3 Things That Can Happen When You Switch from Medicare Advantage to Original Medicare


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Written by Guest | Last Updated October 31st, 2019
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Topics: Medicare

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Guest Post by Troy Frink 

Many people know about Original Medicare (Part A and Part B), the public health insurance program created in 1965 for retiree coverage. Did you know there are additional private plans called Medicare Advantage (MA) plans that can provide more health benefits? MA plans are growing in popularity so much that Medicare Advantage enrollment has nearly doubled in the past decade.

If you already have Medicare Advantage, you might enjoy the additional health benefits it offers, but you might think that switching back to Original Medicare can save you money. Or, you might simply think that you don’t need the extra health benefits that Medicare Advantage plans can provide.

Your health is extremely important, and you shouldn’t make that decision without being well-informed. Here are three things that can happen if you switch from Medicare Advantage to Original Medicare:

1. You may lose all of the additional benefits Medicare Advantage Plans can offer

If you only have Original Medicare, you have coverage for all of the services it offers, but it doesn’t cover everything. Part A is hospital insurance, and it only covers inpatient services. Part B is medical insurance, and it covers outpatient services, doctor visits, and emergency transportation to the hospital. Original Medicare also provides preventive services such as annual wellness visits, tests, and screenings.

However, a lot of benefits are not included. For example, Original Medicare only provides drug coverage when those drugs are part of a hospital service. That means it doesn’t cover many of the medications you need every day.

Some Medicare Advantage plans, however, offer prescription coverage. If you switch from a Medicare Advantage that has prescription benefits to Original Medicare only, you can lose your prescription coverage and more. Some of the other benefits you could lose out on by having Original Medicare only are fitness, hearing, dental, vision, meal delivery, and non-emergency medical transportation benefits.

2. You may end up spending more money

If you drop your Medicare Advantage plan, you could actually end up spending more money.

For example, some MA plans come with a fitness benefit. If you didn’t have that Medicare Advantage coverage, you’d be responsible for paying for your own gym membership. They can also have dental benefits. If you don’t have Medicare Advantage, you may have to pay for a separate dental plan, adding yet another monthly cost.

To further illustrate what could happen if you dropped your Medicare Advantage plan, let’s use a hypothetical prescription drug coverage example.

If you dropped your MA plan and you still wanted prescription coverage, you’d have to enroll in Medicare Part D. The average monthly premium for Part D plans is $33.19. Medicare Advantage plans can cost the same or a little less. If you pay the same (or more) for your Part D, you may only get one benefit (prescription drugs) for the same cost as Medicare Advantage, which can provide several additional benefits.

3. Your quality of care could suffer

CMS releases Medicare Advantage plan ratings called star ratings every year. The star ratings range from one to five stars. The rating system is as follows:

  • Five stars: Excellent
  • Four stars: Above average
  • Three stars: Average
  • Two stars: Below Average
  • One star: Poor

Several different factors affect Medicare Advantage plan ratings:

  • How easy it is to access preventive services (including annual physical exams and health screenings)
  • Care coordination
  • How often plan members receive care for chronic conditions
  • Current beneficiary satisfaction
  • How well the plan performs when compared to years past
  • Quality of customer service

If a plan receives less than a three-star rating for three years in a row, CMS will keep a close eye on it. If the plan continues to under-perform, CMS could remove the plan entirely. The star rating system keeps Medicare Advantage carriers in check. The carriers don’t want their plans removed, so they’ll work to offer the best plans possible.

Your care could suffer if you switch from Medicare Advantage to Original Medicare. There are no star ratings for Original Medicare. Even though CMS rates doctors, your care could suffer because there may not be any coordination between your care team. Plus, you won’t have a tight-knit network, which means that you may not have a secure way of knowing if the doctor you’re seeing has received high ratings from CMS.

Medicare Advantage Plans offer different benefits

If you still want to switch from Medicare Advantage to Original Medicare, you’ll have the opportunity to make changes to your plan or drop coverage during the AEP.

You might find that you really need to find a new Medicare Advantage plan instead of dropping that coverage altogether. Or, you may think about it and decide that you really don’t need Medicare Advantage, and that’s okay, too, as long as you understand your options. This decision is an important one, so be sure to think about it before changing your coverage — you might be stuck with that decision for at least a year!

Troy Frink is the Content Manager at MedicarePlanFinder.com. He has bachelor’s degrees in film studies and journalism from the University of Missouri - Kansas City and has a passion for digital content. When he isn’t writing blogs for Senior Market Advisors and Medicare Plan Finder, he’s either participating in Olympic weightlifting, coaching Special Olympics powerlifting, or playing with his cat, Lemmy Adam.

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