They cover your Medicare Part A and Part B benefits plus prescription drugs (Part D) and other health services and items not included with Original Medicare. Examples of these other items include coverage for dental health, vision, hearing and gym memberships. Medicare Advantage plans also have an annual out-of-pocket limit to protect you from high costs.

You can switch to a Medicare Advantage plan from Original Medicare during the Annual Enrollment Period each fall, October 15 through December 7. And depending on the Medicare Advantage plan you get, if you have a stand-alone Part D plan, you may no longer need it.

A few things to keep in mind when choosing to get a Medicare Advantage plan

• You usually don’t need to buy additional coverage like you may have with Original Medicare.
• You usually don’t need a stand-alone Part D prescription drug plan with Medicare Advantage, because drug coverage is built in.
• Medicare Advantage plans have an out-of-pocket limit, so you’ll have built in financial protection and won’t need a private Medicare plan to provide this.

Once you enroll in a Medicare Advantage plan during Annual Enrollment, the plan will work with Medicare to transfer your benefits. You don’t have to contact Medicare yourself. Your new plan will begin covering you on January 1.

If you have a stand-alone Part D prescription drug plan or other private Medicare plan, you’ll need to contact the plan provider directly to dis-enroll. Simply call the number on the back of your insurance member ID card.

When deciding to change to a Medicare Advantage plan, keep the following in mind:

• You may choose a different Medicare Advantage plan or return to Original Medicare during the Medicare Advantage Open Enrollment Period, January 1 – March 31.

Original Medicare only provides Part A (hospital coverage) and Part B (medical coverage). It does not provide some of the benefits you may have with your Medicare Advantage plan, like drug coverage, dental, vision or fitness. Original Medicare also doesn’t have an annual out-of-pocket limit, so there’s no built-in financial protection.

To switch from a Medicare Advantage plan to Original Medicare, you will need to contact your plan provider or Medicare directly. You can contact Medicare via the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.

When you drop your Medicare Advantage plan, you will lose coverage for other health services and items such as for prescription drugs and vision or dental. You will also lose built-in financial protection on out-of-pocket costs.

If you want to still have these items, you will need to purchase additional coverage, or pay directly out-of-pocket. For example, if you want prescription drug coverage, you will now need to find and enroll in a stand-alone Part D plan. If you decide you want additional coverage, you will need to choose a plan and enroll directly with the plan provider. Search available plans using your zip code here.

Again, you do need to contact your plan provider directly to disenroll, but once you do, nothing more is required on your part. Once you contact your Medicare Advantage plan during Annual Enrollment to dis-enroll, your coverage will automatically revert to Original Medicare. You don’t have to contact Medicare yourself. Your new coverage will begin on January 1.

Think carefully about your options and which coverage is right for your health and lifestyle. Your next opportunity to change your Medicare coverage won’t be until the next year’s Annual Enrollment Period, unless you experience a qualifying life event and become eligible for a Special Enrollment Period.