More than 67.7 million Americans are currently receiving Medicare benefits. Of this number, 24.1 million are enrolled in Medicare Advantage plans. Medicare Advantage offers unique benefits but typically comes at a higher cost than Original Medicare. Recipients of Original Medicare benefits are eligible to switch from their current plan to Medicare Advantage plans, but there are some rules.


Switching From Original Medicare to Medicare Advantage

Many Original Medicare beneficiaries may wish to make changes to their Medicare coverage. During the annual open enrollment period, you will be able to switch from Original Medicare to Medicare Advantage. Although the open enrollment period falls between October 15 and December 7, the changes don’t take effect until January 1. 


Upon switching to Medicare Advantage for the first time, enrollees are eligible for a one-year “trial” plan. During this period, people who have switched from Original Medicare to Medicare Advantage can switch back to Original Medicare whenever they like. They will also be able to access guaranteed-issue Medigap coverage. This trial period is only extended to individuals who had a Medigap plan before switching and who haven’t ever had a Medicare Advantage plan before. 


What to Consider

If you intend to upgrade to Medicare Advantage, you should look out for a couple of factors:

  • Be sure to consider the scope of your provider network
  • Think about whether you will likely need coverage from out-of-network providers
  • Maximum out-of-pocket costs can be as high as $6,700
  • Maximum out-of-pocket costs do not include prescription drugs


Medicare Advantage Networks

While Original Medicare can only be used with doctors or healthcare facilities that accept Medicare, Advantage plans are more versatile. With Medicare Advantage, you become a member of a fixed network of doctors, hospitals, and other healthcare providers. In some cases, beneficiaries may be able to have out-of-network care covered, but this will have higher costs than seeing in-network providers. 


Similarities and Differences

Medicare Advantage plans must at least provide the same benefits as Medicare Parts A and B. This means that when you shop for Medicare Advantage providers, their plans will all offer the same minimum level of coverage as your Original Medicare plan. 


The benefit of switching to Medicare Advantage is that the new plan will offer you more coverage than Original Medicare. While Original Medicare typically only covers medical and hospital costs, Medicare advantage offers a range of additional coverage options. They include:

  • Dental
  • Vision
  • Hearing
  • Prescription drugs


The number of days that Original Medicare will pay for you to stay in a hospital or skilled nursing facility is also limited. In comparison, once you’ve met your maximum out-of-pocket spend with Medicare Advantage, the plans will usually pay the total cost of most covered services. 


If you want to try a Medicare Advantage plan, you have options. For all of your Medicare-related questions, contact Fidelis Consultants.