MA plans can eliminate your coverage at the end of the year if its contract is not renewed with Medicare. These plans may decide to drop select service areas, or it may decide to discontinue the entire plan.
A plan may disenroll you involuntarily if you fail to pay premiums timely manner, for disruption the plans ability to properly provide health care services or if it cannot meet your medical needs. You will be automatically returned to coverage under original Medicare at the beginning of the month following disenrollment if disenrolled involuntarily.
If your Medicare Advantage plan terminates or reduces their service area they are required to notify members of Medigap guaranteed issue rights when disenrolling to Original Medicare during a Special Enrollment Period (SEP). In most cases, the plan terminating the contract must send written notice to all Medicare members at least 60 days before the effective date. However, if CMS initiates a termination, it notifies members 30 days before the effective date. There may be cases when a Medigap issuer requires the beneficiary to provide additional documentation that he/she disenrolled as a result of an SEP and is eligible for such guaranteed issue rights.
Clients that are involuntarily disenrolled from their Medicare Advantage plan due to nonrenewal have the right to apply for a Medicare supplement policy, as long as you do so within 63 days of notice of the disenrollment.
If you elect to voluntarily disenroll because you decide a Medicare Advantage plan is not for you, you may have a right to Medigap coverage as long as you were not covered by a Medicare Advantage plan before and you disenroll from your current Medicare Advantage plan within the first 12 months of coverage. This right is limited to the same Medicare supplement you had in place before enrolling the Medicare Advantage plan, excluding any outpatient prescription drug coverage. If you do not have a right to get your old Medigap coverage back, you will not have a guarantee issue period and the insurance company has the ability to deny your application based on health conditions.
Guaranteed Issuance Rights: Enrollment in an MA plan at age 65 If you enroll in a Medicare Advantage plan when first becoming eligible for Medicare, you have guaranteed issuance rights when disenrolling from the MA plan within the first 12 months. Your Medicare Supplement Guarantee Issue Period starts 60 days prior to disenrollment and ends 63 days after disenrollment. You are also eligible for all Medicare Supplement policies.
Guaranteed Issuance Rights: If you are over age 65, enrolled in a MA plan for the first time and disenroll within the first 12 months You must have had a Medigap policy prior to Medicare Advantage enrollment. Your Medigap Guarantee Issuance Period starts 60 days prior to disenrollment and ends 63 days after disenrollment. If the Medigap policy you owned prior to enrollment in the Medicare Advantage plan is still being sold, you may return to that policy. Otherwise, you can choose from plans A, B, C, F, K or L.
The Medicare Supplement issuer cannot impose conditions on coverage or discriminate in pricing based on your health status except as permitted by state rating regulations. You also have no pre-existing condition exclusions, even without creditable coverage. As a reminder, you must exercise your Guaranteed Issuance rights within 63 days of the disenrollment date from the Medicare Advantage plan.
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