Surgery postponed after enrolling in a Medicare Advantage Plan

on Dec 7, 2023

Toni:

I made a terrible mistake during the recent Medicare Annual Enrollment Period and changed to a Medicare Advantage HMO plan, because I understood from talking with my friends that this plan was an effective way to save my Medicare dollars. I have discovered that my orthopedic surgeon is not in this plan.

I was to have hip surgery in January, and now my surgery is postponed. The surgeon’s office is requesting that I return to Original Medicare so he can do the type of surgery that is needed. Can you explain how I can return to Original Medicare? I am glad I had not canceled my Medicare Supplement Plan G even though the premium has increased.

--Jason from St. Louis

Hello Jason:

If you have discovered you made a wrong choice in selecting a Medicare Advantage Plan, Jan. 1 begins the 3-month period allowing you to change to a different Medicare Advantage Plan or return to Original Medicare. Your changes will take place on the first day of the following month.

On page 72 of my new Medicare Survival Guide Advanced edition, I explain how to disenroll from a Medicare Advantage Plan during this period, called the Medicare Advantage Open Enrollment Period (MA OEP), from Jan. 1 through March 31 each year.

During the MA OEP, a person can switch from one MA Plan to another MA Plan or to Original Medicare with or without a Part D plan. The main difference between MA OEP and Medicare Annual Enrollment Period (AEP) is who can use each one: Only individuals on a Medicare Advantage Plan can utilize the Medicare Advantage Open Enrollment Period.

A person may not disenroll from a Medicare Advantage plan or a Medicare Part D prescription drug plan after March 31, because one is “locked in” from April 1 to Dec. 31. One must wait until the next Medicare Annual Enrollment Period, which occurs annually from Oct.15 through Dec. 7, to change to a different plan or return to Original Medicare.

You made a smart choice, Jason, in not canceling your Medicare Supplement because you may not be able to qualify for a new plan due to your health issues. Most Americans don’t realize there is no special period to enroll in a Medicare Supplement like there is for Medicare Advantage Plans. One may change a Medicare Supplement any day of any week in any month.

Readers, do not cancel your Medicare Supplement plan for the first few months that you are trying a Medicare Advantage Plan just in case you need to return to Original Medicare during the MA OEP, Jan. 1 - March 31.

Jason, at the Toni Says office, we always advise Medicare clients to call all their doctors to see which Medicare Advantage plans the healthcare professional or facility accepts. I do not believe you did this when you enrolled in your Medicare Advantage HMO, and that has caused this surgery postponement problem for you.

Readers, remember to always talk to your doctor or the doctor’s office manager before you make any changes to your Medicare insurance and verify what Medicare Advantage Plans they accept. And be aware that doctors and specialists can stop accepting a particular Medicare Advantage Plan at any time.

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Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. Toni’s books and her newsletter are available at www.tonisays.com. Toni’s new Confused about Medicare video series is now available for purchase at www.tonisays.com, as are Toni’s Medicare Survival Guide and discounted bundle package.