Toni:
Last year, I made a big mistake and changed to a Medicare Advantage HMO from my Medicare Supplement and I want out!! I cannot even get a MRI with this company. I am in Galveston County and most of the doctors are not accepting these plans. What can I do? Signed…George in La Marque, TX
Dear George:
You will be happy to know that going back to “Original Medicare’ and enrolling in a new Medicare Supplement is simple because this year’s Medicare’s Open Enrollment starts on Monday, October 15, and it will end at midnight on Friday, December 7th (Pearl Harbor Day).
For you to disenroll from your Medicare Advantage company, all you need to do is enroll with a Medicare Prescription Drug plan. You will automatically be out of your old Advantage plan and back to “Original Medicare with a Medicare Prescription Drug plan; then apply for a Medicare Supplement to pick up what Medicare does not pay for.
One rule Medicare is if this is your first year out of a Medicare Supplement, you may have guaranteed issue (which means you can pick any Medicare Supplement company and not have to answer health questions) so if you have a serious illness such as cancer, diabetes, COPD etc, and you want the lowest premium company; you can apply and not be turned down when returning to “Original Medicare”. If you have been with a Medicare Advantage plan longer than a year, then you do not have guaranteed issue, when you decide to return back to “Original Medicare”. Many Medicare Supplement Insurance companies have certain plans that you can enroll in when there is a guarantee issue. Don’t be surprised if you cannot pick from all of the plans.
Open Enrollment Period or OEP is also the time when you can make changes to your Part D plan or Medicare Advantage plan or you can enroll In a Medicare Part D plan if you missed your enrollment time when you were first eligible. Below are the changes that a Medicare beneficiary can make during OEP (open enrollment period):
- Enroll in a new Part D Medicare Prescription Drug Plan which automatically disenrolls one from a Medicare Advantage plan***
- Enroll in a new Part D Medicare Prescription Drug Plan when you have never been in Part D from the time you have been with Medicare.
- Change from one Part D Medicare Prescription Drug Plan to a new Part D Medicare Prescription Drug Plan.
- Enroll in a Part C Medicare Advantage Plan with Prescription Drugs
- Change from one Part C Medicare Advantage Plan to a new Part C
Medicare Advantage Plan.
- Return to Original Medicare and purchase a Medicare Supplement and enroll in a Part D Medicare Prescription Drug Plan.
- Return to Original Medicare only and enroll in a Part D Medicare Prescription Drug Plan
- Or Return to Original Medicare with no Part D plan.* Don’t forget there is a penalty for not enrolling in a Part D Medicare Prescription Drug plan when first eligible.*
It is wise to make sure every year that your prescription drugs are covered on your Part D Medicare Prescription Drug plan, even if you get your prescriptions from a Medicare Advantage plan. Plans may change their prescription drug formulary each year and if your prescriptions are not covered the next year, you may have to pay 100% of that prescription out of your pocket if it is not covered on your Part D plan.
For those “Confused about Medicare” join me for my first pre-Open Enrollment workshop on Tuesday, October 23, 2012 at 6:00 PM at the Sugar Creek Baptist Church-Chapel, 13213 Southwest Frwy, Sugar Land, TX 77478. RSVP: 832/800-4674…Everyone welcome.
Toni King is advocate/consultant for those “Confused about Medicare” send Toni an email at toni@tonisays.com or call 832/519-TONI (8664). Visit Toni’s new website and blog at www.tonisays.com.
