Huge mistake…Doctor not accepting Medicare Advantage Plan!

Toni King / Special to Weekly Citizen, The Chief


During Open Enrollment I made a big mistake and changed to a Medicare Advantage PPO because I understood from talking with my friends that this PPO plan was like a Medicare Supplement. Now I have discovered that my diabetes doctor is no longer accepting this PPO plan and has suggested that because of how brittle my diabetes is that I remain on Traditional Medicare. Can you explain how I can return to Medicare? Signed…Jeremy from Tulsa, OK

Dear Jeremy:

Good News… For those who are not happy with the Medicare Advantage plan that they have picked for 2018, on page 72 of my new Medicare Survival Guide® Advanced edition, it explains how you can disenroll from the Medicare Advantage Plan. This time is called the Medicare Advantage Disenrollment Period or MADP in Medicare terms.

Medicare will only give that person 45 days (from January 1 to February 14, not 15 or 16) to find out if the new Part C Medicare Advantage plan is what they want. You can only disenroll from your current Medicare Advantage Plan and return to Original Medicare only and enroll in a standalone Part D Medicare Prescription Drug plan.

Enrolling in the standalone Part D Medicare Prescription Drug plan disenrolls you from your Medicare Advantage plan. You would think that Medicare would give you time to tryout a new Medicare Advantage plan…but Medicare doesn’t!!

If your health prevents you from being accepted by a Medicare Supplement to help pay your Medicare out of pocket, then all you can do is have Original Medicare with a Medicare Part D prescription drug plan. You will pay Medicare costs out of your own pocket.

At the Toni Says® office, we always advise a Toni Says® Medicare client to call all their doctors to see which Medicare Advantage plans the healthcare professional/facility accepts.

One thing to remember is that the doctor can also stop taking a Medicare Advantage plan in the middle of the year. If you find a Medicare Advantage plan that you like and your doctor is not in the plan, then you might have to change doctors to use that plan.

You cannot get out or disenroll from a Medicare Advantage plan after February 14 because you are “locked in” and will have to wait until the next Medicare enrollment period, which should be October 15, 2018. You can then disenroll and make a change with January 1 of the next year as a new start date.

The most important thing to remember is to always talk to your doctor or the doctor’s office manager before you make any changes to your Medicare insurance needs to see what Medicare Advantage plan they accept.

Frequently asked Toni Says® Medicare questions

This week’s Toni Says Medicare column has a different twist and consists of frequently asked Medicare questions from Toni Says® readers around the United States. 2017 has been a great year and thank you from Toni Says® team for allowing us to help you navigate the maze of Medicare.

1. “What if” I did not enroll in Medicare Parts A and B when I should because I don’t want to pay that extra Part B premium each month? I don’t go to the doctor and I don’t take any prescriptions. Can I enroll later? James from Nashville, Tenn.

Toni’s Says®: If you are past 65 and 90 days years old, not working full-time with true company

benefits and decide to enroll in Medicare Part B; YOU must wait until Medicare’s General Enrollment Period, which is January 1 – March 31 of each year to enroll. You will now be penalized an additional 10 percent more for each 12-month period that you could have had Part B but didn’t sign up for it. Say you wait 3 years, which will be a 30 percent penalty. You will pay this late enrollment penalty for as long as you are on Medicare. Remember, you have ABSOLUTELY NO doctor coverage if you do not have Part B. You will pay 100 percent out of pocket for doctor care and any outpatient care, including Hospital, MRI, and X-rays, etc. You will not be a HAPPY CAMPER. NO MATTER WHAT! Get Part B when you are not working full-time with true company benefits.

2. “What if” I am past 65, have retired from work with company benefits and need to get Part B. What do I do? Susan, Spring, Texas

Toni Says®: Before you have been terminated from your group plan and/or not working full-time, apply for Medicare Part B. Seek which plan best fits your needs such as a Medicare Supplement or a Medicare Advantage Plan. Talk to your doctor about what plans they accept. Search for which Medicare Prescription Drug Plan covers your prescriptions. Since you are leaving company benefits and receiving Part B, you only have 60 days to get Medicare Prescription Drug Coverage, not 61 or 62 days. Try and do everything as soon as you become eligible for Part B.

3.“What if” my adult children or a friend help make my medical and financial decisions?

Toni’s Says®: Make sure that your decision maker is a signer on all your legal documents, such as your power of attorney, medical power of attorney and living will. The only way your care can be discussed with an insurance company or any health care professional is with the person who has been named your power of attorney. This does not mean that you are losing control of making your own decisions, but helps make sure that you are making wise medical and financial decisions.

4. “What if” I am on a limited income and cannot afford my prescription drugs or the Part B premium? Tina, Atlanta, Ga.

Toni Says®: Go to the Medicaid office and see if you qualify for Medicaid’s QMB or SLMB. Go to Social Security or apply online for “Extra Help if you don’t qualify for Medicaid. Each year the amounts change. Get proactive about your Medicare!!!! No one can do it for you. The worst Medicaid or Social Security can say regarding qualifying for extra assistance is NO.

About Toni King

Toni King is an author, columnist and radio and TV personality, and has spent more than 27 years as a top sales leader in the Medicare and health insurance fields. She has also conducted “Confused about Medicare “ workshops throughout Texas and the southeastern United States. In 2009, Toni was holding a Medicare workshop in Greenville, Miss., when a member of the audience asked a question about his not needing Medicare Part B. Toni met with the gentleman after the workshop and it didn’t take her long to find out that he had received wrong information from his local Social Security office. It took a couple of days to get this overwhelming problem straightened out and get him his Medicare Part B. When it was all finished, her role as an insurance agent had changed to that of advocate for people on

Medicare. It was then that she took the Medicare and You handbook and put it into “people terms” so the average person could understand Medicare.

Whether Toni is consulting with a client in the office or giving a “Confused about Medicare” workshop to hundreds of people, she emphasizes her mottos: “Medicare is NOT Cookie-Cutter” and “What You Don’t Know WILL Hurt You!” Not understanding the rules and guidelines of Medicare can cause you to make costly mistakes that will last a lifetime. Whether you are helping your parents understand Medicare or choosing a plan for yourself, let Toni show you how to navigate your way through what has become the Medicare maze!