A Less Common, But Real, AEP Decision
Most AEP conversations focus on switching from one Medicare Advantage plan to another, or from one Part D plan to another. But AEP is also your chance to leave Medicare Advantage altogether and return to Original Medicare, paired with a standalone Part D plan and, if you qualify, a Medicare Supplement policy. It’s a bigger move, and it’s worth understanding when it makes sense — and when it doesn’t.
Why Someone Might Make This Switch
Provider flexibility. Original Medicare doesn’t use provider networks the way Medicare Advantage plans do. If you see specialists in multiple states, travel frequently, or simply want to see any doctor who accepts Medicare without checking a network directory first, this is often the biggest driver.
Frustration with prior authorization. Medicare Advantage plans can require prior authorization for certain services. Original Medicare generally does not work this way for most covered services, which some beneficiaries find simpler.
A major health change. If you’re facing a new diagnosis that involves specialists or facilities outside your current plan’s network, moving to Original Medicare can open up more options — provided you can also secure a Medicare Supplement plan, which is the piece that makes this move work financially for many people.
The Catch: Medicare Supplement Underwriting
This is the part people often miss. Outside of your initial Medigap open enrollment period (the six months after you first enroll in Part B at 65 or older), most states allow insurance companies to medically underwrite Medicare Supplement applications. That means if you have certain health conditions, you could be charged more or denied a Medigap policy outright when you try to enroll outside that initial window. Before assuming you can pair Original Medicare with an affordable Supplement plan, it’s worth checking what underwriting rules apply in your state.
Weighing the Cost Difference
Medicare Advantage plans often come with low or $0 premiums and built-in extra benefits like dental and vision. Original Medicare plus a Part D plan and a Medigap policy typically means a higher monthly premium in exchange for more predictable out-of-pocket costs and broader provider access. Neither structure is universally better — it depends on how you use care and what trade-off you’re more comfortable with. For a side-by-side look at the structural differences, see our post on Medicare Advantage vs. Original Medicare.
What You’d Be Giving Up
Extra benefits like dental, vision, hearing coverage, and OTC allowances are common in Medicare Advantage plans but aren’t automatically part of Original Medicare. If those benefits matter to you, factor the cost of replacing them into your comparison.
How to Think This Through
Ask yourself a few honest questions: How often do I currently run into network restrictions? Would broader provider access actually change how I get care, or is my current network already working fine? Am I healthy enough to likely qualify for an affordable Supplement plan, or would I be taking on medical underwriting risk?
If you’re unsure how underwriting works in your state or what the real cost comparison would look like for your situation, that’s a conversation worth having with a licensed agent before AEP closes on December 7 — not after you’ve already made the switch.
Ready to Talk Through Your Options?
Have questions? Schedule a free review with Kayla Price, a licensed insurance agent at Price Services Group. Call 866-648-1578 or visit priceservicesgroup.com/schedule.
Price Services Group, LLC is not affiliated with or endorsed by the U.S. government or the federal Medicare program. NPN: 18530055 | Agency NPN: 20387435