Are You Really Stuck in a Medicare Advantage Plan?

Have you ever thought, Can I quit my Medicare Advantage plan? Do not worry if someone told you that once you join a Medicare Advantage (Part C) plan, you will always be a part of it. Not true! There are ways for you to change or leave your plan, and this article will help you understand them in an easy way.

We are passionate about helping people understand Medicare. We take pride in guiding individuals through the process in a clear and easy-to-understand way, making Medicare less confusing for everyone.

What Does “Locked In” Mean in Medicare Advantage Plan?

Some say that once you choose a Medicare Advantage plan, you can’t change it. Doesn’t that sound scary? But the truth is that you won’t be stuck there forever. You can leave, but not whenever you want.

It means you might have to wait until the right time of year to make a change. So no, you’re not stuck for good. But you might have to wait until a certain time to leave.

When Can You Leave a Medicare Advantage Plan?

There are two main times every year when you can leave your Medicare Advantage plan:

Annual Enrollment Period (AEP)

This happens from October 15 to December 7 each year. During this time, you can:

• Drop your Medicare Advantage plan.
• Go back to Original Medicare (Part A and B).
• Start new coverage beginning January 1st.

Medicare Advantage Open Enrollment Period (MA-OEP)

This happens from January 1 to March 31 each year. During this time, you can:

• Drop your Medicare Advantage plan.
• Go back to the Original Medicare.
• Your change starts next month.

Example: If you decide to leave your plan in February, your new coverage will start on March 1.

Can You Leave Medicare Advantage Mid-Year?

Yes, but it’s harder. You must have a Special Enrollment Period (SEP). Here are a few reasons that might qualify you:

You Move

If you move to a new area and your plan doesn’t work there, you can leave the plan and go back to Original Medicare.

Change in Medicaid or Extra Help

If your financial help changes, like if you:

• Start getting Medicaid.
• Lose Medicaid.
• Start or stop getting Extra Help with prescription drugs.

Then, you can leave your Medicare Advantage plan within 63 days.

Trial Right (First-Time Users Only)

If it’s your first time ever on a Medicare Advantage plan, you get 12 months to decide if you like it. If not, you can go back to Original Medicare at any time during that first year.

What Happens After You Leave?

If you leave a Medicare Advantage plan and go back to Original Medicare, that means:

• Medicare pays 80%.
• You pay 20% out of pocket (for doctor visits, hospital stays, etc.).

If you don’t want to pay that 20%, you can buy a Medigap plan to help cover it. But there’s one big catch:

• You can easily buy Medigap as long as you’re within the first six months of starting Medicare Part B. There are no health questions.
• If it’s after 6 months, you have to pass medical questions to get Medigap coverage.

So, if you’re not healthy, it could be harder to get a Medigap plan.

What Should You Watch Out For?

Before leaving Medicare Advantage, here are three important things to think about:

Are you ready to pay 20%?

If you don’t get Medigap, those bills can add up.

Can you get Medigap without health questions?

If not, you might be stuck with high costs.

Do you have coverage for prescriptions and extras?

When you leave Part C, you might need to buy separate plans for things like medicine, dental, and vision.

Frequently Asked Questions

Can I leave my Medicare Advantage plan anytime I want?

No, you can’t leave anytime. But there are times of the year when you can leave. You can sign up during these times: October 15–December 7 and January 1–March 31.

What happens if I move to a new state or city?

If you move to a place where your current plan doesn’t work, you may be able to leave the plan early and go back to Original Medicare. This is called a Special Enrollment Period.

Will I have to pay more if I leave Medicare Advantage?

Maybe. If you go back to Original Medicare, it only pays 80% of your costs. You would have to pay the other 20% unless you buy a Medigap plan to help cover it.

Can I get back into a Medicare Advantage plan later?

Yes! You can join again during the next enrollment period. Just because you leave now doesn’t mean you can’t sign up again later.

What is a “trial right” for new Medicare Advantage members?

You have a year to decide if you like a Medicare Advantage plan if it’s your first time with one. If you don’t want to, you can go back to Original Medicare at any time.

Final Thoughts

So, can you leave your Medicare Advantage plan? Yes, you can! You are not stuck in it forever. There are specific times when you’re allowed to switch or drop your plan. You can make changes every fall during the Annual Enrollment Period, which runs from October 15 to December 7, or during the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31 each year. You might also qualify to leave your plan at other times if you move to a new area or lose certain types of financial help, like Medicaid or Extra Help. And if it’s your first time trying a Medicare Advantage plan, you have a special 12-month “trial right” that allows you to return to Original Medicare. However, it is very important to know what could happen next before you make any changes. This is especially true when it comes to how your costs and services might change.

Don’t worry if this sounds a little off. You don’t have to figure it out by yourself. At LMS Insurance Group, we help people understand their Medicare options and make the best choices for their health and budget. Contact us today to talk to a friendly expert who will guide you step-by-step.