What can be done about it now?
There are five scenarios in which Medicare Advantage members may disenroll from their plan.
Scenario #1
If you are disenrolled from an MA plan because the plan is leaving Medicare, stops giving care in their area, or the customer moves out of the plan’s service area, you are eligible to change. Customers in this scenario are guaranteed issue of a Medicare Supplement plan A, B, C, F, HDF, K, or L that are sold in their state by any insurer.
Customers can apply for a Medicare Supplement as early as the day they receive notice that their MA coverage will end, but no later than 63 days after the MA coverage ends.
Scenario #2
You joined an MA Plan when you were first eligible for Medicare Part A at age 65, and within the first year of joining you may exercise your right to switch to Original Medicare. Customers in this scenario are guaranteed issue of any Medicare Supplement plan sold in their state by any insurer. Customers can apply for a Medicare Supplement as early as 60 days before the date their MA coverage will end, but no later than 63 days after the MA coverage ends.
Scenario #3
Or … you dropped a traditional Medicare Supplement to join Medicare Advantage for the first time, less than a year ago and you wish to switch back to Original Medicare. Customers in this scenario are guaranteed issue of the Medicare Supplement policy they had before they joined MA if the same insurance company they had before still sells it. If the former Medicare Supplement policy isn’t available, they can buy a Medicare Supplement plan A, B, C, F, HDF, K, or L sold in their state by any insurance company. Customers can apply for a Medicare Supplement as early as 60 days before the date their MA coverage will end, but no later than 63 days after the MA coverage ends.
Scenario #4
You have been with an Medicare Advantage plan for more than one year and are considering dis-enrolling and returning to original Medicare, and then purchasing a Medicare Supplement.
In most cases, an MA enrollee must stay enrolled for that calendar year starting the date their overage begins. According to Medicare, a customer who has been with an MA plan for more than one year may disenroll if Medicare has made a determination that a Medicare Advantage organization materially misrepresented plan provisions or violated its agreement with the enrollee. Customers in this scenario are guaranteed issue of Medicare Supplements A, B, C, F, HDF, K, and L that is sold in their state by any insurance company. [This one is tough to do].
Scenario #5
If you dis-enroll from Medicare Advantage, having been on Medicare Advantage MORE THAN one year and are not in Scenario 4, you are NOT guaranteed issue. This simply means that your application will be medically underwritten. You may or may not qualify, but this is something I will likely be able to tell you at the time of application.
I have been helping people with Medicare Supplements since the early 1980′s. In almost all cases, I prefer my clients to be with original Medicare and purchase a Medicare Supplement. I believe that, in the long run, this is the most cost effective decision. It certainly is the decision with the most stability.
Call me anytime if you have questions, or if I can assist you in any way.
Michael
