If you enrolled in a Medicare Advantage plan and later realized it isn’t the best fit, you’re not alone. Many people find that their needs or preferences change after signing up. Maybe your favorite doctor isn’t in the network, your prescriptions cost more than you expected, or the plan’s coverage just isn’t working for your situation.
The good news is that Medicare gives you specific windows throughout the year when you can leave your Medicare Advantage plan or switch to another one. These are called disenrollment periods. There are about four different types of Medicare Advantage disenrollment periods, and we’ll take you through each one today.
What It Means to Disenroll from Medicare Advantage
Disenrolling from a Medicare Advantage plan simply means you’re leaving your current plan. In most cases, you’ll automatically return to Original Medicare, which includes Part A (hospital coverage) and Part B (medical coverage). Once you’re back on Original Medicare, you can add a Part D prescription drug plan if you want medication coverage, and you may have the option to apply for a Medigap (Medicare Supplement) plan to help cover out-of-pocket costs like deductibles and coinsurance.
It’s important to remember that disenrolling isn’t quite the same as switching to a new Medicare Advantage plan, although some enrollment periods allow you to do both. Essentially, disenrollment means you’re leaving Medicare Advantage entirely, while a plan switch keeps you within the program but with different benefits or providers.
The Medicare Advantage Open Enrollment Period
The first disenrollment opportunity each year happens between January 1 and March 31. This window, known as the Medicare Advantage Open Enrollment Period (MA OEP), is available to anyone who’s already enrolled in a Medicare Advantage plan.
During this time, you can switch to a different Medicare Advantage plan if you find one that better fits your needs, or you can drop your Advantage plan altogether and return to Original Medicare. If you go back to Original Medicare, you can also join a standalone Part D plan to keep your prescription coverage.
However, there are limits. You can only make one change during this period, and you can’t use it to join a Medicare Advantage plan for the first time.
For example, suppose you joined a Medicare Advantage plan in the fall, but after a few months you realize your preferred doctor isn’t covered. During the MA OEP, you can leave that plan and go back to Original Medicare, or switch to a plan that includes your doctor in its network. Your new coverage would begin on the first day of the month after you make the change.
The Annual Enrollment Period
The most well-known time to make changes to your Medicare coverage is the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. This is when most people review their current plan and decide if they want to make adjustments for the coming year.
During the AEP, you can leave your Medicare Advantage plan and return to Original Medicare, switch to a different Advantage plan, or make changes to your Part D prescription drug coverage. Any updates you make during this period take effect on January 1 of the following year.
Many people use this opportunity to disenroll because their current plan is changing. Maybe premiums are increasing, drug coverage is being adjusted, or certain benefits are being reduced. Reviewing your Annual Notice of Change (ANOC) each fall is the best way to know whether your plan will still meet your needs in the upcoming year.
The 5-Star Special Enrollment Period
There’s also a lesser-known opportunity to change plans called the 5-Star Special Enrollment Period. This period runs from December 8 through November 30 of the following year.
Medicare rates all Medicare Advantage and Part D prescription drug plans on a scale from one to five stars, with five stars representing excellent performance. These ratings are based on factors like customer service, member satisfaction, preventive care, and overall quality.
If a 5-star Medicare Advantage plan becomes available in your area, you can use this period to switch to it once during the year, even if it’s outside the normal enrollment windows. You can also use this opportunity to leave your current Advantage plan and join the higher-rated one. It’s a useful option for anyone looking to upgrade to a top-rated plan without waiting for the fall enrollment season.
Special Enrollment Periods for Life Changes
In addition to the standard windows, Medicare also offers Special Enrollment Periods (SEPs) for certain life events. These allow you to make coverage changes outside the typical enrollment periods if your circumstances qualify.
You might qualify for a SEP if you move out of your current plan’s service area, lose other health coverage (like employer or Medicaid benefits), or if your plan stops offering coverage in your region. You could also qualify if you receive Extra Help for prescription drug costs or if you’re eligible for, or leaving, a Special Needs Plan.
Each SEP comes with its own rules about when you can make changes and how long you have to act. If you think one might apply to you, it’s a good idea to review your situation with a licensed Medicare agent who can help determine your eligibility.
What to Expect After You Disenroll
Once you’ve disenrolled from your Medicare Advantage plan, your coverage will automatically revert to Original Medicare Parts A and B. If you want prescription drug coverage, you’ll need to enroll in a separate Part D plan.
You might also consider a Medigap plan to help with out-of-pocket costs. However, Medigap enrollment isn’t always guaranteed outside of your initial enrollment period, meaning insurance companies could require you to answer health questions before approval. Because of this, it’s wise to have your next steps planned before you disenroll so you don’t end up with a lapse in coverage.
How Carolina Senior Benefits Can Help
Deciding to leave a Medicare Advantage plan can be stressful, especially with so many rules and deadlines to keep track of. At Carolina Senior Benefits, our team of licensed agents is here to make the process easy and stress-free.
We’ll help you review your current plan, understand which disenrollment period applies to your situation, and compare your options — whether that’s a new Medicare Advantage plan, a Medigap policy, or returning to Original Medicare with Part D coverage. Our goal is to make sure you don’t just make a change, but make the right change.
You don’t have to navigate the process alone. If you’re considering leaving your Medicare Advantage plan, give us a call. We’ll walk you through every step, explain your options, and make sure there’s no gap in your coverage.
