UNITED STATES—Toni: During last year’s Medicare Open Enrollment time, my husband, John, and I qualified for a Medicare Supplement Plan G over the phone from a telemarketing call. The supplement has never paid a dime! We still must use the same doctor and get referrals from the Medicare Advantage HMO that we were enrolled in. We can’t get the Medicare Supplement to pay because no one advised us how to stop the Medicare Advantage plan and return back to Medicare.
The Medicare Supplement is costing us over $400 a month since the plan began in January. How can we get out of this Medicare Advantage HMO plan and return to Original Medicare to use the Medicare Supplement purchased last November? Toni, looking forward to what you have to say about this complicated situation –Ginger from Sugar Land, Texas.
Hello Ginger: Please be aware that one of the biggest mistakes someone enrolled in Medicare can make is when an insurance company or agent market a Medicare Supplement without advising the client how to disenroll properly from their Medicare Advantage plan and return back to Original Medicare. This situation is what has happened to you and John.
Ginger, as you are now finding out, the agent or company that sold you the Medicare Supplement failed to inform you and your husband how to disenroll properly from your Medicare Advantage plan. Thus, you and your husband have not been enrolled in Original Medicare to use the Medicare Supplement benefits that began in January.
The change would have been a simple one, because you both qualified medically for the new Medicare Supplement. All the agent needed to do was enroll you and your husband into a stand-alone Medicare Part D prescription drug plan by December 7. when Medicare’s Open Enrollment ends. This simple step would have canceled your Medicare Advantage HMO Plan effective January 1. You and John would have returned Original Medicare with a Medicare Supplement and a new Medicare Part D prescription drug plan.
Medicare’s Open Enrollment Period, running this year from October 15 to December 7, is when you both need to enroll in a stand-alone Medicare Part D plan that covers your current prescription drugs and will disenroll both of you back to Original Medicare to begin January 1, 2027. Currently, there is nothing that can be done regarding the Medicare situation which you and John are in with the Advantage HMO Plan. This is one of Medicare’s rules because you and John are out of Medicare Advantage Open Enrollment Period which is from January 1-March 31 every year.
One option you could try, Ginger, is to call Medicare at 1-800-MEDICARE (633-4227) and explain your situation to the Medicare representative. Perhaps the Medicare rep could override the situation you and John are in and enroll you in a Medicare Part D Prescription Drug Plan, which can disenroll you from the Medicare Advantage HMO Plan and return to Original Medicare with your current Medicare Supplement.
Those enrolling into a Medicare Supplement need to be sure they have passed the medical underwriting process and are approved for the Medicare Supplement before enrolling in a stand-alone Part D plan, which will automatically cancel your Medicare Advantage Plan. The average American on Medicare does not realize that they cannot have both Original Medicare and a Medicare Advantage plan at the same time. Medicare will pay the Medicare Advantage plan for your care. Original Medicare and Medicare Advantage plan cannot pay at the same time. Confusing… I know!
Insurance agents who are properly trained regarding Medicare Advantage rules know that those enrolled in Medicare Advantage plans should enroll in a stand-alone Medicare Part D plan by midnight December 7th to be disenrolled properly from a Medicare Advantage plan once the Medicare Supplement is approved.
Remember, with Medicare, what you don’t know WILL hurt you!
Toni King is an author and columnist on Medicare, Social Security, and long-term care issues. Email your Medicare questions to info@tonisays.com or call 832-519-8664. Sign up for the Toni Says newsletter at www.tonisays.com to download Toni’s new Medicare 2026 First Steps guide.
