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How do I Quit Medicare Advantage?

By on July 16th, 2012
Filed: Advice, Caregivers, Consumers, Disabled, Medicare, Seniors, You

(Click ‘here‘ to see a full list of Q&A’s on Medicare Advantage)

If you’re enrolled in a Medicare Advantage plan and you decide for whatever reason that you need to quit that plan, you have several opportunities to change your coverage.

Option #1: Medicare Advantage Disenrollment Period

The first is the Medicare Advantage Disenrollment Period (MADP), which runs from January 1 through February 14, 2012. This period gives Medicare beneficiaries enrolled in Medicare Advantage plans the opportunity to make a change if they find their plan does not meet their needs. Those who leave a Medicare Advantage plan during the MADP cannot switch to another Medicare Advantage plan. They can only revert to “Original Medicare” and also allows for enrollment in a stand-alone Medicare Part D Prescription Drug Plan (PDP).

Option #2: A Medicare Special Election Period (SEP)

There are a handful of special enrollment periods when you can cancel or change your Medicare Advantage plan, some of these periods include:

  1. You move to a new service area where your coverage is no longer effective.
  2. You’re eligible for Medicaid or you become eligible for Medicaid (This is based on income).
  3. You qualify for Extra Help with Medicare prescription drug costs (This is based on income).
  4. You’re receiving care or you begin receiving care in an institution, like a skilled nursing facility or long-term care hospital.

Option #3: Medicare’s Annual Enrollment Period (AEP): In each state you can change your Medicare Advantage plan (or Part D plan) every year without penalty and without undergoing medical underwriting during the Medicare Annual Enrollment Period (AEP). The AEP runs from October 15 to December 7 in 2012. We encourage people to at least check their drug coverage once a year while on Medicare, as the prescription drug  and other benefits tend to change from year to year.

Option #4: A 5-Star Plan is Available

Beginning in 2012, anyone with access to a Medicare Advantage or Prescription Drug Plan with a “5-Star” rating has the ability to enroll in that 5-star plan at any time throughout the year.

The 5-star rating system is used by Medicare to monitor plans and ensure that they meet certain quality standards.  The ratings also make it easier for someone on Medicare to compare plans based on quality and customer service. “Low performer” icons are placed next to the names of plans that have received less than three stars for the past three years.  The star rating system considers 53 quality measures, such as success in providing preventive services, managing chronic illness, and keeping consumer complaints to a minimum.

Option #5: Quitting your plan outside of AEP, MADP and Sep without joining a 5-star plan

If you decide you want to quit your Medicare Advantage plan, but you’re not within one of the windows outlined about (annual enrollment, annual disenrollment, or special enrollment) and you don’t want to or cannot find a 5-star plan to join, you can still quit your Medicare Advantage plan. If you stop making your monthly payments for the plan, your insurer would give you notice that they are dis-enrolling you from the plan.

After that you would default back onto Original Medicare (without prescription drug coverage) and would be unable to add prescription drug coverage or change to a new Medicare Advantage plan until you had an SEP or the next AEP.  And, if you try to get another plan from the insurer who you stopped making payments to, that insurer does have the option to refuse to enroll you or request back payments.

Remember that if you drop your Medicare Advantage plan during this time, you’ll likely be without prescription drug coverage until one of the aforementioned options becomes available to you.

Medicare Part D Late Enrollment Penalty

For every month you’re on Medicare but you go without credible prescription drug coverage, you’re subject to the late enrollment penalty, which is an amount added to your monthly Medicare Part D premium once you do sign up for a new Part D plan. You can owe that penalty if (after your initial enrollment period end), you go for a period of 63 days or more – in a row – without Part D or other creditable prescription drug coverage.

The penalty is calculated by multiplying 1% of the “national base beneficiary premium” ($31.08 in 2012) by the number of complete months you were eligible but didn’t join a Medicare drug plan and went without other creditable prescription drug coverage. The final amount is rounded to the nearest $.10 and added to your monthly premium.

Okay, but how do you actually do this?

As to how you actually do any one of the things listed above… If you’re inside an AEP, SEP, MADP or you have access to a 5-star plan you can research available options online at PlanPrescriber.com, eHealthMedicare.com or Medicare.gov. To make a change during one of these designated periods you can contact one of our licensed eHealthInsurance agents, contact the insurer directly or call 1-800-Medicare for more information.



Medicare has not reviewed or endorsed this information

About Ross Blair

Ross Blair has applied more than 26 years of technology experience to develop PlanPrescriber.com, a website that makes it easier for seniors and their caregivers to select and enroll in the best Medicare products for their specific needs. In his role as CEO, he has worked closely with pharmacists, insurers, physicians, caregivers and seniors to identify the most critical and complex aspects of Medicare and create a system that delivers this information to consumers in a format that is easy to use and understand.

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