Switching From Medicare Advantage to Original Medicare

Why So Many Seniors Are Rethinking Medicare Advantage

If you’ve been on a Medicare Advantage plan and felt frustrated by narrow provider networks, surprise claim denials, or the need for prior authorizations just to see a specialist — you’re far from alone. Switching from Medicare Advantage to Original Medicare is something thousands of seniors consider every year, and for good reason.

A 2023 report from the Kaiser Family Foundation found that roughly 30% of Medicare Advantage enrollees experienced at least one claim denial in the prior year. Meanwhile, a Department of Health and Human Services investigation revealed that some Medicare Advantage plans were denying or delaying care that should have been covered. These aren’t just statistics — they represent real people who couldn’t get the care they needed when it mattered most.

If any of this sounds familiar, you may be wondering whether going back to Original Medicare (Part A and Part B) is the right move. The good news? It absolutely can be — but there are important details you need to understand before making the switch. In this guide, we’ll walk you through the reasons, the timing, the steps, and the potential pitfalls so you can make a confident, informed decision.

Reasons You Might Want to Switch Back

Not every Medicare Advantage plan is a bad fit, but there are several common situations that lead seniors to reconsider. Here are the most frequent reasons people switch back to Original Medicare:

1. Doctor and hospital access: Original Medicare is accepted by about 99% of hospitals and over 97% of non-pediatric physicians nationwide. Medicare Advantage plans, on the other hand, typically restrict you to a specific network. If your favorite doctor or specialist isn’t in-network, you could face steep out-of-pocket costs — or be forced to find someone new.
2. Prior authorization headaches: Many Medicare Advantage plans require you to get approval before receiving certain treatments, tests, or specialist visits. This can delay critical care. Original Medicare generally doesn’t require prior authorization for covered services.
3. Travel and flexibility: If you spend winters in Florida and summers in Michigan — or if you travel frequently — Original Medicare’s nationwide acceptance gives you far more flexibility than a regional Medicare Advantage HMO.
4. Unexpected out-of-pocket costs: While Medicare Advantage plans often advertise $0 premiums, copays for hospital stays, surgeries, and specialist visits can add up quickly. Some plans have maximum out-of-pocket limits as high as $8,300 per year in 2024.
5. Chronic health conditions: Seniors managing complex conditions like cancer, heart disease, or autoimmune disorders often find that Original Medicare paired with a Medigap supplement provides more predictable costs and broader access to top specialists.

If even one of these situations resonates with you, it’s worth exploring your options. Visit our Medicare Benefits Hub for a deeper look at what Original Medicare covers.

When Can You Make the Switch?

Timing is one of the trickiest parts of switching from Medicare Advantage to Original Medicare. You can’t just change plans any day of the year. Here are the key enrollment periods you need to know:

Medicare Open Enrollment Period (OEP)

This runs from October 15 through December 7 each year. During this window, you can drop your Medicare Advantage plan and return to Original Medicare. Your coverage under Original Medicare would begin on January 1 of the following year.

Medicare Advantage Open Enrollment Period (MA OEP)

From January 1 through March 31, current Medicare Advantage enrollees can switch to a different Medicare Advantage plan or disenroll and go back to Original Medicare. If you switch during this period, your new coverage starts the first day of the month after the plan receives your request.

Special Enrollment Periods (SEPs)

In certain situations — such as moving out of your plan’s service area, qualifying for Medicaid, or living in a nursing home — you may qualify for a Special Enrollment Period that allows you to switch outside the normal windows.

The bottom line: plan ahead. Mark these dates on your calendar and start researching well before the enrollment period opens. For a handy reference, download our free Medicare checklist to keep all the important dates and steps in one place.

Step-by-Step: How to Switch to Original Medicare

Once you’ve decided to make the change, here’s exactly what to do:

1. Contact your Medicare Advantage plan. Call the number on your plan’s membership card and tell them you want to disenroll. You can also do this through Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227).
2. Confirm your disenrollment. You should receive a written confirmation that your Medicare Advantage plan has been canceled. Keep this document for your records.
3. Get a new Medicare card. Once you’re back on Original Medicare, you’ll use your red, white, and blue Medicare card. If you’ve misplaced yours, you can request a replacement through your my.Medicare.gov account or by calling Medicare directly.
4. Enroll in a Part D drug plan. Original Medicare does not include prescription drug coverage. If your Medicare Advantage plan included drug coverage (most do), you’ll need to sign up for a standalone Part D plan during the same enrollment period. Failing to do so could result in a late enrollment penalty.
5. Consider a Medigap (Medicare Supplement) policy. This is one of the most important steps — and the one most people overlook. We’ll explain why below.

The Medigap Question: Don’t Skip This Step

Here’s where things get critical. Original Medicare covers a lot, but it doesn’t cover everything. You’re still responsible for deductibles, coinsurance (typically 20% of approved charges), and some services. That 20% can become a very big number if you need surgery, cancer treatment, or a lengthy hospital stay.

A Medigap policy (also called Medicare Supplement Insurance) fills in many of these gaps. Plans like Medigap Plan G or Plan N are popular choices that can save you thousands of dollars a year in out-of-pocket costs.

But here’s the catch: Your guaranteed right to buy a Medigap policy without medical underwriting typically exists only during your initial 6-month Medigap Open Enrollment Period — which starts when you’re 65 and enrolled in Part B. If you’re switching back to Original Medicare after that window has passed, insurance companies in most states can deny you coverage or charge higher premiums based on your health.

There are exceptions:

• Some states (like California, Connecticut, Massachusetts, and New York) have laws guaranteeing Medigap access regardless of when you apply.
• If you’ve had your Medicare Advantage plan for less than 12 months, you may have a “trial right” that allows you to buy a Medigap policy without underwriting.
• Certain qualifying events may also trigger guaranteed-issue rights.

This is arguably the single most important factor in your decision. Before you switch, call a few Medigap insurers in your state to find out whether you can get a policy, and at what cost. This step alone could save you from a costly surprise.

Comparing Costs: Is Original Medicare Actually Cheaper?

The honest answer is: it depends on your health and how you use healthcare. Let’s break down the basic costs of Original Medicare in 2024:

• Part A premium: $0 for most people (if you or your spouse paid Medicare taxes for 10+ years)
• Part B premium: $174.70/month (standard for 2024)
• Part B deductible: $240/year
• Part D premium: Varies by plan (national average is approximately $55/month)
• Medigap premium: Varies widely — typically $100–$300/month depending on your plan, location, and age

So with Original Medicare plus a Medigap plan and Part D, you might pay roughly $330–$530 per month in premiums. That’s more than many Medicare Advantage plans charge upfront.

However, the trade-off is predictability and protection. With a good Medigap plan, your out-of-pocket costs for hospital stays, specialist visits, and procedures can drop to nearly zero. For seniors with chronic conditions or those who value the freedom to see any Medicare-accepting provider, this peace of mind is often worth every penny.

For more guidance on understanding your options, explore our Medicare resources for in-depth articles on every part of Medicare.

Final Tips Before You Make Your Decision

Switching from Medicare Advantage to Original Medicare is a significant healthcare decision. Here are a few final tips to help you navigate it successfully:

• Talk to a licensed Medicare advisor. A State Health Insurance Assistance Program (SHIP) counselor can give you free, unbiased advice. Find one at shiphelp.org.
• Review your medications. Make sure any Part D plan you choose covers your prescriptions at a pharmacy you prefer.
• Check your doctors. While Original Medicare is widely accepted, it never hurts to confirm that your specific providers accept Medicare assignment.
• Don’t rush. Start your research at least 2–3 months before the enrollment period. Gather your current plan documents, make a list of your medications, and compare costs carefully.
• Keep records of everything. Save confirmation letters, plan documents, and notes from phone calls in a dedicated folder.

Switching plans doesn’t have to be stressful. With the right information and a little planning, you can make a choice that gives you better access, more flexibility, and genuine peace of mind for the years ahead.