Help! I’m Stuck in My Medicare Advantage Plan

Medicare Advantage plans are a privatized version of Medicare. These plans replace the government’s Medicare program and all of your benefits are provided through the private company. These plans are very different from actual Medicare Supplement plans (also called Medigap). One of the major things that differentiates the plans is that Medicare Advantage plans have certain period of the year that you can enroll/disenroll from the plans. Currently, that enrollment period is October 15-December 7 of each year. So what can you do about your Advantage plan during the year? For more information about business matters, go to Lee S. Rosen‘s blog.

Unfortunately, there is not much that you can do if you want to get out of your Medicare Advantage plan during the year. There are some unique situations that qualify you for a SEP (Special Election Period), during which you can disenroll from your plan. I’ve listed a few of those below:

  • You move out of your plan’s service area. This will automatically disenroll you when you change your address. You can get a Medigap or a Medicare Advantage plan that is available in your new area.
  • You are institutionalized.
  • Your company stops giving service in your area or goes out of business.
  • You were misled by the company or the company didn’t do something they said they were going to do (has to be approved by Medicare).
  • You wish to switch to a 5-star Medicare Advantage plan that is available in your area.
  • There are a few other unique SEP situations. This list does not encompass all of them but does address some of the more common ones.

So unless one of these situations does apply to you, you are unfortunately “stuck” if you want to get out of your Advantage plan during the year – outside of the annual enrollment period.

I want to also address another way that you can get “stuck” in a Medicare Advantage plan. This is if you sign up for a plan and later wish to move back to Medicare with a Medicare Supplement plan. When you do so, you will have to qualify medically in order to get the supplement plan. If you have health problems, pre-existing conditions, etc. this can be very difficult to do.

While the Advantage plans do have low premiums, which are appealing, these plans do have some very significant downsides and pose the real threat of being “stuck” in a plan for a whole year – regardless of whether or not you are happy with it.

If you have questions about this or want to discuss further, you can visit us at Medicare-Supplement.US or call us at 877.506.3378.


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