If you are currently enrolled in Original Medicare (Part A and Part B) and want more comprehensive benefits, you may be considering switching to a Medicare Advantage Plan (Part C). Medicare Advantage plans are offered by private insurance companies and often include extra benefits like vision, dental, hearing, fitness memberships, and prescription drug coverage. 

This guide will walk you through the step-by-step process of switching from Original Medicare to a Medicare Advantage plan. We will cover eligibility requirements, enrollment periods, what happens to your existing coverage, and the important factors to consider before making the move. 

Table of Contents: 

What Is a Medicare Advantage Plan? 

A Medicare Advantage Plan (Part C) is an all-in-one alternative to Original Medicare. It bundles: 

  • Medicare Part A (hospital insurance) 
  • Medicare Part B (medical insurance) 
  • Extra benefits such as dental, vision, hearing, transportation, or wellness programs 

These plans are offered by Medicare-approved private insurers and may have different rules, costs, and provider networks. 

Medicare Advantage vs. Original Medicare: Key Differences 

Feature  Original Medicare  Medicare Advantage (Part C)  
Coverage Part A (Hospital) + Part B (Medical). Part D optional.  Part A + Part B + usually Part D, plus extra benefits. 
Costs 20% coinsurance after deductible, no out-of-pocket maximum.  Copays and coinsurance, with an annual out-of-pocket maximum. 
Providers Any provider that accepts Medicare nationwide. Limited to plan networks (HMO, PPO, etc.), except emergencies. 
Benefits Standard coverage only. May include dental, vision, hearing, fitness, transportation, meals. 
Medigap Can purchase Medigap for cost-sharing. Medigap is not allowed. 

Why Switch to Medicare Advantage? 

Here are some reasons people switch to Medicare Advantage: 

  • Here are some reasons people switch to Medicare Advantage: 
  • Convenience: One card and one plan for most healthcare needs. 
  • Cost Savings: Many plans have low or even $0 monthly premiums. 
  • Extra Benefits: Includes services not covered by Original Medicare. 
  • Prescription Drug Coverage: Most plans include Part D automatically. 
  • Out-of-Pocket Maximums: Protects you from unlimited expenses (Original Medicare has no cap). 

Types of Medicare Advantage Plans 

Before switching, it is helpful to understand the common plan types: 

HMO (Health Maintenance Organization) 

  1. Must use in-network providers (except emergencies). 
  1. Usually requires referrals for specialists. 
  1. Lower costs if you stay in-network. 

PPO (Preferred Provider Organization) 

  1. More flexibility: can see out-of-network providers at a higher cost. 
  1. No referral needed for specialists. 
  1. Higher premiums than HMOs but more freedom. 

PFFS (Private Fee-for-Service) 

  1. You can see any Medicare-approved provider who accepts the plan’s terms. 
  1. Less common than HMOs and PPOs. 

SNP (Special Needs Plans) 

  1. Tailored for people with specific conditions (like diabetes or heart disease), dual eligibility (Medicare + Medicaid), or living in institutions. 

When Can You Switch? 

You can switch to a Medicare Advantage Plan during one of these official enrollment periods:

Initial Enrollment Period (IEP) 

A 7-month window around your 65th birthday: 

  1. 3 months before your birth month 
  1. The month you turn 65 
  1. 3 months after 

Example: If you turn 65 in January, your IEP runs from October 1 through April 30. 

Annual Enrollment Period (AEP) 

  1. October 15 to December 7 every year. 
  1. Switch from Original Medicare to a Medicare Advantage plan or vice versa. 

Medicare Advantage Open Enrollment Period 

  1. January 1 to March 31. 
  1. Only available if you are already in a Medicare Advantage plan. You can switch to another Advantage plan or return to Original Medicare. 

Special Enrollment Period (SEP) 

  1. Triggered by events such as moving to a new service area, losing employer coverage, or qualifying for Medicaid. 

How to Switch to a Medicare Advantage Plan? 

Follow these simple steps: 

Step 1: Compare Plans 

Use the Medicare Plan Finder to compare available plans. Consider: 

  • Monthly premiums 
  • Out-of-pocket costs 
  • Doctor and hospital networks 
  • Prescription drug coverage (formulary) 
  • Extra benefits (dental, transportation, meals, etc.) 

Step 2: Check Eligibility 

You must: 

  • Be enrolled in Medicare Part A and Part B. 
  • Live in the plan’s service area. 

Step 3: Enroll in a Medicare Advantage Plan 

You can enroll: 

  • Through the plan’s website 
  • By calling 1-800-MEDICARE 
  • With help from a licensed insurance agent 

Once enrolled, your Medicare Advantage plan will administer your Part A and Part B benefits directly, replacing Original Medicare as your primary coverage. 

What Happens to Your Existing Coverage?

When you switch to a Medicare Advantage Plan: 

  • Your Medicare Part A and B coverage remains, but it is managed by the Advantage plan. 
  • If you have a standalone Part D or Medigap policy, you may need to cancel it. 

Important: Medigap cannot be used with Medicare Advantage. If you drop your Medigap plan, you may not be able to get it back later unless you qualify for a guaranteed issue right. 

Things to Consider Before Switching 

  • Provider Network: Ensure your doctors and hospitals are in-network. 
  • Prescription Drugs: Check the plan’s formulary for your medications. 
  • Out-of-Pocket Costs: Review copays, coinsurance, and annual maximum limits. 
  • Travel & Flexibility: Emergency/urgent care is covered nationwide, but routine care may be limited outside your service area. 
  • Extra Benefits: Compare dental, vision, OTC allowances, and wellness benefits. 
  • If you change your mind, you can: 
  • Use the Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31) to switch or return to Original Medicare. 
  • Make changes during the next AEP (Oct 15 – Dec 7). 

Note: Getting back your Medigap plan may not be guaranteed, and you may need to go through medical underwriting. 

Real-Life Example 

Mary, 67, from Florida, had Original Medicare and a standalone Part D plan. She was paying over $200 monthly for premiums and prescription drugs. After researching the AEP, she switched to a local HMO Medicare Advantage plan with a $0 premium, including drug coverage, and dental/vision benefits. She now pays significantly less and enjoys additional benefits like free fitness classes and telehealth. 

Lesson: Comparing plans annually can lead to better value and coverage. 

FAQs About Switching to Medicare Advantage 

Q1: Can I switch back to Original Medicare later? 

Yes, during AEP or Medicare Advantage Open Enrollment. However, regaining Medigap coverage may not be guaranteed. 

Q2: Do Medicare Advantage plans cover nationwide travel? 

They cover emergency and urgent care anywhere in the U.S., but routine care is usually limited to the plan’s network. 

Q3: What happens to my Part D plan if I switch? 

Most Medicare Advantage plans include drug coverage. If yours does, you should drop your standalone Part D plan. 

Q4: Can I have both Medigap and Medicare Advantage? 

No. Medigap is only for Original Medicare. 

Q5: Will switching affect my costs? 

Many Advantage plans offer $0 premiums, but costs vary. Always compare copays, coinsurance, and the annual out-of-pocket maximum. 

Conclusion 

Switching from Original Medicare to a Medicare Advantage plan can be a smart move if you want more bundled benefits and predictable costs. But it is essential to carefully compare plans, provider networks, and drug coverage before making the change. 

Take advantage of official enrollment periods, and do not hesitate to use Medicare.gov or a licensed agent for guidance. The right Medicare Advantage plan could lower your costs, expand your benefits, and simplify your healthcare experience. 

To learn more about Medicare Advantage plans, visit SarvaCare.