Yes, you can leave your Medicare Advantage Plan, but only at designated times during the year.
Annual Election Period
First, you have the opportunity to leave your Medicare Advantage Plan during Medicare’s Annual Election Period, or AEP, which runs from Oct. 15 through Dec. 7 each year. During the AEP, Medicare beneficiaries have the opportunity to change their coverage by:
- Leaving a Medicare Advantage Plan and returning to Original Medicare
- Leaving Original Medicare for a Medicare Advantage Plan
- Switching from one Medicare Advantage Plan to another
- Enrolling in a Medicare Part D standalone drug plan.
If you enroll in a Part D drug plan, you will be forced off your Medicare Advantage Plan because you cannot be on both. Your return to Original Medicare would be effective Jan. 1.
Remember, after you make your annual deductible, Medicare Part B typically covers 80% of approved outpatient medical services. You are responsible for the remaining 20%. This is where a Medicare Supplement Policy is key. While 80% seems like a lot, a $100,000 outpatient procedure would leave you exposed to tens of thousands in medical bills without a supplement policy.
In order to get a Medicare Supplement Policy, however, you will need to be healthy enough to pass underwriting from an insurance carrier. Passing underwriting means that the carrier has evaluated your application and has determined that you meet the criteria and are eligible for coverage. If you don’t pass underwriting, you may be denied coverage or offered a policy with higher premiums or limited coverage.
Open Enrollment Period
The second opportunity you have to leave your Medicare Advantage Plan is during the Open Enrollment Period, or OEP, which runs from Jan. 1 to March 31. Unlike AEP, during which you can make broader changes to your Medicare coverage, during OEP you can make a one-time change if you’re already enrolled in a Medicare Advantage Plan. You can either switch to a different Medicare Advantage Plan or return to Original Medicare. You cannot use this period to move from Original Medicare to a Medicare Advantage Plan.
If it is outside of these two periods, unfortunately you are locked in and you will have to wait until the next Annual Election Period or Open Enrollment Period to make a change.
Medicare Advantage vs. Original Medicare
Even factoring in a Medicare Supplement Policy, the upside of Original Medicare is its flexibility. Unlike a Medicare Advantage Plan, with Original Medicare, you have the freedom to go wherever you choose without a network and with no copays, no maximum out of pockets, no prior authorizations and no pre-approvals.
If you’re on a zero-dollar Medicare Advantage Plan, it may be “free” for you, but the insurance carrier is getting paid $1,200 a month on your behalf from the government. The true cost to you comes into play when medical decisions are made by the carrier. Contractually, Medicare Advantage carriers have the right to deny coverage for procedures they don’t deem medically necessary. A Medicare Supplement carrier, on the other hand, will not get in the way of your care. If a doctor says it’s necessary and Medicare agrees, it will be paid for.