When Medicare Advantage plans terminate coverage
MA plans can make changes to their benefits, premiums, and co-payments, and to the geographic areas that they serve at the beginning of each calendar year. They must notify their Medicare members every fall of the changes that they intend to make the following year. They can add or drop benefits, change premiums and co-payments, and begin or discontinue serving a certain county or region. MA plans must get permission from the Centers for Medicare and Medicaid Services (CMS) before making any changes, and they must also meet certain timelines for notifying their members.
MA plans that contract with Medicare are required to provide all Medicare-covered services. They are not required to provide additional benefits, remain in business in certain areas, or continue their contracts with certain doctors or hospitals.
Your rights to coverage
If your MA plan stops providing benefits in your area
If your MA plan stops providing benefits in your area, you have the right, regardless of your age or health conditions, to join another MA plan if one is available where you live. You must live within its service boundaries. Make sure that your doctor, the medical group where you get your care, and your local hospital are all in the new MA plan network and that they plan to stay there. If you find that you need to switch doctors, make sure the doctor you choose is taking new patients.
If your MA plan stops providing benefits in your area, you also have the right to return to Original, fee-for-service Medicare and, if you don't have end-stage renal disease, you have a choice of several standardized Medicare supplement (Medigap) policies. In this situation, you have "guaranteed-issue" rights — insurance companies must sell you Medigap plans A, B, C, F (with or without the high deductible option), K and L regardless of your health condition.* For more information, see our section about guaranteed issue periods.
Companies cannot impose a waiting period before covering health conditions you already have or charge you a higher premium than what is paid by other people of the same age. Some MA plans may offer you the right to enroll in their own Medigap policy if they sell one.
*Note: Now that we have the Medicare Part D drug benefit, no Medigap policies sold after January 2006 can include drug coverage. However, you may purchase drug coverage through a Prescription Drug Plan (PDP) or a Medicare Advantage Drug Plan (MA-PD) during the annual enrollment period. See our section on prescription drugs for more information.
If your MA plan increases the costs you pay
You also have the right to a Medigap policy when the MA plan stays in your service area, but increases the costs you pay by raising the premium or adding co-payments. You also have this right if the MA plan drops a benefit or if a medical professional who is treating you leaves the MA plan. However, these rights have been restricted to a Medigap policy that is sold by the MA plan that is making these changes.
Some MA plans don't sell a Medigap policy but a sister company does. You can buy a Medigap policy from any company that is part of the same corporation. You have 63 days to make a change, beginning from the time you are notified that one of these changes has taken place, or a medical provider treating you will no longer be eligible to treat members of the MA plan.
For more information, see our page about guaranteed issue periods.
You should select whichever Medigap policy offers you the best coverage at the best price if any of these events occurs. Be sure you understand whether the Medigap policy you choose will require you to use a network of pre-approved doctors and hospitals or whether you can go to any doctor or hospital that accepts Medicare.
How to apply for a guaranteed-issue Medigap policy
If your MA plan plans to stop providing benefits in your area and you want to return to Original, fee-for-service Medicare and you have a health condition that will make it difficult to get a Medigap policy, do not disenroll from your terminating MA plan until your MA plan sends you a final notice of termination. This notice should be dated the beginning of October. Otherwise, if you disenroll before receiving the termination notice, you may lose your right to purchase a Medigap policy without health screening.
Use your MA plan’s final termination notice to apply for one of the "guaranteed-issue" Medigap policies (A, B, C, F [with or without the high deductible option], K or L; see Note, above). You must keep a copy of the MA plan's final notice to show a Medigap insurer as proof that your MA plan is terminating your coverage.
You have a period of 123 days to apply for one of the guaranteed-issue Medigap plans, beginning on December 31, when your MA plan benefits automatically end. You should plan to have your Medigap benefits begin no later than January 1 to avoid any gaps in coverage.
Coordinate the end of your MA plan benefits with the beginning of your supplemental coverage. As long as you are still an MA plan member, you will not be able to use your Medicare benefits outside that MA plan, and a Medigap policy will not pay while you are still an MA plan member.
