Can You Get Kicked Off a Medicare Advantage Plan?

Over 28 million Medicare beneficiaries are enrolled in Medicare Advantage Plans in 2023. Medicare Advantage provides all your Part A and Part B benefits through private insurers. While Medicare Advantage Plans offer benefits beyond Original Medicare, they also come with drawbacks like provider networks. Can you actually get kicked off your Medicare Advantage Plan involuntarily?

In this article, we’ll look at the reasons Medicare Advantage Plans can drop you, your options if you are disenrolled, and how to switch from Medicare Advantage back to Original Medicare.

Reasons Medicare Advantage Plans May Drop You

Medicare Advantage Plans are required to provide an annual notice of non-renewal if they are discontinuing coverage at the end of the year. However, in limited cases, a Medicare Advantage insurer can also involuntarily disenroll you effective the first of the following month.

Here are some reasons why a Medicare Advantage Plan may drop you during the year:

You move out of the plan’s service area
You lose your Part A and/or Part B eligibility
You enroll in a Medicare hospice program
The plan is leaving the Medicare program
You repeatedly behave disruptively even after counseling
You let someone else use your plan membership card to get healthcare
You provide incorrect enrollment information to the plan

If any of these situations apply to you, your Medicare Advantage insurer must notify you in writing they are ending your membership and why.

You cannot be dropped from Medicare Advantage because of health status changes or due to expensive medical care needed. Plans cannot force you out if your costs become too high.

Special Enrollment Period for Involuntary Disenrollment

If your Medicare Advantage Plan disenrolls you, you will have a Special Enrollment Period to join another Medicare Advantage Plan or switch back to Original Medicare. This Special Enrollment Period lasts for up to two months after your Medicare Advantage enrollment ends.

During this time, you can enroll in a new Medicare Advantage Plan if one is available in your area. Or you can switch back to Original Medicare and also purchase a stand-alone Part D prescription drug plan.

Having this Special Enrollment Period allows people kicked off their Medicare Advantage Plan to transition to other Medicare coverage. You won’t face a gap in benefits or late enrollment penalties.

Switching from Medicare Advantage to Original Medicare

If you get notice you are being dropped from your Medicare Advantage Plan, you may want to switch back to Original Medicare. Here is how the process works:

Notify your plan you want to disenroll and return to Original Medicare. This will end your plan membership.
Your Medicare Advantage coverage will terminate on the first day of the month after your disenrollment request.
You’ll automatically be returned to Original Medicare when plan enrollment ends.
You can sign up for a stand-alone prescription drug plan to add that coverage.
If you want to purchase a Medigap policy, you have a 63 day window starting the month your Medicare Advantage Plan ends.
Medigap covers Original Medicare gaps like coinsurance and deductibles.
Your Medigap open enrollment period allows you to buy any policy even with health conditions.

So getting dropped from Medicare Advantage opens a Special Enrollment Period for other Medicare Plans and also gives you access to Medigap Plans without underwriting.

Voluntarily Leaving Medicare Advantage Plans

In addition to involuntary disenrollment, you also have options to voluntarily leave your Medicare Advantage Plan:

Annual Open Enrollment Period

Runs from October 15 to December 7 each year.
Allows you to switch Medicare Advantage Plans or drop Advantage and return to Original Medicare for the next year.

Medicare Advantage Open Enrollment Period

January 1 to March 31 every year.
Lets anyone on a Medicare Advantage Plan switch to another Advantage Plan or go back to Original Medicare.
Available once per calendar year.

Trial Period

New Medicare Advantage enrollees have a 12 month trial period after joining their first Medicare Advantage Plan.
Can go back to Original Medicare anytime during the first year.
Only can use this one time ever.

So you have multiple voluntary opportunities to leave Medicare Advantage each year if you are unsatisfied with your plan.

Losing Medicare Part A or Part B Eligibility

One of the main reasons Medicare Advantage Plans can drop you is if you lose eligibility for Part A and/or Part B. This happens most often when:

You stop paying your Part B premiums and Social Security drops you from Part B coverage.
You lose disability benefits and don’t qualify for premium-free Part A based on your work history.

If you lose Medicare eligibility, you cannot remain on your Medicare Advantage Plan. You would need to re-qualify for Medicare to enroll again.

That’s why it’s crucial to keep paying your Part B premiums and not let Medicare coverage lapse. Losing Part A or Part B makes maintaining Medicare Advantage enrollment impossible.

The Bottom Line

While rare, there are situations where your Medicare Advantage insurer can involuntarily disenroll you from a plan outside your control. This triggers a Special Enrollment Period to enroll in other coverage.

You also have opportunities every year to voluntarily leave Medicare Advantage such as the annual open enrollment period.

But losing underlying Medicare eligibility is the main factor that will force you off Medicare Advantage. So maintain continuous Part A and Part B coverage to avoid involuntary disenrollment.

FAQS

Can I get kicked off a Medicare Advantage Plan?

A: Yes, you can get kicked off a Medicare Advantage Plan if you do not comply with the terms and conditions set by the insurance company. This can happen if you fail to pay your premiums, provide misleading information, or engage in fraudulent activities.

What is open enrollment?

A: Open enrollment is a specific period of time each year when you can make changes to your Medicare coverage. During this period, you can enroll in a Medicare Advantage Plan, switch from one plan to another, or return to Original Medicare.

Can I enroll in a Medicare Advantage Plan outside of the open enrollment period?

Yes, you may be eligible to enroll in a Medicare Advantage Plan outside of the open enrollment period if you experience a qualifying life event, such as moving to a new area or losing your current insurance coverage.

Can I drop my Medicare Advantage Plan and switch back to Original Medicare?

Yes, you have the option to drop your Medicare Advantage Plan and switch back to Original Medicare. However, it is important to note that you may not be able to re-enroll in the same plan if you decide to make this change.

What is the difference between Medicare Advantage and traditional Medicare?

Medicare Advantage, also known as Medicare Part C, is an alternative to traditional Medicare (Part A and Part B) that is offered by private insurance companies. Medicare Advantage Plans often provide additional benefits, such as prescription drug coverage, that are not offered by traditional Medicare.

How can I switch from a Medicare Advantage Plan to Original Medicare?

To switch from a Medicare Advantage Plan to Original Medicare, you can contact your insurance company and inform them of your decision. They will guide you through the process and provide any necessary paperwork or instructions.

Can I sign up for a Medicare Advantage Plan after I already have Medicare Part A and Part B?

A: Yes, you can sign up for a Medicare Advantage Plan even if you already have Medicare Part A and Part B. However, you must meet the eligibility requirements and go through the enrollment process to join a Medicare Advantage Plan.

Can I switch from one Medicare Advantage Plan to another?

Yes, you have the option to switch from one Medicare Advantage Plan to another during the open enrollment period or if you qualify for a special enrollment period due to a qualifying life event.

Can I buy a Medigap policy if I switch from a Medicare Advantage Plan to Original Medicare?

Yes, if you switch from a Medicare Advantage Plan to Original Medicare, you may be eligible to buy a Medigap policy to help cover the out-of-pocket costs associated with Original Medicare.

What happens if I make changes to my Medicare coverage?

A: If you make changes to your Medicare coverage, such as switching from a Medicare Advantage Plan to Original Medicare, it is important to review your new plan and ensure that it provides the coverage you need. You should also be aware of any changes to your premium, deductible, or benefits.