Can you switch from Medicare Advantage to original Medicare without penalty?

Yes, you can switch from Medicare Advantage (MA) to Original Medicare without a penalty for leaving the MA plan, but you must enroll in a standalone Part D drug plan within 63 days to avoid a Part D late enrollment penalty, and you may face underwriting for a Medigap (Medicare Supplement) policy. You can make this switch during the Annual Enrollment Period (Oct 15–Dec 7) or the Medicare Advantage Open Enrollment Period (Jan 1–Mar 31), or via a Special Enrollment Period (SEP) if eligible.

How do I switch from Medicare Advantage to original Medicare?

To switch from Medicare Advantage (MA) to Original Medicare, you must disenroll from your MA plan during the Annual Enrollment Period (Oct 15-Dec 7) or the MA Open Enrollment Period (Jan 1-Mar 31), enroll in a standalone Part D plan (since MA includes drug coverage), and potentially apply for a Medigap plan, ideally within 6 months of leaving MA for guaranteed acceptance in most states. You can disenroll by contacting your MA plan or Medicare directly (1-800-MEDICARE), and enrolling in a Part D plan automatically cancels your MA plan. 

Why are people opting out of Medicare Advantage plans?

People are leaving Medicare Advantage (MA) plans due to difficulty accessing care (like provider network limits, prior authorizations), dissatisfaction with care quality, issues with plan generosity, and challenges with specific plans, especially as their health needs grow, often leading them back to Original Medicare for broader choice but sometimes finding it hard to switch. Healthier individuals might join for perks, but sicker enrollees often face network restrictions, approval hurdles, and poor experiences, prompting disenrollment, notes KFF and ElderLawAnswers. 

Does getting a Medicare Advantage plan make you lose original Medicare?

There are no ``penalties'' going back to original Medicare as you've always had Medicare even while in a Medicare advantage plan. Penalties are for those who disenroll from part b completely which you haven't done.

What is the 7 month rule for Medicare?

This is called your Initial Enrollment Period. It lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65. My birthday is on the first of the month.

Unhappy with Medicare Advantage? How to Leave Your Advantage Plan for Original Medicare

At what age do you stop paying Medicare premiums after?

Your CalPERS health coverage will automatically be canceled the first day of the month after you turn 65. See Cancellation of CalPERS Health Coverage for information on reinstating your health coverage.

What is the biggest disadvantage of the Medicare Advantage plan?

The biggest disadvantage of Medicare Advantage (MA) plans is often the limited provider networks and restricted access to care, requiring prior authorizations, referrals, and potentially forcing you to switch doctors or travel far for specialists, creating barriers to timely treatment, especially for complex health issues, with potential for denials and mid-year changes. While MA offers extras like dental/vision, these networks can significantly limit choice and create hurdles for consistent, high-quality care compared to Original Medicare. 

Is there a penalty for switching from Medicare Advantage to regular Medicare?

No, there's no direct penalty for switching from Medicare Advantage (Part C) back to Original Medicare (Parts A & B), but you risk significant issues: losing drug coverage (Part D penalty if you don't enroll in a separate plan) and potentially being denied or paying much more for a Medigap supplement due to medical underwriting after your initial guarantee period ends. You must switch during specific enrollment periods (Annual Election Period: Oct 15-Dec 7, or MA Open Enrollment: Jan 1-Mar 31). 

Can I cancel my Medicare Advantage plan and go back to Medicare?

Yes, you can cancel your Medicare Advantage (MA) plan and return to Original Medicare (Parts A & B), primarily during the Medicare Advantage Open Enrollment Period (Jan 1 - Mar 31), but also during the Annual Enrollment Period (Oct 15 - Dec 7) or via a Special Enrollment Period (SEP) if you have a qualifying event (like moving out of the plan's service area). When you switch back, you'll need to enroll in a separate Part D drug plan to avoid coverage gaps, and you might consider a Medigap policy for extra help with costs, though underwriting rules apply. 

Which is better, a Medicare Advantage plan or original Medicare?

Neither Original Medicare nor Medicare Advantage (MA) is universally "better"; the best choice depends on your healthcare needs, budget, and preference for provider choice, with Original Medicare offering nationwide provider freedom but requiring separate drug/supplement plans, while MA provides all-in-one coverage with networks and extra benefits like dental/vision but often requires referrals and has regional limits. 

Why are hospitals refusing Medicare Advantage plans?

Across the country, health systems report that Medicare Advantage's growing administrative burden — from denied authorizations to delayed reimbursements — has become unsustainable. Some hospitals have already ended their contracts; others are limiting participation to only a few select plans.

Can I change from a Medicare Advantage plan to a Medicare supplement plan?

Yes, you can switch from a Medicare Advantage (MA) plan to a Medicare Supplement (Medigap) plan, but it's easier to do so within the first year of joining MA, or during specific enrollment periods like the Annual Enrollment Period (Oct 15-Dec 7) or Medicare Advantage Open Enrollment Period (Jan 1-Mar 31). You must first disenroll from your MA plan and return to Original Medicare, then you have a 63-day window to apply for a Medigap policy, but you might face medical underwriting or denial if it's not during your Medigap Open Enrollment Period, unless you're in a state with special rules or have a Guaranteed Issue Right. 

Which Medicare Advantage plan denies the most claims?

Centene (Wellcare) and CVS Health (Aetna) have faced scrutiny for high prior authorization denial rates in Medicare Advantage (MA) plans, with reports showing they had the most denied requests in 2023, though many denials were overturned on appeal, indicating issues with their strict criteria, while UnitedHealthcare also faces lawsuits and uses technology that has led to increased denials, especially for post-acute care, highlighting systemic challenges with MA plan claim approvals. 

Why do people switch back to original Medicare?

However, cost alone was not a driver of plan switching. Instead, factors such as poor access to care, low quality, low plan star ratings and less generous fringe benefits played a more significant role in the decision to leave.

What are the biggest mistakes people make with Medicare?

The biggest Medicare mistakes involve missing enrollment deadlines, failing to review plans annually, underestimating total costs (premiums, deductibles, copays), not enrolling in a Part D drug plan with Original Medicare, and assuming one-size-fits-all coverage or that Medicare covers everything like long-term care. People often delay enrollment, get locked into old plans without checking for better options, or overlook financial assistance programs, leading to higher out-of-pocket expenses and penalties. 

What is the best health insurance for seniors on Medicare?

There's no single "best" health plan, as it depends on your needs, but top providers for Medicare Advantage (Part C) include Humana, UnitedHealthcare, Aetna, and BCBS, offering diverse benefits like $0 premiums, extra perks, and strong networks, while Medigap (Medicare Supplement) complements Original Medicare by filling gaps, with popular carriers like AARP/UHC, Anthem, and Cigna providing standardized policies (Plans G, F, N), with personalized choices best found via your State SHIP counselor or broker. 

How difficult is it to switch from Medicare Advantage to original Medicare?

Switching from Medicare Advantage (MA) to Original Medicare (OM) isn't overly difficult, but timing and Medigap/Part D enrollment are crucial; you can switch during annual periods (Oct 15-Dec 7, Jan 1-Mar 31) or via Special Enrollment Periods (SEPs), but you'll need to get a separate Part D plan for drugs and may face underwriting for a Medigap (supplement) policy unless you're in a trial period or have guaranteed issue rights, which can be tricky. 

Does everyone have to pay $170 a month for Medicare?

If you don't get premium-free Part A, you pay up to $565 each month. If you don't buy Part A when you're first eligible for Medicare (usually when you turn 65), you might pay a penalty. Most people pay the standard Part B monthly premium amount ($202.90 in 2026).

Can you switch from Medicare Advantage to original Medicare preexisting conditions?

Yes, you can switch from Medicare Advantage (MA) to Original Medicare (Parts A & B) with pre-existing conditions because Original Medicare can't deny you coverage, but the real challenge is getting a Medigap (Supplement) plan to cover gaps, as insurers can apply waiting periods or deny coverage outside of specific "guaranteed issue" windows, like the first year or special situations. You can return to Original Medicare during Annual Enrollment (Oct 15-Dec 7) or specific Special Enrollment Periods (SEPs), but after the first year of MA, you might need medical underwriting for Medigap. 

Can you cancel Medicare Advantage at any time?

No, you generally cannot cancel Medicare Advantage (MA) at any time; you must use specific enrollment periods like the Annual Election Period (Oct 15-Dec 7) or the MA Open Enrollment Period (Jan 1-Mar 31) to switch or drop your plan and return to Original Medicare, though you might qualify for a Special Election Period (SEP) for life changes like moving or losing other coverage. Canceling without joining new coverage leaves you responsible for all Original Medicare costs, and you might face late enrollment penalties if you re-enroll later. 

What is the most highly rated Medicare Advantage plan?

There's no single "most highly rated" Medicare Advantage plan nationwide, as ratings vary by location and insurer, but Kaiser Permanente often leads in integrated care markets (like CA) for high CMS & J.D. Power scores. Aetna gets high marks for nationwide reach & ratings, while UnitedHealthcare, Humana, and SCAN Health Plan are consistently strong performers with high CMS Star Ratings and member satisfaction, often offering $0 premium options and extra benefits. 

What is the 3 month rule for Medicare?

Generally, you're first eligible to sign up for Part A and Part B starting 3 months before you turn 65 and ending 3 months after the month you turn 65. (You may be eligible for Medicare earlier, if you get disability benefits from Social Security or the Railroad Retirement Board.)

Is it better to have plain Medicare or Medicare Advantage?

Neither Original Medicare nor Medicare Advantage (MA) is universally "better"; the best choice depends on your healthcare needs, budget, and preference for provider choice, with Original Medicare offering nationwide provider freedom but requiring separate drug/supplement plans, while MA provides all-in-one coverage with networks and extra benefits like dental/vision but often requires referrals and has regional limits. 

What does Dave Ramsey say about Medicare?

Dave Ramsey's Medicare advice centers on planning ahead, understanding enrollment periods to avoid penalties, using Health Savings Accounts (HSAs) if possible, and supplementing Original Medicare with Medigap or Medicare Advantage (Part C) to cover gaps like dental, vision, and long-term care, stressing that mistakes can be costly and recommending expert advice for personalized choices. 

What states have the worst Medicare Advantage plans?

States often cited for weaker Medicare Advantage performance include Louisiana, Mississippi, Kentucky, West Virginia, and Florida, due to challenges with care access, provider shortages, and quality issues like higher rates of avoidable hospitalizations and inappropriate medication prescriptions, though specific rankings vary by report and focus (e.g., satisfaction vs. overall system). Other states like New York, California, Texas, and Michigan appear on lists for low member satisfaction with specific plans, not necessarily the whole state's system.