When Your Health Plan No Longer Fits: How to Disenroll Smartly
We have come to the last blog in the four-part series regarding Medicare and Medicare Advantage enrollment information. We have discussed how to make sure that you are looking for the right plan that best suits your needs, how to look at the ratings of the plans, and how to compare traditional Medicare against Medicare Advantage insurance. Now, we will discuss what to do if you do not like the Medicare Advantage plan now that you have enrolled. Is there anything that can be done?
Similarly to purchasing a new car, it is extremely important to read the contract terms before signing. Before signing up for the plan, you need to read your Medicare Advantage rights since it will help you understand what you are entitled to, how to access services, and what to do if you encounter issues with the plan.
Know Your Coverage Protections: Medicare Advantage rights outline what services and treatments you are guaranteed to receive. This includes protections around emergency and urgent care, out-of-network access in certain cases, and other essential coverage requirements. Your rights also include how to challenge coverage denials; avoiding hidden costs or surprise bills; protections when experiencing poor quality of care; and protection against discrimination and unfair practices.
If you have reviewed your rights and want to proceed with disenrollment, there are a few options for switching to a different plan or going back to Original Medicare. These options are contingent upon the time of year and/or if you qualify for certain events.
Medicare Advantage Open Enrollment Period (January 1 - March 31): If you are currently enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or disenroll and return to Original Medicare. You can only make one change during this period, and coverage changes start the month after you make the switch.
Annual Enrollment Period (October 15 - December 7): During this time, you can change Medicare Advantage plans, return to Original Medicare, or enroll in a Part D prescription drug plan. Coverage changes will take effect on January 1 of the following year.
Special Enrollment Periods (SEPs): Some situations, like moving to a new service area, becoming eligible for Medicaid, or if your Medicare Advantage plan stops serving your area, qualify for a SEP. If eligible, you can switch plans or return to Original Medicare outside the usual enrollment periods. The time frame of a SEP may vary, but it usually involves a 2 or 3-month window from when the event occurs.
There is an additional circumstance when you may seek disenrollment. Again, you must meet specific conditions to qualify. This is called the “Trial Period.”
The “Trial Period “refers to a specific time limit related to Medicare Advantage (Medicare Part C) plans. This period is a form of "trial right" that allows people to switch back to Original Medicare (Parts A and B) if they decide that their Medicare Advantage plan does not meet their needs.
Eligibility for Trial Period: You qualify for the Trial Period if you are new to Medicare (eligible at 65) and joined a Medicare Advantage plan for the first time upon becoming eligible for Medicare Part A and Part B.
Duration: The trial period lasts for the first 12 months after joining the Medicare Advantage plan.
What It Allows: If, during this period, you decide to leave the Medicare Advantage plan, you can return to Original Medicare with guaranteed issue rights. This means you can also enroll in a Medicare Supplement (Medigap) policy, and insurers cannot deny coverage or charge higher premiums due to pre-existing conditions. Having a trial period is highly beneficial because it allows you to try out an Advantage plan before being tied to it.
The “Trial Period” is intended to help new beneficiaries feel comfortable trying Medicare Advantage while retaining the ability to return to Original Medicare and secure Medigap coverage without penalties if they decide to switch back within the first year.
If you qualify for any of the circumstances that have been mentioned, these are the next steps that you need to do to disenroll from a plan:
If you are switching from one Medicare Advantage plan to another, you may make the change during either of the Open Enrollment periods. Disenrollment from the old plan will be automatic when the new policy begins, so there will be no break in coverage.
Call 1-800-MEDICARE (1-800-633-4227): You will need to provide your full name, Medicare number, date of birth, phone number, Social Security number, address, city, state, zip code, Part A/Part B Coverage (Yes/No), and Part A/Part B Effective Date. The Customer Service Representative will verify the plan that you are currently enrolled in. He/she will input the disenrollment. Once the Medicare systems confirm the disenrollment, a confirmation letter will be mailed to you/
Contact your plan and cancel your enrollment and request a disenrollment form.
Submit a written notice to the Medicare Advantage organization by mail or fax telling them you want to disenroll. You may be able to submit an online request if your organization offers an online option.
The disenrollment from your Medicare Advantage plan goes into effect the first of the month after you make the request. For example, if you disenroll from your plan in February, it will not go into effect until March 1.
In summary, if you are in a Medicare Advantage plan and are not happy with your coverage, you cannot switch whenever you want but you have options to make a change, but you need to know when those time periods occur.
We have included the following link for the Fact Sheet from Medicare.gov that gives specific details about plan enrolment. https://www.medicare.gov/publications/11219-Understanding-Medicare-Advantage-Medicare-Drug-Plan-Enrollment-Periods.pdf
If that does not answer all your questions, just email us at info@qsr5.com and we will provide you with more assistance.