NJ Life & Health Insurance Group
  • Ken Connolly

How Can I Get Out of a Medicare Advantage Plan?

Some of our clients love Medicare Advantage plans, while for others it’s not their cup of tea. We always give an honest comparison between the two when our clients are first eligible for Medicare. This way, they make an informed decision that they can be happy with going forward.


Unfortunately, some people are coerced into taking Medicare Advantage plans without a thorough disclosure of what they are signing up for. Agents at insurance companies tout all the great benefits about these plans without covering the downsides. This leaves people feeling like they were duped and wanting a different plan.

It can be hard to leave a Medicare Advantage plan, but it is possible. We will cover the different situations that allow you to leave and go back onto Original Medicare.


Situations Where You Can Switch Out of a Medicare Advantage Plan


You Are in Your First Year of a Medicare Advantage Plan


If you are in the first year of your Medicare Advantage Plan, you have the right to switch back to Original Medicare and get a Medicare Supplement no questions asked. You can do this at any time of the year through what is called “Guaranteed Issue – Trial Right.” This allows you to go onto any Medicare Supplement you are eligible for with no health questions asked.


This first year opt out works in 2 situations. If you took a Medicare Advantage plan when you were first eligible for Medicare, you can decide within the first year to switch back to Original Medicare using this guaranteed issue and join a Medicare supplement. If on the other hand you were in Original Medicare and a supplement for many years and then switched to a Medicare Advantage plan, you have a year to try it out. If during the first 12 months you decide it is not for you, you can switch back to Original Medicare and that same supplement using this guaranteed issue.


Normally when you try to enroll in a Medicare Supplement after age 65 you will be asked a series of health questions. It is a laundry list of medical conditions ranging from heart and lung issues to cancer. If you are healthy, you should have nothing to worry about. But if you do have a more serious medical condition, there is a chance you will be denied. This is why Guaranteed Issue is so important if you qualify; it allows you to skip health questions and enroll automatically into the plan of your choosing.


You Left or Were Kicked Off Your Work Insurance


If you leave your work insurance voluntarily or involuntarily, you will be given 63 days after your disenrollment to get into any Medicare-approved health plan you would like. This is a great option if you initially signed up for a Medicare Advantage plan and are now having doubts. If you are within 63 days of losing your work insurance, you can switch out of your Medicare Advantage plan back into Original Medicare and a supplement no questions asked.


This is a great option for people who stayed on their work insurance even when they had both Medicare A & B. You have lost your Initial Enrollment Period, but you are given the option of Guaranteed Issue. Talk to your broker before you are going to lose your work insurance if possible, to avoid missing this window.


You Have Been on A Medicare Advantage Plan for Several Years


If after a few years on a Medicare Advantage plan you decide it is not for you, you can potentially switch out. It is not always easy, but it is possible. First, talk to your broker to make sure you are not eligible for the two guaranteed issue situations we described above. If you don’t qualify for either, your broker and you have another option to explore.


As discussed earlier, if you apply for a Medicare Supplement outside of any enrollment period you will have to answer health questions. This is called Underwriting. The insurance company you apply to will ask you a series of health questions and look through your medical records to determine your eligibility. If they deem that you have too many pre-existing conditions, you will unfortunately be denied. To get onto to Original Medicare with a Medicare Supplement, you will have to pass this test.


On top of answering all the health questions, you must also time your move to Original Medicare properly. It is not available at all times of the year. This is because when you disenroll from your Medicare Advantage plan you will need to get a new Medicare Prescription Drug Plan in its place. These are only available during the Annual Enrollment Period from October 15th to December 7th or during the Open Enrollment Period from January 1st to March 31st. Enrolling in a standalone Medicare Prescription Drug Plan will complete your disenrollment from Medicare Advantage.


The timing can be tricky, so it is highly recommended you work with a trusted broker to help guide you through the process. To execute everything correctly, you will first apply for a Medicare Supplement during one of these enrollment periods. It will typically take the insurance company 3-7 business days to underwrite your application. Once your application has been approved, you can then sign up for your Prescription Drug Plan to leave your

Medicare Advantage Plan.


Make sure your enrollment date for your Medicare Supplement coincides with when your new Prescription Drug Plan starts. You cannot have a Supplement and Advantage plan at the same time.


Final Thoughts


Getting out of a Medicare Advantage plan can be a chore. It largely depends on your situation and the help you can get from a broker to guide you. Keep your broker in the loop so they can anticipate your changing health needs and keep you on the plan you want to have with no hassle. If you want to change out of a Medicare Advantage plan, reach out to the trusted brokers at NJ Life & Health. We will help you through the whole process and do our best to get you back onto Original Medicare. Visit our website at https://www.njlifeandhealth.com/request-an-appointment or call our office at 848-226-6897 to schedule your appointment.

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We Do Not Offer Every Plan Available In Your Area. Any Information We Provide Is Limited To Those Plans We Do Offer In Your Area. Please Contact Medicare.gov Or 1-800-MEDICARE to get information on all of your options.

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