Free Guide to Switching Back to Original Medicare

Understanding Original Medicare and Why People Switch

Original Medicare is a health insurance program run by the federal government. It has two main parts: Part A covers hospital stays, skilled nursing care, hospice, and home health services. Part B covers doctor visits, outpatient services, tests, and other medical equipment and supplies. Together, these two parts form what people call "Original Medicare."

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Many people who have Original Medicare also buy a supplemental insurance plan (called Medigap) to help pay for costs that Medicare doesn't cover, such as copayments and deductibles. Others choose Medicare Advantage plans (Part C), which are offered by private insurance companies and combine Medicare Part A and Part B coverage in a different way. These plans often include prescription drug coverage and extra benefits like dental or vision services.

People switch back to Original Medicare for several reasons. Some find that their Medicare Advantage plan's network of doctors changed, and their preferred doctors are no longer included. Others move to a new area where their current plan isn't available. Some discover that the out-of-pocket costs with their Medicare Advantage plan are higher than they expected, or they want more flexibility in choosing providers. A few people want to return to Original Medicare after trying a Medigap plan that didn't work for their situation.

Understanding the differences between Original Medicare, Medicare Advantage, and Medigap is the first step in making an informed decision. This guide explains what information you should know when considering a switch back to Original Medicare and how the switching process generally works.

Practical Takeaway: Before deciding to switch, write down your main reasons for considering the change—whether it's provider access, cost concerns, or plan changes in your area. This will help you focus on the information most relevant to your situation.

When You Can Switch Back to Original Medicare

Medicare has specific time periods when you're allowed to change your coverage. Understanding these windows matters because switching outside of them may not be possible without a qualifying event. The main switching period is called the Annual Enrollment Period (AEP), which runs from October 15 through December 7 each year. During this time, anyone with Medicare can make changes to their coverage, whether they want to switch from Medicare Advantage to Original Medicare, change Medigap plans, or make other modifications.

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If you're currently in a Medicare Advantage plan and want to return to Original Medicare during AEP, your coverage change typically takes effect on January 1 of the following year. This means if you make changes in November, you won't see the switch happen until the new year. It's important to plan ahead and submit any changes before the December 7 deadline to ensure your coverage changes on the date you expect.

Beyond the annual enrollment period, you may be able to make changes during the Medicare Advantage Open Enrollment Period (MA OEP), which runs from January 1 through March 31 each year. During this time, if you're already in a Medicare Advantage plan, you can switch to Original Medicare once. This is a special opportunity that applies only to Medicare Advantage members and doesn't apply to people already in Original Medicare.

Certain life events may also allow you to make changes outside of these regular periods. These "qualifying events" can include losing your current coverage, moving to a new area, getting married or divorced, or having a significant change in your health status. The rules around qualifying events are specific, and you should research whether your situation meets the criteria before attempting to make changes.

Practical Takeaway: Mark October 15 and December 7 on your calendar each year as reminders of the Annual Enrollment Period. If you're considering a switch, plan to review your options at least a month before December 7 so you have time to gather information and make your decision.

Steps to Switch Back to Original Medicare

The process of switching from a Medicare Advantage plan back to Original Medicare involves several steps. First, you'll need to notify your current Medicare Advantage plan that you're disenrolling. You can do this by calling the plan directly or contacting Medicare. When you tell them you want to leave, they'll explain what happens to your current coverage and when it ends. Make sure you understand the exact date your current plan ends before your Original Medicare coverage begins, as there should not be a gap in coverage.

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Next, you'll want to review your Original Medicare coverage options. If you currently don't have a Medigap plan and think you might want one, this is a good time to research which Medigap plans might work for your situation. There are ten standardized Medigap plans (labeled A through N), and they each offer different levels of coverage. You can compare what each plan covers and what the monthly premiums might be in your area. Keep in mind that Medigap plans are sold by private insurance companies, not by Medicare itself.

You'll also need to think about prescription drug coverage. Original Medicare doesn't include prescription drug benefits through Part D automatically. If you need prescription medications, you'll want to sign up for a Part D plan offered by a private insurance company. During the Annual Enrollment Period, you can choose a Part D plan that covers the medications you take at a cost that works for your budget. Medicare provides a tool that lets you search for plans based on your specific prescriptions.

Once you've decided what coverage you want, you can submit your enrollment choices. During the Annual Enrollment Period, you can make these changes through Medicare.gov, by calling Medicare at 1-800-MEDICARE, by visiting a local Social Security office, or by working with a State Health Insurance Assistance Program (SHIP). Each method takes you through the same process, though phone and in-person options may take longer depending on call volume.

Practical Takeaway: Create a checklist: (1) Call your current plan to disenroll, (2) Research Medigap plans in your area, (3) Compare Part D prescription drug plans, (4) Choose your new coverage options, (5) Confirm your enrollment changes were received. Check off each item as you complete it to stay organized.

Comparing Costs: Original Medicare vs. Your Current Plan

Cost is often the main reason people consider switching back to Original Medicare. To make a fair comparison, you need to understand all the costs involved with both your current plan and Original Medicare. Start by gathering your current plan's documents, which should show your monthly premium, annual deductible, copayments for different types of services, and coinsurance amounts (the percentage you pay after meeting your deductible).

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With Original Medicare Part A and Part B, costs work differently than with Medicare Advantage plans. There is no monthly premium for Part A if you've paid Medicare taxes for at least ten years. Part B has a monthly premium that changes yearly—it was $164.90 per month in 2024 for most people, though higher earners may pay more. Both parts have deductibles you must meet each year before Medicare starts paying its share. Part A has a deductible for hospital stays (which was $1,632 in 2024), and Part B has an annual deductible (which was $240 in 2024).

After you meet your deductibles, Original Medicare pays a certain percentage of your medical costs, but you typically pay some amount as coinsurance. For hospital stays covered under Part A, you pay copayments for days after the first 60 days. For Part B services like doctor visits, Medicare usually pays 80% and you pay 20%. This is where a Medigap plan becomes useful—it can help cover the costs that Original Medicare doesn't pay. Medigap premiums vary by plan and location, but they can range from around $100 to $300 or more per month depending on which plan you choose.

To compare accurately, add up what you expect to spend in a year with your current plan (your monthly premium times 12, plus expected copayments and deductibles based on how often you use healthcare). Then estimate what you might spend with Original Medicare plus a Medigap plan (the Part B premium times 12, plus your Medigap plan premium times 12, plus any out-of-pocket costs). Don't forget to include Part D prescription drug costs in both scenarios. This comparison will help you see which option costs less based on your personal healthcare needs.

Practical Takeaway: Use a spreadsheet or simple table to list all costs for both plans side by side. Include premiums, deductibles, your typical copayments or coinsurance, and prescription drug costs. Add them up for a yearly total so you can