Have cancer, must return to original Medicare during annual enrollment

Last year, I made a mistake when I retired and enrolled in a Medicare Advantage PPO plan because I understood from talking with retired co-workers and friends that this PPO plan was like a Medicare Supplement. Boy was I wrong!

I need out. Now! I have been diagnosed with lung cancer and many of the cancer specialists and even the facility that specializes in proton therapy to help minimize my lung cancer tumor are out of network and this is costing me a fortune. Right now, I have an $80,000 proton therapy bill which has not been paid.

I have been advised from my cancer facility to return to traditional Medicare with a Medicare supplement to help pick up my Medicare out of pocket, but when I called Medicare, they said I needed to return to original Medicare. Please advise which Medicare plan to return to original or traditional Medicare? Signed, Jerry from Humble, TX

Dear Jerry:

You will be happy to know that “original Medicare” and “traditional Medicare” are the same thing, but the medical profession knows Medicare as “traditional” Medicare not “original Medicare.”

Annual Enrollment Period will be your only time to make that change. It will be simple for you to enroll in original/traditional Medicare and a new Medicare supplement/Medigap (without having to answer questions) only because this is your first year to be out of your Medicare supplement/Medigap or your first year to pick a Medicare Advantage Plan.

Medicare’s annual enrollment period starts on Oct. 15 and ends at midnight on Dec. 7.

For you to disenroll from a Medicare Advantage company simply enroll in a Medicare prescription drug plan that fits your needs. You will automatically be out of your old Medicare Advantage plan and back to “Original/Traditional Medicare” with a Medicare prescription drug plan; apply for a Medicare supplement/Medigap to pick up what Medicare does not pay for.

What happens if you have health issues which can keep you from qualifying with a Medicare supplement’s application. See the Medicare rules concerning this issue in the “Medicare and You Handbook,” which states:

“If you join a Medicare Advantage Plan for the first time, and you aren’t happy with the plan, you’ll have special rights to buy a Medigap policy if you return to Original Medicare within 12 months of joining.”

Below are the changes that a Medicare beneficiary can make to their Medicare plans during Medicare Annual Enrollment Period:

  Enroll in a new Part D Medicare Prescription Drug Plan, which automatically disenrolls you from a Medicare Advantage plan.

  Enroll in a new Medicare Part D Prescription Drug Plan when you have never been in Part D from the time you have been with Medicare.

  Change from one Part D Medicare Prescription Drug Plan to a new Medicare Part D Prescription Drug Plan.

  Enroll in a Part C Medicare Advantage Plan with Prescription Drugs

  Change from one Part C Medicare Advantage Plan to a new Part C Medicare Advantage Plan.

  Return to Original Medicare and purchase a Medicare Supplement and enroll in a Part D Medicare Prescription Drug Plan.

  Return to Original Medicare only and enroll in a Part D Medicare Prescription Drug Plan.

  Or Return to Original Medicare with no Part D Plan.

M Reader Alert: Do not forget there is a penalty for not enrolling in a Part D Medicare Prescription Drug plan when you first become eligible.


Toni Says Medicare Annual Open Enrollment online Zoom webinar begins Thursday, Oct. 15, at 4 p.m. Online reservation link is available at www.tonisays.com.

Toni King, author of the Medicare Survival Guide® is giving a $5 discount on the Medicare Survival Guide® Advanced book to the Toni Says Medicare column readers at www.tonisays.com.

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