If you are enrolled in a Medicare Advantage (MA) plan, February 14th is not only Valentine’s Day… it’s the last day that you can switch back to original Medicare if you no longer want to keep your MA plan.
The regular Medicare open enrollment period to get an MA plan or a prescription drug plan (PDP) is from October 15th through December 7th each year.
NOTE: If you have original Medicare and a Medicare Supplement (also known as a Medigap plan) the annual open enrollment period between October 15th and December 7th does NOT affect you unless you want to sign up for a PDP or change the PDP that you currently have.
Acronyms and Definitions
There are quite a few Medicare Acronyms, which can be a little confusing at first if you aren’t familiar with them. Here is a list of acronyms that are used in this article:
- ANOC — Annual Notice of Change
- MA — Medicare Advantage
- MADP — Medicare Advantage Disenrollment Period
- MAPD — Medicare Advantage Prescription Drug (plan)
- MSA — Medicare Savings Account
- PDP — Prescription Drug Plan
- SEP — Special Enrollment Period
What is the Medicare Advantage Disenrollment Period?
If you have an MA plan and you want to switch back to original Medicare, you can do so during the Medicare Advantage Disenrollment Period (MADP), which is from January 1st through February 14th each year. This means that you will be covered under Medicare
Part A (Hospital) and Part B (Medical).
Can I Still Get Prescription Drug Coverage?
If you have a Medicare Advantage Prescription Drug (MAPD) plan, which is a combination of a Medicare Advantage plan plus a prescription drug plan, you can switch back to original Medicare and apply for a new and separate PDP, if you want to. However, if you have an MA plan that does not currently include prescription drug coverage, you will have to wait until the next Medicare open enrollment period between October 15th and December 7th.
NOTE: If you switch back to original Medicare, you must notify your MA or MAPD plan of your intention to leave their plan. However, if you have an MAPD and you sign up for a new PDP, you will automatically be dropped from your current plan, so it isn’t necessary to notify them.
What Am I Not Allowed to Do During the MADP?
As its name suggests, the MADP is very limited. Its only function is to give participants an opportunity to disenroll from MA or MAPD plans back to original Medicare. During this period, you’re not allowed to switch from one MA or MAPD plan to another, and you are not allowed to switch from original Medicare to an MA plan. You are also not allowed to change from one PDP to another during this period. For these kinds of changes, the only period when you can do so is during the regular Medicare open enrollment period between October 15th and December 7th.
Are All MA Plans Eligible for Disenrollment?
No. If you have a Medicare Medical Savings Account (MSA) or a Medicare MSA plan, then you’re not allowed to drop or switch plans during the MADP. Medicare MSA plans are a special kind of Medicare Advantage plan that combines a high-deductible insurance plan with a medical savings account that you can use to pay for your health care costs. The plan will only begin to cover your costs once you meet a high yearly deductible, which varies by plan.
When Does the MADP Change Take Effect?
Changes that you make during the MADP take effect on the first day of the following month. Therefore, if you want to switch back to original Medicare in February, your new effective date will be March 1st. It is also important to note that if you need to get prescription drug coverage along with the change, you must sign up no later than the February 14th deadline. That change also takes effect on the first day of the following month after enrolling.
If I Switch Back to Original Medicare, Am I Guaranteed the Right to Get a Medicare Supplement Plan?
In most cases, no. Unless you are relatively new to Medicare or in a Special Enrollment Period (SEP), if you switch back to original Medicare during the MADP, you are not guaranteed the right to sign up for a Medicare Supplement policy. This means that you would be responsible for all the deductibles, copayments, and coinsurance that are not covered by Medicare.
Before you switch back to original Medicare, you can (and should) apply for a Medicare Supplement plan, which will, in most cases, be medically underwritten. Ideally, it is best to apply before the February 14th deadline, so that you will know in advance if you meet the underwriting requirements that will qualify you for a Medicare Supplement.
As an independent insurance agent, I work with ALL the major Medicare Supplement insurance carriers. Rates vary significantly between insurance carriers, and I can not only do the shopping for you to make sure that you aren’t paying too much for your coverage, but some carriers have stricter underwriting requirements than others, and I may be able to find a carrier that will accept you if you have certain medical conditions.
What If I Have a Serious Health Condition and I Don’t Qualify For a Medicare Supplement?
If that is the case, I would probably advise that you stay on your current MA plan until the next Medicare open enrollment period that begins on October 15th. There are some “Tips and Tricks” that I am aware of that will usually qualify you for a Medicare Supplement, even if you have serious medical conditions! For example, during the annual open enrollment period, you will receive an Annual Notice of Change (ANOC) from your current MA plan. This notice will tell you of price changes from the current year to the following year.
In California, if your MA plan increased your premiums or copayments by 15% or more, reduced your benefits, or terminated its relationship with your medical provider who was treating you, you will qualify for a Medicare Supplement as a “Guaranteed Issue.” This means that regardless of your health, you can still get certain Medicare Supplement plans (plans A, B, C, F, K, or L)!
NOTE: Plan F is considered to be the most comprehensive plan, and it’s one of the most popular plans. In California, once you have Plan F, you can keep it for as long as you like or you can later switch to any other plan that you want!
Using the MADP is an option for those individuals who aren’t satisfied with their MA plans and want to return to original Medicare. Valentine’s Day is quickly approaching and the clock is ticking! If you want to make a change, you can still do so, but February 14th will be here soon!
If you have any questions or comments, or if you would like a free, no obligation Medicare Supplement quote, please don’t hesitate to let me know. Thank you!!!