If you enrolled in a Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Plan or Part D Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that provides prescription drug coverage. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. plan by mistake or after receiving misleading information, you may be able to disenroll and change plans.
Typically, you have the right to change plans if you:
- Joined unintentionally: You may have enrolled believing you were joining a Medigap A Medigap is a supplemental health insurance policy that is sold by private insurance companies and works only with Original Medicare. Medigaps pay part or all of certain remaining costs after Original Medicare pays first. Depending on where you live and when you became eligible for Medicare, you have up to 10 different Medigap policies to choose from, each with a different set of standardized benefits. plan to supplement Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. . Or, you meant to sign up for a stand-alone Part D plan and accidentally joined Medicare Advantage
- 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 A network is a group of doctors, hospitals, and pharmacies that contract with a Medicare Advantage Plan to provide health care services. Generally, plan members will have the lowest costs when using providers and facilities in the plan’s network. Networks may be made up of both preferred and non-preferred providers. 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: If you tried to switch plans during an enrollment period but were kept in your old plan. You can also make a change if you were enrolled in a plan because of an administrative or computer error.
Disenrollment process
Your disenrollment steps process depends on whether or not you have used services.
- If you used any service since joining the plan (for example, saw a doctor or filled a prescription) and received a denial of coverage A denial of coverage is a refusal by Original Medicare, a Medicare Advantage Plan, or a Part D plan to pay for health services, prescription drugs, or durable medical equipment. , you should request retroactive disenrollment Retroactive disenrollment is a way to discontinue enrollment in a Medicare Advantage Plan or Part D plan that you joined by mistake or due to incorrect or misleading information. You will be disenrolled from the plan back to the date you joined. , meaning disenrollment back to the date you enrolled in the plan. Depending on your situation, you may then wish to select Original Medicare (with or without a Part D plan) or a different Medicare Advantage Plan. If you are granted retroactive disenrollment, be sure to ask your providers to re-file claims with your new plan.
- If you have not used any services since joining the plan, you may want to request a Special Enrollment Period (SEP) to disenroll from your plan. This option may be processed faster than retroactive disenrollment. If your request is granted, you will be disenrolled from your plan at the end of the month in which you made the request. To prevent gaps in coverage Gaps in coverage are services or costs that are not covered by Original Medicare, such as vision, dental, and hearing care, as well as deductibles and coinsurance. , sign up for new coverage immediately after you are disenrolled from the plan you did not want.
To request retroactive disenrollment or an SEP, call 1-800-MEDICARE (1-800-633-4227) and explain to the customer service representative exactly how you joined the plan by mistake.