How to switch to Traditional Medicare from Medicare Advantage?

For years, I’ve been advising people to enroll in Traditional Medicare for easy access to medically reasonable and necessary care. And, I continue to believe that anyone who can afford the upfront costs of Traditional Medicare with supplemental coverage should enroll in Traditional Medicare. Medicare Advantage plans save you money, so long as you’re healthy; but your health care coverage should cover the care you need when you’re sick and you can’t count on a Medicare Advantage plan to do that. So, one Just Care reader asks, how easy is it to switch from a Medicare Advantage plan to Traditional Medicare?

First things first: Twice a year, during the annual Medicare Open Enrollment period between October 15 and December 7 and during the Medicare Advantage Open Enrollment period between January 1 and March 31, you have the right to disenroll from Medicare Advantage and switch to Traditional Medicare. The issue becomes getting supplemental coverage to fill gaps in traditional Medicare if you don’t have Medicaid or retiree coverage that fills those gaps.

Here are the benefits of enrolling in Traditional Medicare, along with the challenges of doing so, and your rights.

The benefits of enrolling in Traditional Medicare:

• You will have easy access to the medical and hospital care you deserve, without the need for prior authorization or a referral from your doctor to a specialist; you won’t need to go through hoops to get care, nor will you face care delays or denials of care your treating physician says you need.
• You and your doctor decide the care you need, not an insurance company that profits from denying you care.
• You will be covered for care from virtually any doctor or hospital in the US; you will not be limited to coverage from a narrow group of physicians in your community.
• With supplemental coverage, either through Medicaid, your former employer or union or a Medigap plan that you buy in the individual market, you are likely to have almost all your care covered without having to pay out of pocket for that care.

The challenges of switching to Traditional Medicare:

• With certain exceptions, if you want to sign up for Traditional Medicare after you’ve been in a Medicare Advantage plan for more than a year, you have no guaranteed right to buy supplemental coverage in all but four states, New York, Massachusetts, Connecticut and Maine. And, because Traditional Medicare has no out-of-pocket limit, you could have higher out-of-pocket costs in Traditional Medicare than you would in a Medicare Advantage plan, which tends to limit your out-of-pocket expenses for medical services to an average of $5,000 for in-network care but could cap those costs as high as $8,700 in 2024.
• Even if your Medicare Advantage plan is not covering the care you need from the providers you need to see, you can only switch to Traditional Medicare during the Medicare Open Enrollment Period between October 15 and December 7, effective January 1 of the following year and during the Medicare Advantage Open Enrollment Period between January 1 and March 30, effective the month after you disenroll from your Medicare Advantage plan.
• If you are able to switch to Traditional Medicare and you don’t have Medicaid or a union or employer retiree plan to provide supplemental coverage, supplemental coverage could cost a lot, easily $200 a month or more. Medigap Plans K and L tend to be lower cost and cap your out-of-pocket expenses.

Your rights to buy a Medigap without medical underwriting or a waiting period:

• When you first enroll in Medicare, you have a guaranteed right to buy Medigap coverage to fill gaps in Traditional Medicare during a six month open enrollment period beginning the month you turn 65.
• If you enrolled in a Medicare Advantage plan when you were first eligible for Medicare and disenroll within 12 months, you have a guaranteed right to buy Medigap coverage.
• If you move out of your Medicare Advantage plan’s service area, you have a right to switch to Traditional Medicare and a guaranteed right to buy Medigap coverage.
• If you had supplemental coverage from your employer or union and that coverage ends, you have a guaranteed right to buy Medigap coverage.
• If your Medicare Advantage plan ends its coverage or commits fraud, you have a guaranteed right to buy Medigap coverage.

Insurers still might sell you Medigap coverage even if none of the above federal rights apply to your situation:

You still might be able to buy a Medigap policy in your state if you want to switch from a Medicare Advantage plan to Traditional Medicare and none of the above guaranteed federal rights to buy Medigap apply. Contact your State Health Insurance assistance Program or SHIP for free help. Or call your state department of insurance to see if you can buy a policy. Some Medigap plans have out-of-pocket limits like Medicare Advantage and cost much less than more comprehensive Medigap plans.

Here’s more from Just Care:

• With Medicare Advantage, less for you is always more for insurers
• Four things to think about when choosing a plan to fill gaps in Medicare, a “Medigap” or Medicare supplemental insurance plan
• 2023: Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan
• The choice between traditional Medicare and Medicare Advantage: It’s a sham
• Five concerning policy outcomes of Medicare Advantage program