Medicare Advantage disenrollment usually takes place automatically when a person registers for a new plan. Contacting the plan provider or Medicare is only necessary for some instances.
After a person enrolls in a Medicare Advantage plan, they may decide they would prefer a different policy. Alternatively, certain life events could make it necessary to choose a different plan option.
If a person wishes to cancel their Medicare Advantage plan without changing to a new one, they should contact their plan provider directly.
When switching to a different plan, disenrollment is normally automatic.
In this article, we discuss Medicare Advantage plans, enrollment periods, and how disenrollment takes place.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Advantage, also known as Medicare Part C, is the alternative to original Medicare, parts A, and B.
For Medicare Advantage plans, private companies contract with Medicare to provide the hospitalization insurance of Part A and the outpatient medical insurance of Part B.
In addition, many plans include prescription drug coverage and extra benefits, such as dental and vision care.
One of the primary ways in which Medicare Advantage plans differ from original Medicare is that most of them require a person to use in-network providers.
Another difference is that Medicare Advantage plans place a yearly cap on expenses, while original Medicare does not.
Although there are various types of Advantage plans, four of the most common ones include Health Maintenance Organization, Private Preferred Organization, Private Fee-for-Service, and Special Needs Plans.
People may disenroll and change Medicare Advantage plans for several reasons, such as:
- a change in healthcare needs
- requiring a higher or lower benefit range
- cost
A person may decide that they no longer want their Medicare Advantage plan and they can disenroll in the same way as with a prescription drug plan, by:
- contacting the plan provider by phone and asking for a disenrollment notice, which will be mailed for a person to complete and return
- faxing or mailing a written notice that has been signed by the plan holder
- calling Medicare at 1-800-633-4227
- requesting disenrollment online (if the plan provider has this option)
When a person has a Medicare Advantage plan and switches to another, disenrollment is automatic.
The first step for someone considering a change is to use the Medicare search tool to see what options are available in their area.
After comparing the coverage and prices of the plans, an individual can choose the one that best suits their needs, and enroll.
Disenrollment from the old plan will be automatic when the new policy begins, so there will be no break in coverage.
People with a Medicare Advantage plan may also switch back to original Medicare. To do so, they may contact their plan provider to let them know or call Medicare directly.
Before a person may enroll in a Medicare Advantage plan, they must first have an original Medicare plan.
Most people do this during the Initial Enrollment Period (IEP) when they first become eligible for the program. This is the 7-month time frame that begins 3 months before a person’s 65th birth month.
Once an individual has enrolled in original Medicare and subsequently joins a Medicare Advantage plan, disenrollment should be automatic.
A person may also change from one Medicare Advantage plan to another during the first 3 months.
Medigap
Instead of joining a Medicare Advantage plan, a person may prefer to keep their original Medicare and buy a Medigap plan, which is Medicare supplement insurance to help cover out-of-pocket expenses.
Disenrollment is not required in these cases, as private medical insurance companies administer Medigap plans, and as such, are held separately to original Medicare.
The best time to sign up for a Medigap plan is during the IEP.
If a person wishes to change to another Medicare Advantage plan they may make the change during either of two Open Enrollment periods (OEPs).
Medicare Advantage and Part D OEP
During this Open Enrollment Period, from October 15 to December 7, a person with Medicare Advantage may:
- change from one Medicare Advantage plan to another
- change to a Medicare Advantage plan that does or does not offer prescription drug coverage
- change from a Medicare Advantage plan to original Medicare
If a person has original Medicare, they may:
- change from original Medicare to a Medicare Advantage plan
- buy a Part D plan, which adds prescription drug coverage to their original Medicare
- leave a Part D plan
- change from one Part D plan to another
Medicare Advantage OEP
In this Open Enrollment Period, from January 1 to March 31, a person may make changes, but the options Medicare allows are more limited.
During this time, someone may change from a Medicare Advantage plan to original Medicare and, if desired, enroll in a Part D plan, or change to another Medicare Advantage plan with or without prescription drug coverage.
Switches that an individual may not do during this period include:
- change from original Medicare to a Medicare Advantage plan
- buy a Part D plan if enrolled in original Medicare
- change from one Part D plan to another if enrolled in original Medicare
In both OEPs, once a person registers with a new plan, disenrollment will be automatic once the new policy begins.
Instead of making a decision to change plans based on personal preference, sometimes various life events can force someone to change plans.
Examples may include scenarios such as:
- having to move to a location where the old plan is not available
- moving into a skilled nursing facility
- the private insurer ends the plan’s contract with Medicare
- joining a plan due to the mistake of a federal employee
- developing a disabling condition that qualifies a person for a Special Needs plan, which offers benefits tailored to their needs
Under these circumstances, a person may switch to a different Medicare Advantage plan during a Special Enrollment Period (SEP), and automatic disenrollment with the old policy will apply.
The time frame of a SEP may vary, but it usually involves a 2 or 3-month window from when the event occurs.
A person may wonder when they can disenroll from a Medicare Advantage plan. The answer depends on the reason someone wishes to make a change.
If an individual chooses to cancel their plan, they can contact the plan provider directly to request a disenrollment notice.
Different enrollment periods apply to canceling and switching plans. Once a person has chosen a new policy, disenrollment is usually automatic and will take place once the new plan begins.