What can I do if my Medicare Advantage plan leaves?

What do I do if my Medicare Advantage plan Terminates my Coverage?

At the beginning of each calendar year, Medicare Advantage (MA) plans can make changes to their benefits, premiums, copayments and geographic service areas. They must notify their members every fall of the changes they intend to make the following year. They can add or drop benefits, change premiums and copayments, and begin or discontinue serving a certain county or region. MA plans must get permission from the Centers for Medicare and Medicaid Services (CMS)before making any changes, and notify their members by early October of changes effective January 1 of the following year.

Sometimes at the end of the year, Medicare Advantage Plans can decide to leave the Medicare Program, pull their plans from the area and leave Medicare Eligibles in need of a new plan.  If you have gotten a letter stating your plan is leaving the Medicare Program, the letter you receive will explain your options.

In recent years, few plans have left the Medicare Program.  In those cases, an individual gets a letter describing the change and explains to them Special Rules they might be entitled to by Medicare. If your MA plan stops providing benefits in your area at the end of the year, you have the right — regardless of age or health condition — to join another MA plan if one is available where you live or to return to Original Medicare and join a Part D plan.

If you do not join a Medicare Advantage Plan or Medicare Supplement by December 31st, you will continue to have Medicare coverage through Original Medicare only, as of January 1.

Your Special Election Period (SEP) is from December 8 of the current year through the end of February of the next year.

  • You will be automatically returned to the Original Medicare Plan if you don’t choose to join another Medicare Advantage Plan. You will also have the right to buy a Medigap policy, often with a Guaranteed Issue clause regardless of your health condition, unless you are younger than 65 and have end-stage renal disease (ESRD).  You should learn as much as you can about your choices before making a decision.  No matter what you choose, you are still in the Medicare Program and will get all Medicare-covered services.

You have the right to buy Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state.  You only have this right if you switch to Original Medicare rather than joining another Medicare Advantage Plan.

You can/must apply for a Medigap policy up to 123 days after your Medicare Advantage plan benefits actually end to apply for a guaranteed issue Medigap policy.

Medigap coverage can’t start until your Medicare Advantage Plan coverage ends.

  • If your health plan covers prescription drugs and you want to keep getting prescription drug coverage, you need to join another plan that offers this coverage.  If you decide to return to the Original Medicare Plan and want to continue to have drug coverage, you will have to join a Medicare Prescription Drug Plan.  REMEMBER: by not selecting a Prescription Drug plan you could be subject to a late enrollment penalty if you decide to enroll later.
  • If you want to simply replace your exiting Medicare Advantage plan you can either:
    • Make a change during the Annual Election Period (AEP) as you are able to do yearly from October 15 through December 7;  or
    • You can use your Special Election Period (SEP) given to you by Medicare.

Your SEP to join a Medicare Advantage Plan with drug coverage or a stand-alone Medicare Part D drug plan begins the month you are told your coverage will end and lasts for

  •   2 months after you lose your coverage; or
  •   2 months after you receive notice, whichever is later.

This particular Special Enrollment Period (SEP) is exceptional, and will only be granted if the changes to your provider network are considered as “significant”.   You also cannot just telephone Medicare and request this SEP.  Instead, CMS will contact you if this particular SEP becomes available.

Whatever option you want to take contact one of our Local and Licensed Agents to help guide you through this.  Contact us below:




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