TONI SAYS: Surgery postponed after enrolling in Medicare Advantage Plan

By Toni King


I made a terrible mistake during the recent Medicare Annual Enrollment Period and changed to a Medicare Advantage HMO plan because I understood from talking with my friends that this plan was an effective way to save my Medicare dollars. Now I have discovered that my orthopedic surgeon is not in this plan, and I am to have hip surgery in January. Now my surgery is postponed since the surgeon’s office is requesting that I return to Original Medicare to do the type of surgery that is scheduled. Can you explain how I can return to Original Medicare? I am glad I had not cancelled my Medicare Supplement Plan G even though the premium has increased. Signed…Jason from St. Louis, MO.

Hello Jason:

If you have discovered you made the wrong choice in selecting a Medicare Advantage Plan, Jan. 1 begins the 3-month period allowing you to change to a different Medicare Advantage Plan or return to Original Medicare. Your changes will take place on the first day of the following month.

On page 72 of my Medicare Survival Guide Advanced edition, I explain how to disenroll from a Medicare Advantage Plan during this period, called the Medicare Advantage Open Enrollment Period (MA OEP), which runs from Jan.1 through March 31 each year.

During the Medicare Advantage Open Enrollment Period (MA OEP), a person can switch from one Medicare Advantage Plan to another Medicare Advantage Plan, or to Original Medicare with or without a Part D plan. The main difference between Medicare Advantage Open Enrollment Period (MA OEP) and Medicare Annual Enrollment Period (AEP) is who can use each one: Only individuals on a Medicare Advantage Plan can utilize the Medicare Advantage Open Enrollment Period which begins yearly on January 1.

A person may not disenroll from a Medicare Advantage plan or a Medicare Part D prescription drug plan after March 31, because one is “locked in” from April 1 to Dec. 31. One must wait until the next Medicare Annual Enrollment Period (AEP), which occurs annually from Oct.15 through Dec. 7 to change to a different plan or return to Original Medicare.

You made a smart choice, Jason, in not cancelling your Medicare Supplement because, due to your health issues, you may not be able to qualify for a new plan. Most Americans do not realize there is no special period to enroll in a Medicare Supplement like there is for Medicare Advantage Plans. One may change a Medicare Supplement any day of the year.

Readers do not to cancel your Medicare Supplement plan for the first few months that you are trying a Medicare Advantage plan just in case you need to return to Original Medicare during the Medicare Advantage Open Enrollment Period (MA OEP) from Jan.1-March 31.

Jason, at the Toni Says office, we always advise Medicare clients to call all their doctors to see which Medicare Advantage plans the healthcare professional or facility accepts. I do not believe you did this when you enrolled in your Medicare Advantage HMO and that has caused this surgery postponement problem for you.

Remember to always talk to your doctor or the doctor’s office manager before you make any changes to your Medicare insurance and verify what Medicare Advantage Plans, they accept. And be aware that doctors and specialists can stop accepting a particular Medicare Advantage Plan at any time.

For assistance in disenrolling from a Medicare Advantage plan that does not fit your needs and finding a Medicare Supplement, call the Toni Says Medicare office at 832/519-8664 or email [email protected].

Merry Christmas from Toni Says with a discount to the Toni Says readers on the Medicare Survival Guide bundle package at