Cancer Patient’s Medicare Mistake Threatens Life-Saving Treatment in Houston

Hello Toni,

The first week my wife and I moved to Houston from Oklahoma, I have a wonderful surprise in my front yard! There was your Medicare column discussing different Medicare options for someone with health issues.

I am 70 years old and am seeking medical care from MD Anderson for colon cancer. I enrolled in the Medicare Advantage HMO when I was in Oklahoma and was told that I could transfer to a Houston doctor when I moved on June 15. I made a big mistake in enrolling because I did not know I could wait until I moved. Now I have discovered that MD Anderson does not accept this Medicare HMO plan. I need to enroll in a Medicare Supplement, but I do not know how to disenroll from this Medicare Advantage plan and return to Medicare with a supplement. Time is ticking because my cancer treatment needs to begin soon. I need to do this fast!!

Thanks,

James from Spring, TX

Hi 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 drained due to a serious illness. Let me explain how the Toni Says® Medicare team helps clients who want to disenroll from their Medicare Advantage plan and return to Original/ Traditional Medicare. 

Your Medicare Special Enrollment Period

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 for certain situations when you are able to join, switch and drop a Medicare Advantage Plan. Your special situation is:

• Moving Out of Area: This is when you have moved out of your area, (James moving from Oklahoma to Houston). This qualifies you for an SEP allowing you to disenroll from your Medicare Advantage Plan and return to Original Medicare. There is a time limit which is 60 days from the date one moves. James’ date is August 15, since he moved to Texas on June 15.

Other Special Enrollment Periods

• Enrolled in Medicaid
• Qualify for Extra Help for prescription drugs
• Moving into a long-term care facility (such as a skilled nursing facility, assisted living facility, personal care home, Alzheimer’s assisted living facility, etc.)
• Loss of creditable prescription drug coverage (such as insurance through your employer)

The Trick to Disenrolling from a Medicare Advantage Plan

The trick to disenrolling from a Medicare Advantage Plan when an SEP is granted is to enroll in a stand-alone Part D plan. Then automatically you are disenrolled from your Advantage plan and re-enrolled in Original Medicare. Returning to Original Medicare will be effective on the 1^st of the next month.

Medicare Supplement Open Enrollment

James because you enrolled in Part B beginning June 1, you are within your 6-month Medigap/Medicare Supplement open enrollment period which ends November 30. This means you can receive your Medicare Supplement without having to answer health underwriting questions. Medicare states, “During the Medigap Open Enrollment Period, an insurance company can’t use medical underwriting to decide whether to accept your application.” 

The Medigap/Medicare Supplement open enrollment period 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 by having to answer medical underwriting questions.

James, I’m glad you reached out to me with your question, because with Medicare… what you don’t know WILL hurt you!

Toni’s new book Maze of Medicare is the first book explaining Medicare that includes scripture and positive quotes to help relieve the common stress in understanding Medicare is available at www.tonisays.com.

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