Medicare Advantage Plans provide all your Medicare Part A and Part B coverage along with extra benefits not offered through Original Medicare. These plans are provided by private insurance companies that have contracts with Medicare. Many beneficiaries choose Medicare Advantage for the expanded coverage and potential cost savings.
If you’ve enrolled in a Medicare Advantage Plan, you may wonder - can I get kicked off or lose coverage involuntarily? Understanding the circumstances that could lead to termination of your plan will help you avoid potential gaps in coverage.
Key Facts About Losing Medicare Advantage Coverage
Here are some important points to keep in mind:
Plans are generally required to renew your coverage every year if you continue to pay your premiums and live within the plan's service area.
There are limited situations where a plan may terminate your coverage against your wishes, such as moving out of the plan's service area.
You have special enrollment rights if your plan terminates your coverage or leaves the Medicare program. This allows you to join a new Medicare Advantage Plan or switch back to Original Medicare without penalty.
Your health status cannot be used as a reason for terminating coverage. Medicare Advantage Plans cannot drop you if you develop health conditions or need expensive care.
Next, we’ll look at the specific circumstances that could potentially lead to an involuntary end of your Medicare Advantage coverage.
Moving Out of the Plan’s Service Area
Medicare Advantage Plans are regional. Each plan has a defined geographical service area approved by Medicare. In order to join a Medicare Advantage Plan, you must reside within the plan’s service area.
If you permanently move outside of the plan’s service region, the plan will terminate your coverage. They are no longer obligated to cover you once you live somewhere outside their approved area.
Here’s what you should do if you intend to move:
Notify your Medicare Advantage Plan of your upcoming move date and new address.
Research plans that serve your new area and choose one to enroll in so you have seamless coverage.
Or, you can switch back to Original Medicare by contacting Medicare directly.
You’ll have a special enrollment period around the time of your move that allows you to make a new Medicare Advantage or Medigap Plan selection without penalty.
Plan Goes Out of Business
Occasionally, a Medicare Advantage Plan may leave the Medicare program entirely and stop providing coverage in a geographic area. If this happens, your coverage through that plan will be terminated.
You will receive an advance notice from both Medicare and your plan explaining that your coverage is ending along with information on your options:
Enroll in another Medicare Advantage Plan during the special enrollment period
Return to Original Medicare and purchase a stand-alone Part D prescription plan
Purchase a Medigap policy if you choose to enroll in Original Medicare
As long as you take action promptly, you will not experience a gap in coverage. Medicare gives you a special enrollment period so you won't face penalties or delays in enrolling in a new plan.
Plan Reduces Service Area
Medicare Advantage Plans can reduce the size of their service area from one year to the next. For example, a plan may drop certain counties that were previously included.
If you live in an area being eliminated from the plan's coverage region, you'll be notified your coverage is ending along with instructions for selecting a new plan. As with other involuntary terminations, a special enrollment period allows you to transition to a new plan without penalty.
Non-Payment of Plan Premiums
If your Medicare Advantage Plan charges a monthly premium, you must continue paying this premium on time to maintain coverage. If you fail to pay premiums for a number of months, your plan has the right to terminate your coverage.
Before terminating your coverage for nonpayment, the plan must:
Notify you in writing that your premiums are delinquent
Provide a grace period for you to pay the outstanding amount
The grace period must be at least 2 months for plans with quarterly premium or deductible billing. It's important to open any notices from your plan to avoid losing coverage. If facing financial hardship, contact your plan as they may be able to offer options to help avoid termination.
Loss of Medicaid or Extra Help Eligibility
Some Medicare Advantage Plans are designed for specific populations, like dual eligibles who have both Medicare and Medicaid. These are Special Needs Plans (SNPs). Others are designed for those who qualify for Extra Help paying Medicare drug costs.
If you lose eligibility for Medicaid or Extra Help, a Special Needs Plan may terminate your coverage since you no longer meet the population the plan serves. However, you'd have a special enrollment period allowing you to select a new Medicare Advantage Plan.
Failure to Pay Part B Premium
All Medicare Advantage members must continue paying their monthly Part B premium to remain enrolled in the Medicare program.
If you stop paying your Part B premium, Medicare may terminate your Part B benefits and will notify any Medicare Advantage Plan that they must disenroll you. So keeping your Part B premiums current is essential to avoiding involuntary termination.
How to Avoid Losing Coverage
While there are limited cases where you could get disenrolled from a Medicare Advantage Plan, you can take steps to help maintain continuous coverage:
Always pay plan premiums on time, if required, to avoid termination for nonpayment.
Keep your Part B premium current to maintain enrollment in Medicare.
Notify your plan immediately if you move or have an address change.
Respond promptly to any mailings from Medicare or your plan to avoid missing important notifications.
Understand enrollment periods to take timely action if you need to switch plans for any reason.
Compare new plan options each year during annual enrollment and make changes if better plans are available.
Remaining aware of your coverage status and plan communications can help you steer clear of involuntary terminations. But if you do have to switch plans, make sure to exercise your special enrollment rights to transition smoothly and not face gaps in Medicare coverage.
Your Rights if Coverage is Terminated
If your Medicare Advantage Plan does terminate your coverage, either because they are leaving Medicare or dropping your service area, you are entitled to certain rights:
Guaranteed issue rights: This means the new Medicare Advantage Plan or Medigap insurer must accept your enrollment application. They cannot deny you due to pre-existing conditions.
No waiting periods: The new plan can't impose a waiting period before covering your medical services or pre-existing conditions. Coverage starts once your old plan ends.
No underwriting: Medigap insurers can't charge you higher premiums or deny coverage due to your health status or claims history when enrolling under guaranteed issue rights.
Special enrollment period: This gives you more time beyond open enrollment to join a new Medicare Advantage or Medigap Plan without penalties.
Knowing your rights can give you peace of mind that your health needs will remain covered even during transitions between plans.
The Bottom Line
While Medicare Advantage Plans generally renew coverage annually, there are some limited situations where you could potentially be disenrolled, such as moving out of the plan's service area.
The key is paying attention to notifications from both Medicare and your plan and taking prompt action if directed to switch plans. As long as you transition to a new plan during your special enrollment period, you can avoid any gaps in coverage.
With a basic understanding of the circumstances that may lead to involuntary disenrollment, you can take steps to help maintain continuous Medicare Advantage coverage and exercise your rights if you ever do have to change plans. Reach out to Medicare or your State Health Insurance Assistance Program if you have any questions or concerns about your Medicare Advantage coverage.
We’re Here to Help
You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at Next Steps Insurance a Call at (717)-271-2326. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.
FAQs
Can you get kicked off a Medicare Advantage Plan during the enrollment period?
Yes, it is possible to get kicked off a Medicare Advantage Plan during the enrollment period.
What is a Medicare Advantage Plan?
A Medicare Advantage Plan, also known as Medicare Part C, is an alternative to Original Medicare, which is managed by private insurance companies approved by Medicare.
Can you switch from Medicare Advantage Plan back to Original Medicare?
Yes, you can switch from a Medicare Advantage Plan back to Original Medicare during the open enrollment period.
What is the enrollment period?
The enrollment period is a specific time period during which you can enroll in or make changes to your Medicare coverage.
How do I enroll in a Medicare Advantage Plan?
To enroll in a Medicare Advantage Plan, you can contact the plan directly or call 1-800-MEDICARE for assistance.
What is the open enrollment period?
The open enrollment period is a yearly period during which you can make changes to your Medicare Advantage or Medicare prescription drug coverage.
Can I switch from my current Medicare Advantage Plan to a new one during the open enrollment period?
Yes, you can switch from your current Medicare Advantage Plan to a new one during the open enrollment period.
What is a Part D Plan?
A Part D Plan, also known as a prescription drug plan, is a Medicare Plan that provides prescription drug coverage.
Can I drop my Medicare Advantage Plan and switch back to Original Medicare?
Yes, you can drop your Medicare Advantage Plan and switch back to Original Medicare during the open enrollment period.
What should I do if I want to switch from a Medicare Advantage Plan to a Part D prescription drug plan?
If you want to switch from a Medicare Advantage Plan to a Part D prescription drug plan, you should contact an insurance agent or call 1-800-MEDICARE for assistance.
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