Search Articles

Find Attorneys

Entering and Leaving Medicare Advantage Plans

  • January 10th, 2019

You generally must be enrolled in Medicare Part A and Part B before you can enroll in a Medicare Advantage plan. If you want to join a Medicare Advantage plan, you should contact the plan and ask if it is accepting new member enrollments or if it has a waiting list.

You may enroll in a Medicare Advantage plan during the seven-month period that starts three months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. You can also enroll in a plan or switch plans during the "open enrollment" period between October 15 and December 7 for coverage beginning January 1. Medicare Advantage plans do not always have to accept new enrollments, however. Some plans have approved limits on the number of beneficiaries they can enroll (called "capacity limits"). Once a plan has reached its capacity limit, it does not have to accept any new enrollees. Still, if a plan refuses to accept your enrollment, it must provide a written denial.

Local Elder Law Attorneys in Your City

Elder Law Attorney

Firm Name
City, State

Elder Law Attorney

Firm Name
City, State

Elder Law Attorney

Firm Name
City, State

Once you choose a plan, you can leave a plan only at certain times of the year. You can switch once during the open enrollment period that runs from October 15 through December 7 every year. In addition, you can switch Medicare Advantage plans or switch from a Medicare Advantage plan to original Medicare between January 1 and March 31 of each year. However, you can't switch from original Medicare to a Medicare Advantage plan during this time. You also can't switch prescription drug plans or join, switch, or drop a Medicare Medical Savings Account Plan during this period.  If you switch to original Medicare during this period, you'll have until March 31 to also join a Medicare prescription drug plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.

Medicare Advantage plans can drop doctors and other health care providers from the plan in the middle of plan year without much warning. Beginning in 2015, there is a new Special Enrollment Period (SEP) available on a case-by-case basis to some enrollees whose doctors have been dropped. The SEP applies only when significant provider changes have occurred, so more than one doctor would have to be terminated from the plan. The SEP begins the month you are notified of the change and continues for an additional two months. You can leave your Medicare Advantage plan and join original Medicare or switch to another Medicare Advantage plan during this time.

You can leave a Medicare Advantage plan in one of three ways:

  • Call the plan you wish to leave and ask for a disenrollment form
  • Call 1-800-MEDICARE (1-800-633-4227) to request that your disenrollment be processed over the phone
  • Call the Social Security Administration or visit your Social Security Office to file your disenrollment request

You need not fill out a disenrollment form if you decide to join another managed care plan. You will be automatically disenrolled from your old plan when your new plan enrollment becomes effective.

After you leave Medicare Advantage, you automatically return to the regular Medicare program. It is very likely you will be able to continue seeing the same doctors and other providers you were seeing in the managed care plan, if this is your wish.

Avoiding the Medigap Gap

One risk of switching from original Medicare to a Medicare Advantage plan is that when you leave you may not be eligible for the same Medigap policy you had before you shifted to Medicare Advantage.

When you return to regular Medicare, you have the right to go back to the same Medigap policy you had before you joined the Medicare Advantage plan, if the same insurance company you had before still sells it.  If the policy is no longer available, you have a guaranteed right to buy a Medigap policy designated A, B, C, F, K or L that is sold in your state by any insurance company as long as you had Medicare Advantage for less than a year. In these circumstances the insurers cannot refuse you coverage as long as you apply for the Medigap policy no later than 63 days after coverage from your Medicare Advantage plan terminates. The insurance company is required to by law to sell or offer you a Medigap policy even if you have health problems (called "pre-existing conditions").  If you had Medicaid Advantage for a year or more or wait longer than 63 days, you can apply but you aren’t guaranteed of acceptance.

Plan Withdrawals from Medicare

Medicare Advantage plans voluntarily enter into 12-month contracts (January to December) with the Medicare program to serve Medicare enrollees. Each year, plans can choose whether or not to renew their contracts, and they generally must notify Medicare officials by July 1 if they are not going to renew for the following year. 

For the Medicare program's information on enrolling in Medicare Advantage plans, click here.


Last Modified: 01/10/2019
Learn the secrets of estate planning from an expert
ADVERTISEMENT
Medicaid 101
What Medicaid Covers

In addition to nursing home care, Medicaid may cover home care and some care in an assisted living facility. Coverage in your state may depend on waivers of federal rules.

READ MORE
Medicaid’s Eligibility and Transfer Rules

To be eligible for Medicaid long-term care, recipients must have limited incomes and no more than $2,000 (in most states). Special rules apply for the home and other assets.

READ MORE
Medicaid’s Protections for Spouses

Spouses of Medicaid nursing home residents have special protections to keep them from becoming impoverished.

READ MORE
What Medicaid Covers

In addition to nursing home care, Medicaid may cover home care and some care in an assisted living facility. Coverage in your state may depend on waivers of federal rules.

READ MORE
Medicaid’s Eligibility and Transfer Rules

To be eligible for Medicaid long-term care, recipients must have limited incomes and no more than $2,000 (in most states). Special rules apply for the home and other assets.

READ MORE
Medicaid’s Protections for Spouses

Spouses of Medicaid nursing home residents have special protections to keep them from becoming impoverished.

READ MORE
Medicaid Planning Strategies

Careful planning for potentially devastating long-term care costs can help protect your estate, whether for your spouse or for your children.

READ MORE
Estate Recovery: Can Medicaid Take My House After I’m Gone?

If steps aren't taken to protect the Medicaid recipient's house from the state’s attempts to recover benefits paid, the house may need to be sold.

READ MORE
Help Qualifying and Paying for Medicaid, Or Avoiding Nursing Home Care

There are ways to handle excess income or assets and still qualify for Medicaid long-term care, and programs that deliver care at home rather than in a nursing home.

READ MORE
Are Adult Children Responsible for Their Parents’ Care?

Most states have laws on the books making adult children responsible if their parents can't afford to take care of themselves.

READ MORE
Applying for Medicaid

Applying for Medicaid is a highly technical and complex process, and bad advice can actually make it more difficult to qualify for benefits.

READ MORE
Alternatives to Medicaid

Medicare's coverage of nursing home care is quite limited. For those who can afford it and who can qualify for coverage, long-term care insurance is the best alternative to Medicaid.

READ MORE
ElderLaw 101
Estate Planning

Distinguish the key concepts in estate planning, including the will, the trust, probate, the power of attorney, and how to avoid estate taxes.

READ MORE
Grandchildren

Learn about grandparents’ visitation rights and how to avoid tax and public benefit issues when making gifts to grandchildren.

READ MORE
Guardianship/Conservatorship

Understand when and how a court appoints a guardian or conservator for an adult who becomes incapacitated, and how to avoid guardianship.

READ MORE
Health Care Decisions

We need to plan for the possibility that we will become unable to make our own medical decisions. This may take the form of a health care proxy, a medical directive, a living will, or a combination of these.

READ MORE
Estate Planning

Distinguish the key concepts in estate planning, including the will, the trust, probate, the power of attorney, and how to avoid estate taxes.

READ MORE
Grandchildren

Learn about grandparents’ visitation rights and how to avoid tax and public benefit issues when making gifts to grandchildren.

READ MORE
Guardianship/Conservatorship

Understand when and how a court appoints a guardian or conservator for an adult who becomes incapacitated, and how to avoid guardianship.

READ MORE
Health Care Decisions

We need to plan for the possibility that we will become unable to make our own medical decisions. This may take the form of a health care proxy, a medical directive, a living will, or a combination of these.

READ MORE
Long-Term Care Insurance

Understand the ins and outs of insurance to cover the high cost of nursing home care, including when to buy it, how much to buy, and which spouse should get the coverage.

READ MORE
Medicare

Learn who qualifies for Medicare, what the program covers, all about Medicare Advantage, and how to supplement Medicare’s coverage.

READ MORE
Retirement Planning

We explain the five phases of retirement planning, the difference between a 401(k) and an IRA, types of investments, asset diversification, the required minimum distribution rules, and more.

READ MORE
Senior Living

Find out how to choose a nursing home or assisted living facility, when to fight a discharge, the rights of nursing home residents, all about reverse mortgages, and more.

READ MORE
Social Security

Get a solid grounding in Social Security, including who is eligible, how to apply, spousal benefits, the taxation of benefits, how work affects payments, and SSDI and SSI.

READ MORE
Special Needs Planning

Learn how a special needs trust can preserve assets for a person with disabilities without jeopardizing Medicaid and SSI, and how to plan for when caregivers are gone.

READ MORE
Veterans Benefits

Explore benefits for older veterans, including the VA’s disability pension benefit, aid and attendance, and long-term care coverage for veterans and surviving spouses.

READ MORE