Dear Marci,

I recently read an article discussing the pros and cons of Original Medicare and Medicare Advantage Plans. I signed up for a Medicare Advantage Plan last year, but I want to switch to Original Medicare. When can I do that?

Kaleb (Aspen, CO)

Dear Kaleb, 

There are a few points in the year when you might be able to change your coverage. Below are several different circumstances that might apply for you to be able to change your coverage. 

  1. You can make certain changes during the Medicare Advantage Open Enrollment Period (MA OEP). Between January 1 and March 31, folks enrolled in a Medicare Advantage Plan (like yourself) can switch to a different Medicare Advantage Plan or to Original Medicare with or without a stand-alone Part D plan. If you do decide to make changes to your coverage during this time, they would take effect the first of the month after you make the change. You can call 1-800-MEDICARE to request the change.
  2. If you enrolled in a Medicare Advantage Plan by mistake or after receiving misleading information, you may be able to disenroll and change plans. Typically, you can change plans if you:
    • Joined unintentionally: You may have enrolled believing you were joining a Medigap plan to supplement Original Medicare. Or you meant to sign up for a stand-alone Part D plan and accidentally joined a Medicare Advantage Plan. 
    • Joined based on incorrect or misleading information: For example, if a plan representative told you that your doctors are in the plan’s network, but they are not, or you were promised benefits that the plan does not in fact offer. 
    • Through no fault of your own, ended up or were kept in a plan you do not want: If you tried to switch plans during an enrollment period but were kept in your old plan. You can also make a change if you were enrolled in a plan because of an administrative or computer error. 

This change may be retroactively effective, depending on the circumstances. 

  1. You may be eligible for a Special Enrollment Period (SEP) during which you can change your coverage. SEPs allow you to change your health and/or drug coverage outside regular enrollment periods. For example, if your Medicare Advantage Plan was discontinued in your area, you would have an SEP to switch to another Medicare Advantage Plan or to Original Medicare. If you’re enrolled in certain cost assistance programs, like Extra Help or the Medicare Savings Program, you may be eligible for other SEPs. Read about other circumstances that might trigger an SEP on Medicare Interactive.
  1. Your last option is to wait for the Fall Open Enrollment Period to make changes to your coverage for next year. The Fall Open Enrollment Period occurs each year from October 15 through December 7, with your new coverage starting January 1. 

Best of luck with any changes you make! 

-Marci 

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