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Joining, Dropping or Switching a Medicare HMO?

 

Solkoff Legal, P.A. counsels its clients on how to maximize Medicare and overall access to health care. The firm generally advises against enrolling in Medicare HMOs due to limitations on coverage. See our article on “Medicare and Medicare HMOs.” One negative of Medicare HMOs is that even if the limitations start affecting the quality of your care and your choices, you cannot just “get out” whenever you want.

You can join, switch, or drop a Medicare HMO (Advantage Plan):

  • When you first become eligible for Medicare (3 months before you turn age 65 to 3 months after the month you turn age 65). If you get Medicare due to a disability, you can join during the 3 months before to 3 months after your 25th month of disability benefits (SSDi).
  • From November 15–December 31 each year. Your new choice of coverage will begin on January 1 of the following year. If you have a Medicare HMO (Advantage Plan) and need to get out, this means that your disenrollment is not effective until the following January 1st at which point you would be back on straight Medicare.
  • From January 1–March 31 of each year. However, you can’t add or change to a plan with prescription drug coverage during this time unless you already have Medicare prescription drug coverage. In certain situations, you may be able to join, switch, or drop Medicare HMOs (Advantage Plans) at other times (like if you move out of the service area, have both Medicare and Medicaid, or live in an institution).

As with all of the articles and information on this website, you should not rely upon this article as legal advice for you or any other specific person. There are many factors that must be weighed. You should take this information and then consult with Solkoff Legal, P.A. or another qualified firm in your area.

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