HMO Disenrollment

Source

Karl Note: The health insurance system is deliberately complex -- those who designed it know that almost all of the people who would be interested in "disenrollment" are elderly and not likely to understand the complexity or follow the complicated instructions exactly. I found, in my case, that if we did not complete certain paperwork, the way they wanted it, the insurance cost would have jumped up by more than $100 per month. The form below? You can hardly find that anywhere. It is here! I'll write more about this, but be warned that the Medicare People are under threat of bankruptcy and are using every crooked trick they can to make you pay more than the law requires.

The Disenrollment Form

HMO Disenrollment

You can always disenroll from an HMO and switch back to original Medicare.

This is your right, and you do not have to explain why you want to leave the HMO.

Your original Medicare coverage will begin on the first day of the month following your disenrollment from the HMO. From that time forward, you will receive original Medicare coverage for services received outside the HMO.

Notification of disenrollment:

In order to disenroll from an HMO, you may either notify the HMO in writing or complete a form (HCFA Form 566) at your local Social Security Office. To ensure prompt disenrollment and notice to Medicare, you should visit your local Social Security Office.

If you choose to write the HMO, send your request by certified mail, return-receipt requested, so that you are covered for services received outside the HMO on the first day of the month following the notification.

Planning your disenrollment:

You may want to purchase Medigap insurance before you disenroll from the HMO. It is a good idea to plan your disenrollment for the time your Medigap coverage begins. Check out the Medicare Supplemental Insurance section for more information.

Remember that some Medigap policies do not provide coverage for pre-existing conditions until three to six months after you enroll. You should be aware that if you return to original Medicare, you may not be able to purchase a Medigap policy. In many states, insurance companies may refuse to issue you a Medigap policy after the six-month open enrollment period (which occurs only when you first enroll in Part B) but there are exceptions to this rule. Check out the Medicare Supplemental Insurance section for more information.

Handling Medicare's mistakes once you have disenrolled:

Medicare may mistakenly deny coverage for out-of-plan services after you disenroll from the HMO.

If you receive Medicare denials after you have disenrolled, do not worry. Send a letter to your Medicare carrier requesting that it reprocess your claims. Be sure to attach a copy of the HMO statement indicating the date of your disenrollment, as well as copies of your Explanation of Medicare Benefits forms in which Medicare improperly denied your claims.

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