Editor’s note: As of January 1, 2019, you can disenroll from a Medicare Advantage plan between January 1 and March 31 of each year.
Many people enroll in a Medicare Advantage plan, (a commercial health plan that offers Medicare benefits,) without fully understanding how their health care coverage will work under that plan. Once they learn that they are only covered for care from doctors and hospitals in the health plan’s network, or that the network will not cover their care out of state except in emergencies, or that their out-of-pocket costs could be astronomical, they often want to switch to traditional Medicare. If you want to disenroll from your Medicare Advantage plan, you have the right to leave the health plan during the Medicare Advantage Disenrollment Period, any time between January 1 and February 14.
Why would you want to disenroll from a Medicare Advantage plan?
- You are not covered for care from doctors and/or hospitals that you know and trust.
- You discover that you have long waits to see the health plan’s in-network doctors or those doctors are no longer seeing patients enrolled in the health plan. Don’t trust the health plan’s provider directory.
- You do not want to deal with the headache of receiving treatment from out-of-network doctors if you are hospitalized, along with surprise medical bills.
- Your out-of-pocket costs for the deductible, if there is one, and copays could be as high as $6,700 for in-network care alone, more than double the cost of Medicare supplemental insurance (“Medigap”) coverage.
- Your out-of-pocket costs for care could be astronomical if you need to use out-of-network doctors and hospitals–there is no limit at all on your costs–either because they offer the specialty care you need and that you cannot get from in-network doctors or because you have moved outside of the area your Medicare Advantage plan covers–e.g., a winter or summer home, a family member or friend’s home.
How do you disenroll from a Medicare Advantage plan?
- Notify your Medicare Advantage health plan in writing as soon as possible before February 14th, ideally in January. Call the health plan as well. You will be officially disenrolled on the first day of the following month.
- You will be automatically enrolled in traditional Medicare on the first day of the following month, but you will need to sign up for a Medicare Part D drug plan as soon as possible, along with a Medicare supplemental insurance policy, so that you have coverage to fill gaps in Medicare and drug coverage beginning the following month.
- You want to be sure you can get Medicare supplemental coverage either through Medicaid or through a private Medicare supplemental insurance plan before you drop your Medicare Advantage plan. Under federal law, Medicare supplemental insurance (“Medigap”) companies do not have to sell you a policy except during your Medicare initial enrollment period at 65 or during your Medicare special enrollment period if you sign up for Medicare after 65. However, four states–Connecticut, Maine, Massachusetts and New York–require Medigap companies to sell you coverage at any time. And some insurers may sell you coverage even if not required to under the law. Call your State Health Insurance Assistance Program (SHIP) to learn whether you can buy a Medicare supplemental insurance policy in your state.
Tip: You can disenroll from your Medicare Advantage plan at any time if you were misled into enrolling or signed up by mistake or otherwise did not intend to be in the Medicare Advantage plan. Call 1-800-633-4227 (1-800-MEDICARE) to ask to be disenrolled from your Medicare Advantage plan. You can be disenrolled retroactively if you saw an out-of-network doctor because you thought you were enrolled in traditional Medicare. If you have not received any services through the Medicare Advantage plan, you can ask for a special enrollment period to enroll in traditional Medicare, a Part D plan, and a Medicare supplemental insurance (Medigap) plan.
Here’s more from Just Care:
- Four things to think about when choosing between traditional Medicare and a Medicare Advantage plan
- Four tips for choosing among Medicare supplemental insurance (“Medigap”) plans
- Medicaid: Why it matters to all of us
- Medicare Part D prescription drug coverage: Three tips
- Medicare out-of-pocket costs