Thousands of Medicare beneficiaries enroll in Medicare Advantage (MA) every year during the Annual Election Period. With the low premiums and extras built into the plans, some overlook aspects of their Medicare Advantage coverage. With all the chaos of the election period, some realize that once the new year starts, they’re not in a plan they want.
Don’t worry though, because Congress created a special disenrollment window to fix this problem. Every January 1 to February 14 beneficiaries can disenroll from their current Medicare Advantage plan. When you disenroll, you are returned to your Original Medicare and are able to add a Part D drug plan too.
Top reasons to disenroll
Two common reasons for beneficiaries being dissatisfied with their MA plan are drug formularies and doctor networks. Some don’t realize that their plan has a network of providers that they must use when they switch over to Medicare Advantage.
Medicare Advantage networks
HMO and PPO networks are the most common. While some PPO plans have out of network benefits, the costs for care outside the network are significantly higher. There could also be deductibles to satisfy before benefits kick in. Plans like HMO plans have no coverage outside the network at all except in emergencies. Not having access to certain doctors or hospitals could be a deal breaker for someone needing treatment for a chronic condition.
Many MA plans have a built-in Part D drug plan that has a formulary or list of covered medications. If you don’t review the formulary before joining your plan, you could find yourself in a plan that doesn’t allow easy access to your medications. While you can file an exception to request that the plan cover the medication, there is no guarantee that your request will be approved.
When one of these situations happens, beneficiaries can use the Medicare Advantage Disenrollment Period to opt out of their MA plan and go back to Original Medicare. You can’t switch from one MA plan to another during this window. You can only return to Original Medicare Parts A and B.
If your MA plan had drug coverage included, you will lose that coverage when you disenroll. This is why the Medicare Advantage Disenrollment Period also gives you the opportunity to join a Part D drug plan.