When can Medicare Advantage plan enrollees switch to Original Medicare coverage?

This question raises complex issues in that it addresses changes to Medicare Advantage, enrollment periods for both MA and Part D, the differences between MA and original Medicare, and the concept of "lock-in." Prior to 2006, there was an ongoing, continuous Open Enrollment Period for Medicare Advantage. Medicare beneficiaries were entitled to enroll into, disenroll out of, or switch MA plans throughout the plan year. As of January 2006, beneficiaries may only enroll, disenroll, or switch MA plans during a designated MA enrollment period. Outside of such periods, enrollees are locked into (or out of) MA plans. It is therefore important to understand the available MA enrollment periods.

• Initial Election Period: An individual's first opportunity (someone who is newly eligible for MA) to enroll in MA is the Initial Election Period (IEP), which begins three months before the individual's entitlement to Medicare Part A and Part B and ends either the last day of the beneficiary's Part B initial enrollment period. The last day of the initial enrollment period for Part B is generally the last day of the third month after the month the individual turns 65. Similar rules apply to most people whose Part B entitlement is based upon SSI disability.
• Annual Election Period: The Annual Election Period (AEP) is held every year from November 15-December 31. During the AEP, beneficiaries can change between original Medicare with a PDP and a Medicare Advantage plan with prescription drug coverage (MA-PD)
• Open Enrollment Period: The OEP extends from January 1 to March 31 of each year. During the OEP, an enrollee is entitled to switch plans or types of plans, but cannot enroll or disenroll into or out of Part D benefits. Only the following changes are permitted during the OEP:
  • MA-PD to Original Medicare and a PDP
  • Original Medicare and a PDP to MA-PD
  • MA-PD to MA-PD
  • MA-only to MA-only
  • MA-only to Original Medicare-only (and vice versa)
• Special Enrollment Periods: Special Enrollment Periods (SEP) for MA are similar to the SEPs for Medicare Prescription Drug Plans (PDPs), which allow enrollees to change plans outside of the traditional rules for other enrollment periods. Generally the MA SEPs coordinate with the PDP SEPs. HAP has created a Chart of Special Enrollment Periods that includes coordinated MA plan SEPs. 

In very few situations would a beneficiary be locked into an MA-PD for 12 months from the date of enrollment. More information about enrollment is available in CMS' PDP Enrollment Guidanceand the MA-PD Enrollment Guidance.