Choosing the right Medicare coverage is a big decision, and sometimes, what seemed like the best option at first doesn’t end up being the right long-term fit. If you’re currently enrolled in a Medicare Advantage plan but are considering a switch back to Original Medicare (Parts A and B), you’re not alone.
At Wise Insurance, we help Texans evaluate their Medicare choices every day. Whether it’s due to changes in your health, financial situation, or provider network, switching from Medicare Advantage to Original Medicare is possible and, in many cases, relatively straightforward.
Here’s what you need to know about how and when to make the switch, what coverage you’ll lose or gain, and how to protect yourself from out-of-pocket costs along the way.
Why Do People Switch From Medicare Advantage?
Medicare Advantage (Part C) plans are popular for good reason. They often offer low monthly premiums and include extra benefits like dental, vision, hearing, and prescription drug coverage. But they also come with some limitations, which is why many people decide to return to Original Medicare.
Common reasons for switching include:
- Limited provider networks (your doctor or hospital may no longer be covered)
- Unexpected out-of-pocket costs
- Changing health needs that require more flexibility in choosing providers
- Dissatisfaction with plan rules, such as referrals or prior authorizations
- Relocation to an area where your plan is no longer offered
When Can You Make the Switch?
You can’t switch from Medicare Advantage to Original Medicare anytime you want, but there are specific enrollment periods during which you can make this change:
Medicare Advantage Open Enrollment Period (Jan 1 – March 31)
If you’re already enrolled in a Medicare Advantage plan, you can switch to a different Advantage plan or return to Original Medicare. You can also join a standalone Part D prescription drug plan at this time.
Annual Enrollment Period (Oct 15 – Dec 7)
You can switch from Medicare Advantage to Original Medicare during this window each year. Your new coverage will begin on January 1 of the following year.
3. Special Enrollment Periods (SEPs)
You may qualify for an SEP due to circumstances such as moving out of your plan’s service area, losing other coverage, or your plan leaving Medicare.
What Happens to My Coverage When I Switch?
When you move from Medicare Advantage back to Original Medicare, your coverage changes significantly. Here’s a breakdown:
| Coverage Area | Medicare Advantage | Original Medicare (Parts A & B) |
| Doctors & Hospitals | Network-based | Nationwide coverage |
| Referrals Required? | Often, yes | No |
| Prescription Drugs | Usually Included (Part D) | Not included – you must add a Part D plan |
| Dental/Vision/Hearing | Often included | Not covered |
| Out-of-Pocket Limit | Yes (annual cap) | No cap – you pay 20% co-insurance |
As you can see, Original Medicare offers more provider flexibility, but it also lacks an annual out-of-pocket maximum, which can leave you vulnerable to high medical costs. That’s where Medigap comes in.
Do I Need a Medigap Policy?
Most people who switch to Original Medicare consider adding a Medicare Supplement Insurance policy (also known as Medigap) to help cover out-of-pocket costs like deductibles, copayments, and coinsurance.
However, you may not be guaranteed Medigap coverage when switching from Medicare Advantage to Original Medicare.
Unless you qualify for a Medigap guaranteed issue right (such as losing coverage through no fault of your own), insurers in Texas can require medical underwriting. This means they can deny your application or charge you more based on your health history.
That’s why it’s important to coordinate your switch carefully and work with a knowledgeable insurance advisor who can guide you through the timing and eligibility rules.
Prescription Drug Coverage
Original Medicare doesn’t include drug coverage, so if you drop your Medicare Advantage plan and return to Original Medicare, you’ll likely need to enroll in a standalone Part D plan to avoid a gap in your prescriptions and potential late penalties.
During both the Medicare Advantage Open Enrollment and Annual Enrollment Period, you can enroll in a Part D plan at the same time you drop your Advantage plan.
Steps to Switch from Medicare Advantage to Original Medicare
Here’s a simple step-by-step guide to help you make the change:
- Review your current coverage and decide why you want to switch.
- Check the enrollment period you qualify for.
- Enroll in Original Medicare through Social Security if you’re not already enrolled.
- Select and enroll in a Part D prescription drug plan (if needed).
- Apply for a Medigap plan (if eligible and desired).
- Disenroll from your Medicare Advantage plan by contacting Medicare at 1-800-MEDICARE or enrolling in another type of Medicare coverage.
Wise Insurance can help you complete all these steps so you don’t miss any important deadlines or end up with a gap in coverage.
Let’s Make Medicare Work for YOU
If you’re ready to explore switching back to Original Medicare or require help with Medicare in general, we’re here to help. Receive clear, honest answers from people who care. We’ll make sure your Medicare plan fits your life – not the other way around.
Emily Trevino, Senior Managing Partner at Wise Insurance, leverages her extensive background in biology and business finance to master Medicare, health insurance, and retirement planning. With over a decade in the field, Emily has co-authored “Medicare Breakdown – The Alphabet Soup of Medicare,” marking her as a pivotal figure in insurance education. Her commitment extends through active participation in the National Association of Benefits and Insurance Professionals (NABIP) and speaking at major industry events. Emily’s drive for community service and personal resilience shines through her adventurous pursuits and dedication to societal well-being. Connect with Emily on LinkedIn to explore the future of informed insurance decisions.
