So somebody told you that you can switch between Medicare Advantage (MA) and Original Medicare (OM) any time you want did they?
Stay tuned for the rest of the story.
I’ll be sharing with you the details of when and how you can switch between these options as well as the dangers involved. Spoiler alert: you may get stuck someplace you don’t want to be.
But first a brief introduction. My name is Greg Howard. I’m regional manager for USA Benefits Group, author of Medicare Made Easy, a 3-step guide to enrolling in Medicare, host of the internet talk radio show “Would The Real Obamacare Please Stand Up”, and a Medicare broker since 2009. All of that and $5 will get you a cup of coffee at Starbucks.
Having said all of that, now let’s take a look at the process of switching between MA and OM.
The short answer is to the question “Can I Switch Between Medicare Advantage and Original Medicare is YES, but as you will discover, there are lots of complications. So the real question is not “Can I Switch”, but “Should I Switch” or "Should I take a MA plan at all?" Confused? I try to clear things up.
Scenario 1 starts with you taking a MA plan when you first become eligible for Medicare.
Your first year is your MA test drive year. You can drop the plan and enroll in original medicare with a medicare supplement plan just as if you were enrolling in the Medicare for the first time. You can pick any supplement plan your like with no medical underwriting.
HERE’S THE RUB:
After your test drive year, you can always switch between MA and OM, but you will typically be subject to medical underwriting to get a supplement plan. Well what does that mean? It means that the insurance companies who offer supplement plans will look at your medical history and can decline to offer you a supplement plan because of it.
The result is that you become responsible for all the deductibles, copays and the 20% coinsurance that original Medicare doesn’t cover with no limit to your out-of-pocket expense. This is particularly important since according to a CBS News report released in August of 2017, quote “a large number of Medicare Advantage enrollees, especially those in poor health, drop out of the plans because they have trouble getting access to the care they need.” CBS’s report continues to say that this is a direct result of the fact that“provider networks have become smaller, with fewer specialists.”
So although you can always switch from MA to OM, there are situations in which you may not want to or can’t afford to.
Scenario 2 starts with you enrolling in OM and a supplement plan.
Then at a later date, say during open enrollment, you enroll in a MA plan. Again, you have 1 year to test drive the MA plan, but should you decide to switch back to OM during that 1st year, the only supplement plan that is required to take you is the plan you originally had. All others can be medically underwritten and you can be declined if you are in poor health.
After a full year on a MA advantage plan you are in the same place as in scenario 1 where you may be declined supplemental coverage due to your medical history. Again that puts the expense of the 20% OM doesn't cover squarely on you with no limit to out of pocket costs.
WHAT SAY YOU
A recent client told us this:
“Medicare Advantaged look like a good deal, but with my diabetes and other complications I could see it could get to be really expensive later on. I got a lot of good information out of the article Greg wrote.”
Jenny – Wichita KS
The article she is referring to is title “Is Medicare Advantage Really an Advantage?” If you would like a copy, drop me a line at firstname.lastname@example.org and I’ll send you one.
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