Dear Toni: I moved from Little Rock, Arkansas, in May and discovered your Medicare article in the local newspaper. I enrolled in a Medicare Advantage HMO plan when I turned 65 in March. I didn’t realize I could have chosen a Medicare supplement to my Parts A and B instead of an Advantage plan. One of your articles explained that I have a six-month Medicare supplement window to change from this HMO.
I have been diagnosed with lung cancer, and the cancer center that my physician uses is not in the HMO’s network. I need help disenrolling from this HMO and going back to traditional Medicare with a supplement since I am in the six-month Part B window. — James, Houston
Dear James: I know how overwhelming Medicare’s rules can be, especially when you are stressed because of an illness.
There is a special enrollment period, triggered by specific circumstances, in which a Medicare recipient is allowed to join, switch or drop a Medicare Advantage or Medicare Part D prescription drug plan.
Here are a few of the circumstances that qualify:
■ Moving out of area, such as when James moved from Arkansas to Texas.
■ Newly enrolled in Medicaid.
■ Qualified for Extra Help for prescription drugs.
■ Moving into a long-term care facility such as skilled nursing, assisted living, personal care homes or Alzheimer’s living facilities.
■ Loss of creditable prescription drug coverage (employer benefits from you or your spouse’s employment).
The trick to disenrolling from a Medicare Advantage Plan when a special enrollment period is granted is to enroll in a stand-alone Part D plan, which will automatically disenroll you from your Advantage plan and back to original Medicare.
James, because you want to be enrolled in original Medicare as soon as possible, I would suggest that you go to medicare.gov and enroll in whichever Part D plan best fits your prescription drug needs. The change to Medicare will be effective on the first day of the following month.
Because you enrolled in Part B in March, you are correct that you’re within your six-month medicare open enrollment period, which will end Aug. 31. Wait longer than six months from the date you enrolled in Part B, and you must then qualify by medical underwriting.
James, since your Medicare Parts A and B began March 1, you can only apply for supplemental Plans G or N. (Benficiaries with Part A that began before Jan. 1, 2020, may apply for Plan F.) The difference between Plans G and N:
■ Plan G offers lower premiums than Plan F, with the 2026 Part B deductible of $283 not covered.
■ Plan N has a lower premium than Plan G with higher out-of-pocket costs. There is a $20 copay for a doctor’s visit and a $50 copay for the emergency room. The Part B deductible and “excess charges” are not paid by the insurance company.
Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.
