Medicare Advantage Plan Terminating or Reducing Their Service Area: Understand Your Rights
Medicare Advantage plans can drop you at the end of the plan year if the plan does not renew its contract with Medicare. A plan that does not renew its contract with Medicare may decide to drop select geographic areas of service, or it may decide to nonrenew the entire plan.
There are a few reasons a plan may involuntarily disenroll you. First, if you fail to pay premiums timely manner. Next, for causing a disruption in the plans ability to deliver health care services and lastly, if it cannot meet your medical needs. If disenrolled involuntarily, you will be re-enrolled in the Original Medicare program the month following your disenrollment.
By terminating or reducing their service area, a Medicare Advantage plan is required to notify members of their Medigap guaranteed issue rights when disenrolling to Original Medicare during a Special Enrollment Period (SEP). For the most part, written notice must be sent to all Medicare members at least 60 days prior to the termination effective date. However, if CMS requires the termination, they will notify members approximately 30 days before the effective date ot termination. Medigap issuers, in certain situations, may require the beneficiary to provide additional documentation that he/she disenrolled as a result of an SEP and is eligible for such guaranteed issue rights.
If you are involuntarily disenrolled because your Medicare Advantage plan nonrenews its plan, you have the right to apply for a Medigap policy, as long as you do so within 63 days of notice of the nonrenewal.
If you elect to voluntarily disenroll because you decide a Medicare Advantage plan is not for you, you may have a right to Medigap coverage as long as you were not covered by a Medicare Advantage plan before and you disenroll from your current Medicare Advantage plan within the first 12 months of coverage. This right is limited to the same Medicare supplement you had in place before enrolling the Medicare Advantage plan, excluding any outpatient prescription drug coverage. If you do not have a right to get your old Medigap coverage back, you will not have a guarantee issue period and the insurance company has the ability to deny your application based on health conditions.
Guaranteed Issuance Rights: Enrollment in an MA plan at age 65 If you enrolled in a MA plan when you turned 65, you have Medigap guaranteed issue rights if you disenrolled from the plan within the first 12 months. Your Medigap Guarantee Issue Period starts 60 days prior to your disenrollment and ends 63 days after your disenrollment. In this situation, you are eligible for all Medigap policies.
Guaranteed Issuance Rights: If you are over age 65, enrolled in a MA plan for the first time and disenroll within the first 12 months You must have had a Medigap policy prior to Medicare Advantage enrollment. Your Medigap Guarantee Issuance Period starts 60 days prior to disenrollment and ends 63 days after disenrollment. If the Medigap policy you owned prior to enrollment in the Medicare Advantage plan is still being sold, you may return to that policy. Otherwise, you can choose from plans A, B, C, F, K or L.
The Medicare Supplement issuer cannot impose conditions on coverage or discriminate in pricing based on your health status except as permitted by state rating regulations. You also have no pre-existing condition exclusions, even without creditable coverage. As a reminder, you must exercise your Guaranteed Issuance rights within 63 days of the disenrollment date from the Medicare Advantage plan.
Our licensed insurance agents are available to help answer any specific or detailed questions you have.