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

I am 70 years old and am seeking medical care from MD Anderson for colon cancer. I have been informed that MD Anderson does not accept the Medicare Advantage HMO plan I enrolled in when I was in Oklahoma and that I could transfer to a Houston doctor when I moved in May. Now that I have moved I find out that MD Anderson does not accept this Medicare HMO plan.

I did not realize I could have chosen a Medicare Supplement instead of a Medicare Advantage plan when my Medicare Part B began this May after losing my job with company benefits. Your article explained that a 6-month Medicare Supplement open enrollment period because I am new to Medicare and just enrolled in Part B.

I am confused on 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 Branch area.

Hi there, 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 stressed due to a serious illness.

Below is how the Toni Says® Medicare team help clients who contact the office and want to disenroll from their Medicare Advantage plan and return to Original also known as 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 a certain situation when you are able to join, switch and drop a Medicare Advantage Plan. The special situations are:

  • Moving Out of Area: Is when you have moved out of your area such as when James moved from Oklahoma to the Houston, TX area. Qualified James for a SEP to disenroll from his Medicare Advantage Plan and return to Original Medicare

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
  • Loss of creditable prescription drug coverage.(insurance through your employer)

The trick to disenrolling from a Medicare Advantage Plan when a SEP is granted is to enroll in a Stand-alone Part D plan and automatically you are disenrolled from your Advantage plan and back to 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 this May and are within your 6-month Medigap/Medicare Supplement open enrollment period which ends on October 31, when your 6-month winds down and you can receive guaranteed issue.  Medicare’s definition for guaranteed issue is that your acceptance in any Medicare Supplement plan is guaranteed during your Medigap/Medicare supplement open enrollment period which 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 with having to answer medical underwriting questions.

For Medicare enrollment questions call the Toni Says Medicare hotline at 1-888-TONI-SAY (888-866-4729) and talk with the Toni Says® Medicare team or email info@tonisays.com for help.

Toni King, Medicare author/advocate is giving a $5 discount to the Toni Says® readers on the new 2021Medicare Survival Guide® Advanced book at www.tonisays.com.