UNITED STATES—Hello Toni: The first week, my wife and I moved to Houston from Oklahoma, I had a wonderful surprise in my front yard! There was your Medicare column discussing different Medicare options for someone with health issues.

I am 70 years old and am seeking medical care from MD Anderson for colon cancer. I enrolled in the Medicare Advantage HMO when I was in Oklahoma and was told that I could transfer to a Houston doctor when I moved on June 15th. I made a big mistake in enrolling because I did not know I could wait until I moved. Now I have discovered that MD Anderson does not accept this Medicare HMO plan.

I need to enroll in a Medicare Supplement, but I do not know how to disenroll from this Medicare Advantage plan and return to Medicare with a Medicare supplement. Time is ticking because my cancer treatment needs to begin soon. I need to do this fast!!  Thanks, James from Spring, TX.

Hi, James thank you for the great compliment! I know how overwhelming it can be to understand the rules of Medicare, especially when you are mentally drained due to a serious illness. Let me explain how the Toni Says® Medicare team helps clients who want to disenroll from their Medicare Advantage plan and return to Original/ Traditional Medicare.

There is a “Special Enrollment Period or SEP” to help you qualify for a change from your Medicare Advantage plan. A Special Enrollment Period or SEP is for certain situations when you are able to join, switch and drop a Medicare Advantage Plan. These special situations are:

  • Moving Out of Area: Is when you have moved out of your area, such as James moving from Oklahoma to the Houston area. This qualified James for an SEP allowing you to disenroll from his Medicare Advantage Plan and return to Original Medicare. There is a time limit which is 60 days from the date one moves, and James’ date is August 15th, since he moved to Texas on June 15th.

Other SEPs are:

  • Enrolled in Medicaid.
  • Qualify for Extra Help for prescription drugs.
  • Moving into a long-term care facility (such as skilled nursing facility, assisted living facility, personal care home, Alzheimer’s assisted living facilities, etc.)
  • Loss of creditable prescription drug coverage (such as insurance through your employer)

The trick to disenrolling from a Medicare Advantage Plan when an SEP is granted is to enroll in a Stand-alone Part D plan. Then automatically you are disenrolled from your Advantage plan and re-enrolled in Original Medicare. Returning to Original Medicare will be effective on the 1st of the next month.

Receiving Medigap/Medicare Supplement Open Enrollment: James because you enrolled in Part B beginning June 1st, you are within your 6-month Medigap/Medicare Supplement open enrollment period which ends November 30. This means you can receive your Medicare Supplement without having to answer health underwriting questions. Medicare states, “During the Medigap Open Enrollment Period, an insurance company can’t use medical underwriting to decide whether to accept your application.”

The Medigap/Medicare supplement open enrollment period lasts for 6 months beginning the first day of the month in which you are either age 65 or older and have enrolled in Medicare Part B. Wait past 6 months from enrolling in Part B and you must qualify by having to answer medical underwriting questions.

James, I’m glad you reached out to me with your question, because with Medicare… what you don’t know WILL hurt you! Need Medicare help? Call the Toni Says Medicare hotline at (832) 519-8664 or email info@tonisays.com for assistance.

Toni’s new book Maze of Medicare is the first book explaining Medicare that includes scripture and positive quotes to help relieve the common stress in understanding Medicare is available at www.tonisays.com.