Doctor doesn’t accept Medicare Advantage… How do I return to Original Medicare

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Hi Toni:

I never should have listened to my brother, who bragged about how his Medicare Advantage Plan was a great way to save money and not have to spend so much on my Medicare supplement plan’s premium. I discovered that the eye doctor who was to perform surgery on my right eye in early January is not in my Medicare HMO plan. I should have called his office before I signed up for it.                                                                             

Now my eye surgery is postponed since the doctor’s office is requesting that I return to Original Medicare to do the type of surgery that is needed. Can you explain how and when I can return to Original Medicare? I am glad I did not cancel my Medicare Supplement Plan G even though the premium has increased. Thanks, Toni.

--Stephanie 

Hello, Stephanie:

Readers, if you have discovered you made the wrong choice in selecting a Medicare Advantage (MA) Plan during Medicare’s Open Enrollment Period (OEP), which ended on December 7, I have good news for you. Beginning January1, you can return to Original Medicare or change to a different Medicare Advantage Plan during the Medicare Advantage Open Enrollment Period (MA OEP).

During MA OEP, a person can switch from one Medicare Advantage Plan to another Medicare Advantage Plan, or to Original Medicare with or without Part D and a Medicare Supplement plan. Only individuals on a Medicare Advantage Plan can utilize the Medicare Advantage Open Enrollment Period (MA OEP). The enrollment time is from January 1 through March 31 each year. This information is provided on page 72 of the 2026 Medicare & You handbook.

Changes in your chosen Medicare coverage start the first day of the month after the specific plan receives the change. Enrolling in MA OEP in January change begins February 1,enrolling in February change begins March 1,enrolling in March change begins April 1. After March 31, MA OEP ends and one is “locked” into whatever Medicare Advantage or Medicare Part D prescription drug plan you’ve chosen.

From April 1 to December 31, one is “locked”  and must wait until the next Medicare Annual Enrollment Period (AEP), which occurs annually from October 15 through December 7. During this period one can change to a different plan or return to Original Medicare with the specific Medicare change that will begin January 1of the next year.

Stephanie, you made a smart choice with not cancelling your Medicare Supplement due to your health issues because you may not be able to qualify for a new Medicare Supplement plan. Most Americans do not realize that there is not a special period to enroll in a Medicare Supplement like there is for Medicare Advantage Plans. One can change a Medicare Supplement any day of the year with qualifying medically with underwriting questions.

Readers do not 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 MA OEP from January1through March 31.

During a Toni Says Medicare consultation, whether in person or by Zoom, the Toni Says Medicare agent always advises clients to call all of their doctors and ask which Medicare Advantage plans the healthcare professional or facility accepts. Not asking your eye doctor’s office prior to changing to the Medicare Advantage HMO  has caused this surgery postponement problem for you, Stephanie. Be aware that doctors, specialists, and facilities can stop accepting a particular MA Plan at any time.

For assistance with 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 Medicare questions to [email protected].

Toni’s new course, “Confused about Medicare Workshop,” a downloadable video series, and the “Medicare Survival Guide Advanced” edition are available at www.tonisays.com. Sign up for the Toni Says newsletter on the Toni Says website at tonisays.com to keep up to date with Medicare changes … Merry Christmas from Toni and the Toni Says Medicare Team!

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