Are There Any Protections If I Enroll In A Plan And Do Not Like It?
In order to enable beneficiaries to try a Medicare+ Choice plan, but still have the option of returning to Original Medicare, a number of protections are in place. These protections will enable beneficiaries, in certain situations, to try a plan, but then return to Original Medicare and a Medicare Supplement policy if they want to do so.
Under these protections, beneficiaries will have guarantee issue of a Medicare Supplement policy as long as they meet one of the following criteria. For eligible beneficiaries, companies which sell supplement policies will not be able to deny coverage, charge more, or exclude benefits. However, in order to receive these protections, beneficiaries must apply for a supplement policy within 63 days of disenrolling from the health plan, or within 63 days of the termination of the health plan.
A beneficiary would be eligible for the Medicare Supplement protections if they meed one of the following criteria:
Case #1
You are enrolled in a Medicare+ Choice plan (such as a Medicare HMO) and one of the following happens:
- The contract between Medicare and the plan ends.
- The plan service area no longer covers the county where you live.
- You move out of the plan service area.
- There are violations by the plan.
Protection:
In this case, you would get a guarantee issue of a Medicare Supplement Plan A, B, C, or F from any company (as long as you apply within 63 days of losing your other coverage).
Case #2
You have a Medicare Supplement plan and you cancel it in order to enroll in a Medicare+ Choice plan for the first time. Then you disenroll from the plan within 12 months and return to Original Medicare.
Protection:
You are able to return to the same Medicare Supplement plan with the same company if it is still available. If it is not still available, you will get a Medicare Supplement plan A, B, C, or F from any company (as long as you apply within 63 days from disenrolling).
Case #3
When you first take Medicare Part B, you enroll in a Medicare+ Choice plan. Then you disenroll from the plan within 12 months and return to Original Medicare.
Protection:
You are guaranteed to get any Medicare Supplement plan with any company (as long as you apply within 63 days from disenrolling).
Case #4
You have an employer group health plan which supplements Medicare and your employer terminates the health plan, or stops providing supplemental coverage. (This does not apply if you voluntarily drop the employer group health plan.)
Protection:
You are guaranteed to get a Medicare Supplement policy A, B, C, or F from any company.
Remember, to be eligible for any of these protections, you must apply within 63 days of losing, or disenrolling from your other health coverage.
