Switching to Medicare Advantage Plans From Original Medicare
Key Takeaways
- Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). (Part C) offers an alternative to Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). by bundling Parts A and B, often with additional benefits that could include prescription drug coverage, dental, vision, and hearing care.
- Switching to Medicare Advantage is only allowed during the Initial Enrollment Period (IEP) and Annual Enrollment Period (AEP). Those who meet criteria may enroll during a Special Enrollment Period (SEP).
- When selecting a Medicare Advantage plan, consider your budget, network of providers, extra benefits (e.g., dental and prescription drugs), and the plan’s star ratings.
Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare provided by private insurance companies. It includes the same benefits of Original Medicare (Parts A and B) but often offers additional services, such as prescription drug coverage, dental, vision, hearing, and wellness programs.
Medicare Advantage plans can cost less than Original Medicare for many Americans and offer additional benefits beyond Original Medicare’s coverage. If you switch from Original Medicare to Medicare Advantage, enrollment periods only occur at certain times throughout the year. Learn more about how and when to make the switch.
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Original Medicare vs. Medicare Advantage At a Glance
| Original Medicare | Medicare Advantage | |
|---|---|---|
| Part A | Yes | Yes |
| Part B | Yes | Yes |
| Part D | No; you can enroll in a stand-alone Part D plan | Sometimes; some plans include Part D benefits or you can enroll in a stand-alone Part D plan |
| Additional Benefits | No | Sometimes; some plans include vision, dental, etc. |
| Premium (2025) | Part A: Usually $0, but some people pay $285 or $518 per month; Part B: Usually $185 | Varies; some plans charge supplemental premiums in addition to Part A and/or B premiums |
| Deductible (2025) | Part A: $1,676 per benefit period; Part B: $257 | Varies; some plans have a $0 deductible |
| Copay and Coinsurance | Yes; varies by service | Yes; varies by plan and service |
| Annual out-of-pocket Maximum (2025) | None; you can enroll in Medigap to reduce out-of-pocket costs | Varies; out-of-pocket maximums capped at $9,350 for in-network and $14,000 for in- and out-of-network combined |
| Compatible with Medigap | Yes | No |
Why Switch to Medicare Advantage?
Switching from Original Medicare to a Medicare Advantage plan can offer several benefits depending on your healthcare needs, budget, and where you live. Here are some key reasons to consider switching from Original Medicare to Medicare Advantage.
- Simplify your benefits. Many Medicare Advantage plans bundle in Part D benefits, so you would not have to enroll in a separate Medicare Part D prescription drug plan to get coverage for your medications. Many Medicare Advantage plans also offer extra benefits such as vision, dental, and hearing care. However, plan benefits vary so check your plan’s details for specific coverages.
- Lower your out-of-pocket costs. Medicare Advantage plans include an annual out-of-pocket maximum, which limits how much you can spend per benefit year on covered benefits before your insurance covers 100% of all remaining costs. Original Medicare has no such limit. This can help protect against high medical expenses.
- Join a growing trend. Enrollment in Medicare Advantage plans have doubled over thepast decade. In 2024, a record 33.8 million seniors and people with disabilities enrolled in a Medicare Advantage plan, representing nearly 55% of the Medicare population.
How to Switch to Medicare Advantage
When you’re ready to change to a Medicare Advantage plan, be sure to have the necessary information and documents ready. Also, mark your calendar because switching to Medicare Advantage can only occur during an enrollment period.
What Do You Need to Switch to Medicare Advantage?
To make the switch from Original Medicare to Medicare Advantage, make sure you meet the eligibility criteria:
- You must be enrolled in Medicare Part A and B
- You must be a citizen or lawful resident of the U.S.
- You must live in the service area of your desired Medicare Advantage plan
Having the following information and documentation handy can also help to make the switch more seamless:
- Proof of identity and address
- Date of birth
- Medicare ID number to verify eligibility
- List of benefits in order of priority for your healthcare needs
- Desired budget
- Preferred doctors, pharmacies, and hospitals
When Can You Switch to Medicare Advantage?
Medicare enrollment periods are specific times when people can enroll or make changes to their Medicare coverage. There are several key enrollment periods to know when switching to a Medicare Advantage plan:
- Initial Enrollment Period (IEP): This seven-month period starts three months before the month you turn 65, includes your birthday month, and continues for three months after. Those under the age of 65 with qualifying disabilities may also enroll at this time. During the IEP, you can sign up for Original Medicare or Medicare Advantage.
- Annual Enrollment Period (AEP): The AEP starts on October 15 and continues until December 7 every year. The AEP is open to anyone with Medicare. During this period, you can make changes to your Medicare Advantage and/or Part D plan. Changes take effect on January 1 of the following year.
- Special Enrollment Period (SEP): This is a time outside of the regular Medicare enrollment periods when you can sign up for Medicare. Special enrollment periods are triggered by qualifying life events such as losing employer coverage or moving to a new service area. Generally, the SEP lasts for eight months. For example, if you are enrolling because you moved out of your current plan’s service area, then you have 8 months to choose your Medicare Advantage plan without any penalties.
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What to Consider When Picking Your Medicare Advantage Plan
Choosing a Medicare Advantage plan can appear complex, as plans vary widely in costs, coverage, and provider networks. Let’s review the main factors to consider when choosing the best plan for your needs.
- Budget: Medicare Advantage plans vary in their monthly premiums. In addition, deductibles, copayments, and coinsurance vary depending on the plan. Make sure that all out-of-pocket costs fit within your budget.
- Network: Medicare Advantage plans have network restrictions, meaning typically only select providers are covered. Confirm that your preferred doctors, hospitals, and pharmacies participate within the network. If you frequently travel, consider plans with a national network or out-of-network coverage.
- Benefits: Medicare Advantage plans must offer the same benefits as Original Medicare. However, some plans offer additional benefits like vision, dental, hearing, and wellness programs. Many Medicare Advantage plans also include Part D prescription drug benefits. When choosing a Medicare Advantage plan with prescription drug benefits, make sure to choose a plan that covers your medication and consider potential costs like deductibles and copayments.
- Insurer reputation: Medicare assigns star ratings to plans based on factors like customer satisfaction, management of chronic conditions, and quality of care. Look for highly rated plans to ensure you’re selecting a reputable plan with good member services.
Going Back to Original Medicare
Medical Advantage plans are appealing due to the ease and convenience of having hospital, outpatient and prescription drug coverage wrapped into one package. However, you may decide that Original Medicare is a better option and want to switch from Medicare Advantage back to Original Medicare. You may make the switch back during the following enrollment periods:
- Medicare Advantage Open Enrollment Period: January 1 – March 31. If you are currently enrolled in a Medicare Advantage plan, you can switch back to Original Medicare and join a Medicare Part D prescription drug plan during this period.
- Annual Enrollment Period: October 15 – December 7. During this time, you can switch from Medicare Advantage to Original Medicare, or vice versa. You can switch between Medicare Advantage plans. The change will take effect on January 1 of the following year.
- Special Enrollment Period: If you meet certain criteria, such as work status, health conditions, or living arrangements, then you are eligible for an 8-month special enrollment period that will allow you to switch back to Original Medicare.
Putting It All Together
When switching from Original Medicare to Medicare Advantage, make certain that you find a plan in your service area that participates with your preferred physicians, hospital, and pharmacy. This will help you make the most of your plan benefits. Be aware of enrollment periods so you do not miss your opportunity to change plans. If you need more help selecting and enrolling in Medicare Advantage, consider working with a licensed insurance agent or broker who can walk you through your options.
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Sources
- Better Medicare Alliance Releases Annual State of Medicare Advantage Report for 2024. Better Medicare Alliance.
- Joining a health or drug plan. Medicare.gov.
- Special Enrollment Periods. Medicare.gov.
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