What if I enrolled in a Medicare private health plan or drug plan by mistake or because I was misled?
Question 8 of 10 (use "Last" or "Next" buttons to see more)
Last Update: October 08, 2008
You have the right to disenroll and change plans if you
- joined unintentionally. For example, you may have enrolled believing you were joining a Medigap plan or a stand-alone private drug plan (PDP) that would supplement Original Medicare. You did not realize you were joining a Medicare private health plan with a limited doctor network through which you must get all of your Medicare health benefits.
- joined based on incorrect or misleading information. You may have been misled, for example, if a plan representative told you that your doctors are in the plan’s network but they are not, or you were promised benefits that the plan does not really cover.
- through no fault of your own, ended up or were kept in a plan you do not want. For example, if you tried to switch plans but were kept in your old plan, you have the right to disenroll and change plans. You can also make a change if you were enrolled in plan through an administrative or computer mistake.
To find out what rules Medicare private health and drug plans must follow when they market their products, click on the link in the GO TO box.
How you should request disenrollment depends on whether or not you have used services.
- If you have used health services since you joined your plan (for example, saw a doctor or filled a prescription), and your plan has denied coverage for services, you may want to request “retroactive disenrollment”—disenrollment back to the date you enrolled in the health plan.
Retroactive disenrollment allows you to be disenrolled from a Medicare private health or drug plan as if you had never joined it. Depending upon your situation, you may then wish to select Original Medicare (with or without a Medicare private drug plan) or a Medicare private health plan with or without drug coverage. If you are granted retroactive disenrollment, once the request has officially gone through, you should ask any provider who gave you care during the time when you were enrolled in the plan to refile claims with Original Medicare and/or, your new Medicare drug plan, or private health plan.
- If you have not used any health services since you’ve had your Medicare private health plan, you may want to request a “special enrollment period” to disenroll from your plan and make a new choice going forward. If your request is granted, you will be disenrolled from your plan at the end of the month in which you made the request. Such requests are generally processed faster than “retroactive disenrollment” requests. To prevent gaps in coverage, you should sign up for new coverage right away so that it starts as soon as you are disenrolled from the plan you did not want.
To request a retroactive disenrollment or a special enrollment period, call 800-MEDICARE and explain to the customer service representative exactly what happened to cause you to join the plan by mistake.
To find out more about other circumstances that may qualify you for a special enrollment period, click on the link below.
This information was provided by the Medicare Rights Center (MRC), the largest independent
source of health care information and assistance in the United States for people with Medicare.
Founded in 1989, MRC is a nonprofit organization that helps older adults and people with
disabilities get good, affordable health care.
You can learn more about MRC at www.medicarerights.org