Switch Back From Advantage To Original Medicare

Has anyone switched back to Original Medicare from one of the Medicare Advantage plans ? How difficult was it to accomplish ? How long did the switch take ?

My Medicare Advantage HMO type plan has become too restrictive by limiting "in network" providers....

The only lesson that has been brought to me constantly from my support groups is exactly that.

The downside of changing - the companies reserve the right to qualify you, price in their scheme accordingly, and they are not required to accept you. Only the first company you sign with in the availability window is prohibited from review. My friends in the business say the first option is the only option for us.

Advantage plans are lousy for cancer folks.

Won't hurt to ask, but be prepared ...
Don't leave the one you're in until you have acceptance somewhere else.

This topic is a real sore spot for me. My wife goes on Medicare in 3 months. I have researched for over a year her best options since she has Parkinson’s with beginning dementia. Imagine my surprise to find out you only have a 6 month window once in part B to pick any plan regardless of your condition. I was under the misguided notion that Obamacare had done away with preexisting conditions. Wrong, that doesn’t apply to medigap plans! I have been told that a couple of states like NY and ME do require insurance companies to pick up everybody during open enrollment periods regardless of preexisting conditions if they want to sell insurance in that state. I don’t know if that’s true or not but it’s not the case where we live now in MD. Although we don’t have a lot of money we are going to start with a medigap plan which agent says has history of small annual rate increases because he told me another company is unlikely to ever pick her up again. If we live long enough to run out of money we will go to a Medicare advantage part C plan because they will pick up everybody except people on dialysis

Is "Original Medicare" now administered by private insurance companies? I thought it was still government run..A lot has changed since I signed up 12 years ago..

I'll talk to a representative tomorrow and see what I can and can not do..My "open enrollment period is not until next January But I think it's possible to go back into Original Medicare anytime..

My problem started when I tried to enroll in a clinical trial (in Denver) which required that I have working health insurance. My Medicare Advantage HMO type plan said the provider was "out of network" and refused to provide coverage. I asked for a one time exception and so far they refuse. The trial provider takes regular Medicare patients no problem so I'm trying to switch..

When you choose Medicare C Advantage you have opted out of the government run Medicare and are completely in a commercial insurance plan. All the government does is send the company money to pay premiums from the money you have paid into Medicare. All claims are paid by the insurance company only. The coverage must cover at least what Medicare does and can include additional coverages. The lower the premium the more restrictive the network and higher the out of pocket costs, generally speaking.

You can only opt back into Medicare during the annual open enrollment period, at such time you move from one Medicare region to another, or if your current company makes your plan unavailable. Fairwind, your problem isn’t Medicare. It is that if you go back on Medicare you will also need a supplement plan to fill in the gaps, deductibles and co-pays of Medicare plus a Plan D prescription plan. Remember part B pays 80% with you paying 20% with no limit and most everything we do with advanced PCa falls under B. The drugs like Zytiga fall under D as they are prescription and self administered.

Medicare supplement insurance can be underwritten except upon first enrolling in Medicare, moving to another region or in some states during open enrollment. Obamacare had little to do with Medicare and did not change this. Had it done so, Medicare supplements would have had huge price increases and would probably no longer be available. Traditional Medicare simply can not work without affordable supplement insurance. Initially Obamacare was to eliminate Advantage plans. about 35% of seniors use Advantage plans. Then Florida Senator, Bill Nelson, publicly said he would be a no vote if that happened and the provision was changed to allow Advantage plans.

All Medicare claims are administered and paid by 54 regional administrators. These are usually the insurance companies. The government does not administer the claims and payments.

In some areas like Florida, Advantage plans can be great with wide networks and additional coverages like vision and dental. In other areas they can be pretty bad. When I went on Medicare I was advised to enrol in Medicare and have a supplement plan. That would provide the most comprehensive coverage and allow me to see any provider in the US so long as they accepted Medicare. There is no in or out of a network for me.

Please see a good agent and see if the Shine program is active in your state. Great suggestion by Spouse21.

I am concentrating on having my existing Advantage plan make an exception and grant my request for an out of network visit so I can be interviewed for a clinical trial being conducted by The University Of Colorado Medical Center which is not in my network..Time is of the essence here, I can't wait until January to change plans..I get 95% of my care from the VA including drugs and cancer treatments but they can't help me with the trial..I need to get into treatment ASAP and the trial, offering a new approach, LU-177, the "Vision" trial, is my best bet. Failing that I'll go with Radium 223..

(No politics! None! - comment removed. - 142)

Rob, not sure you meant it as such, but just to clarify, there are A Lot of people receiving Medicaid benefits who have paid into the system - and many continue to do so. 🙂

Moderators - not wanting to politicize, just adding some accuracy.

Post Edited By Moderator (142) : 5/21/2019 7:19:09 PM (GMT-6)

I'm going on Medicare next year. I didn't realize it was going to be so confusing. Sounds like a Medicare agent is the only way to go. I'll be transitioning from Colorado's version of Obamacare to boot and my wife will be staying on it. It's bound to get ugly.

I started climbing the learning curve on how Medicare works a year or so before I turned 65. When I retired from teaching at age 60 I elected to stay on my former employer's insurance which meant that I had to pick up the premium. I'd already been paying to have my wife on the plan. They are self-insured and the coverage is excellent. She went through breast cancer/chemo 4 years ago and the bill was over $250K and our out-of-pocket was only about $5K.

I did not want to go with an Advantage Plan as a supplemental because we live in a relatively small community and don't have many choices plus we like to travel. To go on the open market for a regular supplemental meant that I would be leaving my former employer's plan which meant my wife would have to go too. The option was to buy a supplemental through them which is actually from a company on the East Coast. It's a Type "F" plan, meaning one of the best in terms of coverage.

When I elected to go to Cleveland for my RALP my insurance never balked. My total out-of-pocket was about $300.

Yes, I pay more than an Advantage Plan and I don't get the free gym membership but I figure I'm ahead in that game right now.

BTW, I have a relative with an Advantage Plan who snowbirds in Arizona and while there last winter got a cancer diagnosis. Their insurance told them they were on their own since they were out of network, meaning that they had to travel back to the home state for treatment.

As I turned 65, 12 years ago, many doctors, including my own, refused to accept Medicare. But they did accept Medicare Advantage. I was healthy at the time and signed up for a "free" (no extra cost) HMO type plan offered by ARRP through United Health Care. Living in Denver, the "in network" providers were many and the plan worked well for us for these 12 years especially when you consider its low cost..I must admit, when the Zytiga / Xtandi costs became difficult, I discovered I was eligible for care at the VA ! What a Godsend! From that point on, my Medicare insurance became secondary and was seldom used..Until this interesting clinical trial opened up and I discovered the trial provider was "out of network". As the wheels are turning, I think I'm going to be granted approval to see the out of network provider and all these problems go away..Wish me luck..

Fairwind - Good luck and I hope you are successful, hang in there and keep fighting the system.

Hi Jim.. No 'Nam and no disability except hearing loss (jet engine noise) so they gave me a pair of nice hearing aids which have helped me a lot..I too investigated the VA when the Zytiga / Xtandi co-pays became a burden..A VA Oncologist must write the script..No big deal, I LIKE my VA oncologist better than my Medicare one..The care they recommend and provide is virtually the same. While traveling, I have also been treated at the VA Hospital in Providence with no complaints. The VA has a "system" Don't fight the system and you will have no problems...

When I applied a few years ago, they cared nothing about assets, just annual income. A simple question, what's your annual income, that was it.. For a married Vet to be eligible, their annual income had to be below $38,500 or something close to that.. Also, the requirements have been loosened as the number of Vets diminishes.. And yes, they do check..They publish a booklet, "Veterans Health Benefits Handbook" usually available at the front desk at any VA facility.. Or www.va.gov/healthbenefits