Assisting Residents Who Wish To Disenroll From Medicare Advantage Plans/HMO’s

Often individuals have enrolled in Medicare Advantage Plans and HMO’s only to learn that their out of pocket expenses are greater than when they were on regular Medicare.  In many instances these individuals cannot disenroll from the Medicare Advantage plan because they have been “locked in” and cannot change until the next year’s open enrollment season in November/December of each year. 

HCS has confirmed through CMS that this “lock in” does not apply to individuals who are admitted to nursing homes or assisted living facilities.  These individuals have a “special election period” which allows them to enroll in or change PDP’s upon admission to the facility.  If your new resident is not satisfied with his/her Medicare Advantage/HMO plan when he/she is admitted to your facility, he/she can simply enroll into a Medicare PDP.  Enrollment into a PDP will automatically remove him/her from the Medicare Advantage Plan/HMO and place him/her back into regular Medicare.  The effective date of enrollment back into regular Medicare will be the month following the month of enrollment into the PDP.  For example:  if you admit a resident in November, 2006 who is dissatisfied with his current MA/HMO plan, he/she can select and enroll into a Medicare Prescription Drug Plan prior to the end of November, 2006.  In December, 2006, the resident will be enrolled in the selected PDP and will be placed back into regular Medicare.