If you or someone you know is not happy with their Medicare Advantage Plan, you can change your plan or return to Original Medicare and get a new Part D plan during the Medicare Advantage Open Enrollment Period (MA OEP). The MA OEP runs from January 1 through March 31 each year. This opportunity to change coverage is one of several that are important to remember, especially with the rise of complaints regarding misleading marketing for MA and Part D plans and enrollment fraud. If you find you’re in a plan you don’t want to be in, you can change.
Here are your options as to how to do it:
- If you’re in a Medicare Advantage Prescription Drug plan (MA-PD), you can either:
1) Submit an enrollment request to the new MA-PD plan you’re enrolling into.
2) Submit a disenrollment request to your MA-PD plan and enroll in a Part D plan to return to Original Medicare, or
3) Simply enroll in a Part D plan, which automatically disenrolls you from your MAPD and puts you back into Original Medicare.
- If you’re in an MA-only plan, you must first request disenrollment from your MA plan to trigger your right to return to Original Medicare and join a Part D plan.
- If you want to get out of a Medicare Advantage plan, and you don’t want to join another MA-PD or Medicare Part D plan, you must send a written request to the plan or call 1-800- MEDICARE during one of the enrollment/disenrollment periods mentioned above.
NOTE: if you were fraudulently enrolled in an MA or Part D plan, contact our California Senior Medicare Patrol (SMP) at 1-855-613-7080. We will work with the Centers for Medicare and Medicaid Services (CMS) to get you a Special Enrollment Period to either return to Original Medicare with a Part D plan or switch to another plan. You can also get retroactively enrolled into your previous plan.
Other rights to change your coverage
In addition to the MA OEP and any SEPs granted by CMS for misleading marketing or enrollment fraud, there are two opportunities for eligible beneficiaries to disenroll from their MA plan and return to or buy a Medigap policy to supplement Original Medicare. These “opportunities” are two Medigap guaranteed issue rights known as Medicare Trial Period #1 and Medicare Trial Period #2.
- Under Medicare Trial Period #1, you have the right to purchase certain Medigap plans if you joined an MA plan when you first became eligible for Medicare at age 65, and you want to switch to a Medigap policy during your first 12 months in your MA plan. Note: If you were previously in an MA plan, you are not eligible for this guaranteed-issue right. Also, this event only applies at age 65, and does not apply if you delay Part B and apply later.
- Under Medicare Trial Period #2, you have the right to purchase certain Medigap plans if you switched from a Medigap policy to an MA plan for the first time since becoming eligible for Medicare, and you disenroll from that plan within the first 12 months. You have the option to return to your previous Medigap policy if it is still available. If it is not available, you can choose plans A, B, C, F, K, L, M or N from any company. Note: If you were previously in an MA plan, you are not eligible for this guaranteed-issue right.
There are also many other Special Election Periods for Medicare Advantage and Part D prescription drug plans under certain circumstances. These SEPs allow you to enroll in or disenroll from a Medicare Advantage plan or Part D plan depending on your situation. You can find a list of these situations here.
In summary, if you are in a Medicare Advantage plan and are not happy with your coverage, there are several opportunities for you to make a change:
- The Medicare Advantage Open Enrollment Period from January 1 to March 31
- Various Special Election Periods to change your MA and/or Part D plan based on certain circumstances
- Medicare Trail Periods #1 and 2 for eligible beneficiaries that give you a guaranteed issue right to disenroll and purchase a Medigap plan, and
- A Special Enrollment Period from CMS for anyone who is in the wrong plan due to misleading marketing or enrollment fraud.
For more information and/or assistance in exercising any of these change in coverage opportunities, contact your local Health Insurance Counseling and Advocacy Program (HICAP). HICAP provides free, individual and unbiased assistance on Medicare and other health insurance related issues and is available in every county.