Medicare Advantage

Dropping Medicare Advantage for Original? Here’s What You Need to Know

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From January 1 through February 14, Medicare Advantage members can disenroll from their MA plans. If you’re enrolled in a Medicare Advantage plan, you might wonder why someone would want to switch to original Medicare. There are plenty of benefits to choosing a private, MA plan for your post-retirement coverage, but for some people, MA plans may actually offer too much coverage. Perhaps you signed up because you thought it was a great deal, only to realize later that you don’t need comprehensive benefits and prescription drug coverage. Medicare Advantage isn’t for everyone. If you need to drop your plan and move to original Medicare, here are some things to keep in mind.

Check Your Coverage

When you first enrolled in Medicare Advantage, you had reasons for doing so. Perhaps the lower monthly premiums or additional benefits caught your eye. But now that you’re evaluating your healthcare needs as you age, you may find that original Medicare offers advantages that Advantage just doesn’t. It’s important to re-evaluate your healthcare needs routinely but especially if you’re preparing to drop a more comprehensive policy for one that doesn’t cover as much.

You may have found that you’re paying more for additional coverage that you don’t actually need. You may even have discovered that you were automatically enrolled in a Medicare Advantage plan without your knowledge due to a practice called “seamless conversion.” In any case, now’s the time to take a hard look at your spending habits and medical needs to make sure switching is a good idea. For instance, do you:

  • Take pricey or multiple prescription medications?
  • Have limited income and want to cap how much you spend each year on medical care?
  • Need glasses or want dental care?

Medicare Advantage plans often cover prescription drugs, and some may include benefits like dental and vision. Advantage may also cover assisted living facilities and nursing home care, other benefits that original does not. You might be able to cover the cost of some of these services with supplemental Medigap policies, but be aware that it’s harder to get Medigap once you’re past the initial eligibility window.

Original Medicare Might Be Better for You

There’s no doubt that Medicare Advantage is a good choice. It’s also increasingly popular among Medicare enrollees for its bevy of benefits. But there are good reasons to stick with original Medicare or disenroll from your MA plan during the disenrollment period. You may prefer original if you:

  • Want to use any provider nationwide that accepts Medicare;
  • Don’t use prescription drugs, or use a generic occasionally and can pay out of pocket; and/or
  • Travel frequently

Medicare Advantage comes with networks. It’s partly how these plans keep costs low. With original Medicare, you’re free to use any provider nationwide that accepts Medicare, which means that you can see a specialist when needed without having to get a referral or stay inside a network. It also means that for those who travel, getting medical care can be less stressful since Medicare is widely accepted. And if you don’t need a lot of prescription drugs, there’s no point in paying for that coverage.

Keep in mind, though, that original Medicare comes with some pretty big limitations. For starters, it covers basic medical and hospital care with Parts B and A, respectively, but it doesn’t cover much else. You’ll also have to cover about 20 percent of your medical bills all year without a cap. Medicare Advantage caps out-of-pocket spending per year, which will save you money if you have an expensive condition, like diabetes, that requires constant management.

When and How Can I Disenroll?

If you’re still sure about disenrolling from your Medicare Advantage plan, you can do so during a specific time period each year: January 1 through February 14. This is a designated disenrollment period. You can’t use it to switch from one MA plan to another or join an MA plan if you have original Medicare. You can only do two things during this period:

  • Leave your Medicare Advantage plan and join original Medicare
  • Sign up for a Medicare Part D drug plan if you switch to original Medicare

The process for switching depends on your plan. Start by contacting your plan provider or 1-800-MEDICARE for specific information. Make sure that you’re getting the coverage you want before dropping your MA plan. If the plan isn’t working, it may be worth waiting until the open enrollment period – October 15 to December 7 – to find a new MA plan that better fits your needs. No matter what you choose, carefully review your options before signing up for a plan, and don’t hesitate to ask questions first.

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