- Medicare Advantage plans offer the coverage of original Medicare but often with additional benefits.
- Once you sign up for Medicare Advantage, your options for dropping or changing your plan are limited to certain time periods.
- During these periods, you can go back to original Medicare or switch to a different Medicare Advantage plan.
You’ve done your research and made the leap from original Medicare to Medicare Advantage. But what happens if you change your mind or decide it’s not the right plan for you? If you want to disenroll or change your Medicare Advantage plan, you have to wait for certain enrollment windows, similar to when you first signed up.
We’ll go over each of these enrollment periods, explain what type of plan you can choose during these times, how to pick the best plan for you, and more.
Medicare Advantage is an optional Medicare product that you purchase through a private insurance provider. It combines all the aspects of original Medicare (Part A and Part B) plus added or optional services like Medicare Part D prescription coverage and supplemental insurance.
Also known as Medicare Part C, Medicare Advantage is a private combination plan that offers a comprehensive Medicare inpatient and outpatient coverage with additional coverage and services.
You can sign up for Medicare Advantage when you’re first eligible for Medicare. You become eligible for Medicare on your 65th birthday, and you can sign up for the program over a span of 7 months (3 months before you turn 65, the month of your birthday, and 3 months after).
If you sign up during this period, this is when you can expect coverage to begin:
- If you sign up during the 3 months before your 65th birthday, your coverage begins the first day of the month after you turn 65 years old (example: your birthday is May 15 and you sign up in February, April, or March, your coverage will begin on May 1).
- If you enroll during the month of your birthday, your coverage will begin one month after you’ve enrolled.
- If you sign up during the 3 months after your birthday, your coverage begin 2 to 3 months after you enroll.
If you choose a Medicare Advantage plan during initial enrollment, you can change to another Medicare Advantage plan or return to original Medicare within the first 3 months of your coverage.
After you’ve signed up during initial enrollment, there are only a few times throughout the year when you can change or drop your Medicare Advantage coverage. These periods occur at the same times each year.
- Medicare open enrollment (October 15–December 7). This is the time each year that you can review your coverage and make changes if needed. During open enrollment, you can make changes to your original Medicare plan, sign up for Medicare Advantage or Medicare Part D, or switch from one Medicare Advantage plan to another.
- General enrollment/Medicare Advantage open enrollment (January 1–March 31). During this period, you can switch from Medicare Advantage back to original Medicare and vice versa. You can change to a different Medicare Advantage plan or add Medicare Part D coverage.
Enrolling in or changing plans during these specific periods can help you avoid penalties for late enrollment.
There are some special situations that are outside of your control, like having to move to an area your plan doesn’t serve. In these types of situations, Medicare allows you to make changes outside of the usual time periods without penalty.
Special enrollment periods take effect when you need them. For example, if you’ve moved and your current Medicare Advantage plan doesn’t cover the new area where you live, your special enrollment period can begin the month before your move and then 2 months after you move. Special enrollment periods typically begin when you need them and last for about 2 months after the qualifying event.
A few other examples of these events would be:
- you’ve moved into or out of an inpatient living facility (a skilled nursing facility, assisted living, etc.)
- you’re no longer eligible for Medicaid coverage
- you are offered coverage through an employer or union
We’ll discuss more of the reasons you might want to switch plans in the next section.
What types of plans can I choose between?
Whether your needs have changed, you’ve moved, or you just don’t like your current plan, the various enrollment periods allow you to make any changes needed. This doesn’t just mean you have to go back to original Medicare – you can always switch from one Medicare Advantage plan to another. You’re also able to change your prescription drug coverage as well.
While a lot of effort goes into making an initial decision on Medicare plans, you may need to switch for a variety of reasons. Maybe the plan changed its offerings, or your needs have changed.
If your Medicare Advantage plan isn’t meeting your needs, you may want to go back to original Medicare or switch Part C plans. You may need to add or change your prescription plan, switch to a Medicare Advantage plan that covers different providers or services, or find a plan that covers a new location.
Some of the most common reasons for changing plans include:
- you’ve moved
- you’ve lose your current coverage
- you have the chance to get coverage from another source, like an employer or union
- Medicare ends its contract with your plan
- your provider decides not to offer your plan any longer
- you qualify for additional services, like Extra Help or a Special Needs Plan
All of the above situations would qualify you for a special enrollment period.
Once you’ve decided to drop or change your Medicare Advantage plan, the first step is to enroll in the new plan you’ve chosen. Do this by filing out an enrollment request with the new plan during an open or special enrollment period to avoid penalties. After you’ve signed up with a new plan and your coverage begins, you will automatically be disenrolled from your previous plan.
If you’re leaving Medicare Advantage to return to original Medicare, you can call 800-MEDICARE to resume original Medicare services.
There are a lot of factors to consider when choosing a Medicare plan, and your needs or finances might change down the road. Weigh your options carefully at the beginning, keeping your current and future healthcare needs and your budget in mind.
Medicare Advantage plans offer optional additional services but will cost more than original Medicare. Some of the costs you pay upfront with Medicare Advantage may save you money in the long run, especially on extra services like prescription coverage, vision, and dental.
If you go with a Medicare Advantage plan, you should also review the plan’s quality rating and whether your existing or preferred doctors and facilities are in-network. Compare plans carefully to find one that fits your specific needs.
You should also review your prescription drug plan options, considering which plans cover your medications. Each plan should outline cost ranges for various drugs. Make sure what you need is covered at a price you can afford.
- Medicare Advantage plans expand on the services and coverage offered by original Medicare, but they may cost more.
- If you’ve enrolled in a Medicare Advantage plan, you can switch Advantage plans or go back to original Medicare during specific time periods.
- To avoid penalties, you should switch or drop plans during open or annual enrollment periods, or check to see if you qualify for a special enrollment period.