Paul Sanchez
Medicare Advantage, also known as Part C, is a type of Medicare coverage provided by a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but they can do so with different rules, costs, and coverage restrictions. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Private Fee-for-Service (PFFS) plans. You can switch between Medicare Advantage Plans or from Medicare Advantage to Original Medicare during specific enrollment periods, such as the Fall Open Enrollment or the Medicare Advantage Open Enrollment Period. To change your insurance provider in Medicare, you can compare plans, review costs, and select a new plan during the appropriate enrollment period.
| Characteristics | Values |
|---|---|
| When can you change your insurance provider? | During certain periods of time called Special Enrollment Periods (SEP) when you can join the Original Medicare program, or enroll in a Medicare Advantage Plan, Part D plan, or supplemental insurance plan (Medigap). |
| What are Special Enrollment Periods? | Special Enrollment Periods are triggered by certain life events, such as losing health coverage, moving, getting married, or having a baby. |
| How do you change your insurance provider? | By selecting "Enroll" for the plan you want to join at Medicare.gov/plan-compare, or by contacting the plan to join by calling them, visiting their website, or mailing them a paper form. |
| How do you choose a new provider? | By comparing plans in your area, including their costs and services, and reviewing whether your doctors and pharmacies are in the plan's network. |
| What are the different types of Medicare plans? | Medicare Advantage (Part C), Original Medicare (Part A and Part B), and Medicare Supplement Insurance Plans (Medigap). |
| How do Medicare Advantage and Original Medicare differ? | Medicare Advantage allows you to get Medicare coverage from a private health plan that contracts with the federal government, whereas Original Medicare is the fee-for-service health insurance program offered directly through the federal government. |
| How do Medicare Advantage and Medicare Supplement Insurance Plans differ? | Medicare Advantage plans have different rules, costs, and coverage restrictions compared to Original Medicare, while Medicare Supplement Insurance Plans help cover your out-of-pocket costs with Original Medicare. |
| How do you change your primary care doctor? | By filling out a change form online with your insurer or calling member services. |
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What You'll Learn
Switching from Medicare Advantage to Original Medicare
You can switch from Medicare Advantage to Original Medicare during two periods each year: Medicare Advantage open enrollment (January 1 to March 31) and Medicare open enrollment (October 15 to December 7).
If you joined a Medicare Advantage Plan during your Initial Enrollment Period, you can change to Original Medicare within the first 3 months of having Medicare Part A and Part B.
If you move away from your Medicare Advantage plan's service area, you can re-enroll in Original Medicare without penalty. This works even if other Medicare Advantage plans are available at your new address. You can switch from a Medicare Advantage plan to Original Medicare the month before you move out of your plan's service area. This opportunity lasts for two full months after the month you move. If you wait to tell your Medicare Advantage plan about your move, then you can switch to Original Medicare for up to two full months after the month that you inform your plan.
If you’re admitted to any type of long-term care setting, you can switch your plan up to once per month during your stay if you want to leave Medicare Advantage for Original Medicare.
There are three ways you can make the change:
- Visit your local Social Security Office and ask to be disenrolled from Medicare Advantage
- Call 1-800-MEDICARE (1-800-633-4227) and process your disenrollment over the phone
- Contact your plan provider or Medicare directly
Medicare Advantage and Original Medicare have different benefits. Original Medicare only provides Part A (hospital coverage) and Part B (medical coverage). It does not provide some of the benefits you may have with your Medicare Advantage plan, like drug coverage, dental, vision, or fitness. Original Medicare also doesn’t have an annual out-of-pocket limit, so there’s no built-in financial protection.
Many Medicare Advantage plans include Part D prescription medication coverage, while Original Medicare requires you to purchase a standalone Part D plan. Though, with Original Medicare, you may be able to buy a Medicare supplement insurance (Medigap) plan to help cover your out-of-pocket costs.
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Changing your primary care doctor
If you are enrolled in Original Medicare, you generally don't have to choose a primary care doctor. With this coverage, you can go to any doctor who accepts Medicare patients. However, it's important to make sure the doctor who manages your health care accepts Medicare assignment to keep your out-of-pocket costs low.
If you have a Medicare Advantage plan, you may need to choose a primary care doctor from their network. You can do this by visiting your plan's website and browsing through the doctors listed in your network. Your insurance company can also provide you with a hard copy of the network list through the mail.
Once you've chosen a new primary care doctor, you can update your secure online account with your insurer or call member services to notify them of your new provider.
- Find the doctors near where you live who accept new Medicare patients, including their office locations and specialties.
- Contact the doctor's practice and confirm they are accepting new Medicare patients.
- Make an initial appointment with your new doctor and transfer your care to them.
- Update your secure online account or call member services to notify them of your new primary care doctor.
- While it's not essential, you may want to add your primary care doctor's details to your Medicare.gov account to give them access to tools and services that allow them to effectively manage your care.
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Special Enrollment Periods
There are two types of Special Enrollment Periods:
- Qualifying Life Events: This period lasts for two months. Qualifying life events include losing health coverage, moving, getting married, having a baby, losing other drug coverage, or moving into or out of a qualified institutional facility, such as a nursing home. If you have signed up for Part A or Part B during a Special Enrollment Period due to an exceptional situation, such as a natural disaster, you will have two months to join a Medicare Advantage Plan or a Medicare drug plan (Part D).
- Working Past 65: This period lasts for eight months. If you work past 65 and qualify to delay Medicare due to creditable employer coverage, you can enroll in Part A (if you haven't already), Part B, Part C, and Part D without late penalties. However, you only have the first two months to enroll in Part C or Part D without incurring late enrollment penalties.
If you joined a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan or go back to Original Medicare within the first three months of having Medicare Part A and Part B.
If you have Medicaid or receive Extra Help, you can make changes to your coverage once a calendar month, and the changes will take effect on the first day of the next month.
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Medicare Advantage Open Enrollment Period
Medicare Advantage Open Enrollment is a period when Medicare Advantage plan members can make changes to their existing plan or disenroll from their current plan and return to Original Medicare. It runs from 1 January to 31 March. This period is only for people who are already enrolled in a private Medicare Advantage plan (with or without drug coverage).
During the Medicare Advantage Open Enrollment, you can:
- Switch to another Medicare Advantage plan (with or without drug coverage).
- Drop your Medicare Advantage plan and return to Original Medicare.
- Join a separate Medicare drug plan.
You cannot switch from Original Medicare to a Medicare Advantage plan during this period.
To make changes to your plan, you can call your insurance provider or visit their website. You can also ask for a paper form to fill out and mail back to the plan, but they must get it before your enrollment period ends.
If you have questions or need help making enrollment changes, you can call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
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Comparing plans
When comparing Medicare plans, there are a few key factors to consider. Firstly, it is important to understand the different types of Medicare plans available, such as Original Medicare, Medicare Advantage Plans, and Medicare drug plans. Each type of plan offers different coverage and benefits, so it is essential to choose the one that best suits your needs.
Original Medicare is the traditional fee-for-service program offered by the government. It includes Part A (hospital insurance) and Part B (medical insurance). You can also add Part D, which provides prescription drug coverage. Medicare Advantage Plans, also known as Part C, are offered by private companies approved by Medicare. These plans combine the benefits of Part A and Part B and often include additional coverage for things like prescription drugs, dental, and vision care. Medicare drug plans, as the name suggests, provide coverage specifically for prescription drugs.
Once you understand the different types of plans, you can start comparing specific plans within each category. Consider the following factors:
- Cost: Review the monthly premiums, deductibles, and estimated yearly costs for any drugs you take.
- Doctor and pharmacy networks: Check if your preferred doctors and pharmacies are in the plan's network.
- Coverage and benefits: Look into the specific services covered by each plan and the benefits offered. This includes things like prescription drug coverage, dental, and vision care.
- Special considerations: If you live in another state for part of the year, confirm whether the plan will cover you in that state as well.
Additionally, you can utilise online tools and resources to compare plans. The Medicare website provides a plan comparison tool that allows you to input your information and receive estimates for different plans. You can also refer to the "Medicare & You" handbook, which contains a list of available plans and their details. Seeking assistance from your local State Health Insurance Assistance Program (SHIP) can provide you with free personalised health insurance counselling to aid in your decision-making process.
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Frequently asked questions
You can change your Medicare insurance provider by filling out a change form online with your insurer or calling member services.
There are two main types of Medicare insurance providers: Original Medicare (fee-for-service health insurance offered through the federal government) and Medicare Advantage (private health plans that contract with the federal government).
You can change your Medicare insurance provider during certain periods, such as the Fall Open Enrollment Period, the Medicare Advantage Open Enrollment Period, and the Special Enrollment Period.
Some reasons to switch Medicare insurance providers include moving out of your plan's service area, losing other coverage, or wanting to change your type of plan (e.g., dropping drug coverage or adding a prescription drug plan).
