Every year, thousands of Medicare beneficiaries enroll in Medicare Advantage plans during the fall Annual Election Period. With low premiums and ancillary "extras" built in, these plans on paper appeal to many individuals. However, in all the election period excitement, people sometimes overlook aspects of Medicare Advantage coverage that are important. All too often, January rolls around and they find themselves locked into a plan that they no longer want.
Fortunately, Congress created a special disenrollment window to address this very problem. Every winter from January 1st to February 14th, Medicare beneficiaries can disenroll from their Medicare Advantage plan with no questions asked. When they disenroll, they are returned to Original Medicare and allowed to add on a standalone Part D drug plan as well.
Common reasons for plan dissatisfaction are drug formularies and doctor networks. Most Medicare Advantage plans are coordinated care programs, which means that the plans have a network of providers. HMO and PPO networks are the most common. Beneficiaries who aren't aware of this sometimes enroll in a plan without first verifying that their important doctors participate in the network.
While some PPO plans have out of network benefits, the costs for care outside the network are significantly higher. There might be deductibles to satisfy before benefits kick in as well. Other plans, like HMO plans, have no coverage outside the network at all except in emergencies. Not having access to certain doctors or hospitals can be devastating for someone needing treatment for a chronic condition.
Many Medicare Advantage plans also have a built-in Part D drug plan. That drug plan has a formulary or list of covered medications. If you don't review the formulary before joining, you could find yourself in a plan that doesn't provide easy access to your medications. While you can file an exception to request that the plan cover the medication, there is no guarantee that your request will be approved.
When one of these situations happens, beneficiaries can use the Medicare Advantage Disenrollment Period to opt out of their Medicare Advantage plan and go back onto Original Medicare. It's important to understand that you can't switch from one Medicare Advantage plan to another Advantage plan during this window. You may only return to Original Medicare Parts A and B.
If this was your first time ever trying an Advantage plan and you have been in the plan less than 12 months, you can return to Medicare and also return to your prior Medigap plan, if you had one. No underwriting is required in this situation. However, anyone outside of that will have to apply for Medigap and go through health underwriting. You will have to answer medical questions on your application and could be turned down for coverage. Be sure to consider this before disenrolling from your Medicare Advantage plan.
If your Medicare Advantage plan had drug coverage included, you will lose that coverage when you disenroll. This is why Medicare will give you a special election period to join a Part D drug plan to go alongside your Original Medicare.
For further reading about the Medicare Advantage Disenrollment Period, see this article.
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