My Medicare Advantage HMO not being accepted by the Cancer Center…What do I do?

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Hello, Toni:

I have moved to Houston    from Little Rock in May and discovered your Medicare article in the local newspaper. I enrolled in Medicare Advantage HMO when I turned 65 in March.  I didn’t realize I could have chosen a Medicare Supplement instead of a Medicare Advantage plan. The article explained that I have a 6-month Medicare Supplement window to change from this HMO.

I have been diagnosed with lung cancer, and the cancer center that my physician uses is not in the HMO’s network. I need help disenrolling from this HMO and going back to Traditional Medicare  with a Medicare supplement since I am in the 6-month Part B window because Part B started March 1.

Time is ticking and I need to do this fast!! Toni, you have no idea what a blessing it was to discover your article. Thanks so much.

James, a new Texas resident

Hi there, James, and welcome to Texas:

I know how overwhelming it can be to understand Medicare’s rules, especially when you are mentally stressed due to an illness. Below is how I help clients who want to disenroll from their Medicare Advantage plan and return to “Traditional” Medicare, also known as “Original” Medicare. 

There is a Special Enrollment Period (SEP) to help you qualify for a change from your Medicare Advantage plan.  The SEP is a time period

triggered by special circumstances.  At this specific time period, a Medicare recipient is allowed to join, switch or drop a Medicare Advantage or Medicare Part D Prescription Drug Plan. Page 80 of the 2026 Medicare & You handbook and medicare.gov explain in detail how a Medicare beneficiary can change a Medicare Advantage or Medicare Part D drug plan.  Below are a few of the circumstances that can trigger a Medicare change:

-- Moving Out of Area, such as when James moved from  Arkansas to the Houston

-- Newly enrolled in Medicaid

-- Qualify for Extra Help for prescription drugs,

-- Moving into a long-term care facility such as skilled nursing, assisted living, personal care    homes and Alzheimer’s living facilities

-- Loss of creditable prescription drug coverage (employer benefits from you or your spouse’s employment).

The trick to disenrolling from a Medicare Advantage Plan when a SEP is granted is to enroll in a Stand-alone Part D plan, which will automatically disenroll you from your Advantage plan and  back to Original/Traditional Medicare. James, because you want to be enrolled in Original Medicare as soon as possible, I would suggest that you go to www.medicare.gov and enroll in whichever Medicare Part D plan best fits your prescription drug needs. The change to Medicare will be effective on the first of next month.

Because you enrolled in Part B this March, you are correct that you’re within your 6-month Medicare Open Enrollment Period (OEP) which will end on Aug. 31. Wait past 6 months of enrolling in Part B, then the Medicare beneficiary must qualify by medical underwriting.

           James, you received a “little blessing” when you read my article and learned you have other Medicare options to use!

James, since your Medicare Parts A and B began March 1, then you can only apply for Medicare Supplement Plans G or N. (Those with Part A that begin prior to January 1, 2020, can apply for Medicare Plan F.)  Your Medicare Part A begins after January 1, 2020, so you can only apply for Plans G or N. (Medicare Supplement Plan F is no longer an option.)

The difference between Medicare Supplement Plan G and Plan N is:

--Plan G: offers lower premiums than Plan F with the 2026 Part B deductible of $283 not covered.

--Plan N has a lower premium than Plan G with higher out-of-pocket costs. There is a $20 co-pay for a doctor’s visit and a $50 co-pay for the emergency room. Part B deductible and “excess charges” are not paid for by the insurance company.

Remember, with Medicare, what you don’t know WILL hurt you!

Email your Medicare questions to [email protected] 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 

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