What happens if my Medicare HMO goes out of business?

Question:

What happens if my Medicare HMO goes out of business?

Answer:

You have several choices:

  • Return to the original fee-for-service Medicare plan
  • Supplement your fee-for-service Medicare plan with a Medigap policy
  • Enroll in another Medicare Advantage managed care plan if one is available in your area

The decision to return to your original fee-for-service Medicare plan is an important one. Make sure you consider your need for Medigap insurance before you disenroll from your HMO. You can disenroll in early October when you receive the final notice from your HMO. This will give you time for your Medigap policy to start on the first day of the next month so you will not have a lapse between plans. A disenrollment form is available from your HMO plan administrator or a Social Security Administration office.

You can stay with your HMO until the end of the year. You then have 63 days after your HMO coverage expires to purchase a Medigap A, B, C, or F plan with guaranteed insurability. This means that the Medigap insurance company cannot turn you down for pre-existing conditions or discriminate in the price of the policy because of your health or claims experience.

Carefully read the information you receive from your HMO, which should explain your options and provide a list of other Medicare Advantage plans available in your area. A disenrollment form is not required if you go to another HMO. If you have questions, call your plan administrator or Social Security Administration office.