Humana PPO (Preferred Provider Organization) is a Medicare Advantage plan that provides beneficiaries with additional benefits beyond Original Medicare, such as vision, dental, and prescription drug coverage. While these plans offer flexibility, some individuals may find that their healthcare needs are better met under Original Medicare (Medicare Part A and Part B). If you are considering switching back to Original Medicare from Humana PPO, understanding the process is crucial.
Reasons To Switch Back To Original Medicare
Several reasons may prompt individuals to return to Original Medicare from a Humana PPO plan:
- Network Limitations: While PPO plans offer flexibility, they still require beneficiaries to use network providers for lower costs, which may not be ideal for those needing out-of-network care frequently.
- Coverage Concerns: Some beneficiaries find that Humana PPO plans do not cover certain services or specialists as extensively as they need.
- Cost Considerations: Monthly premiums, copayments, and out-of-pocket expenses may be higher under a Humana PPO plan compared to Original Medicare.
- Access to Any Provider: Original Medicare allows beneficiaries to see any doctor or hospital that accepts Medicare without network restrictions.
- Desire for a Medigap Policy: Those seeking additional coverage through a Medigap (Medicare Supplement Insurance) policy may need to switch back to Original Medicare.
When Can You Switch From Humana PPO To Original Medicare?
You can only switch back to Original Medicare during specific enrollment periods:
- Medicare Annual Enrollment Period (AEP) – October 15 to December 7: You can drop your Humana PPO plan and return to Original Medicare during this time.
- Medicare Advantage Open Enrollment Period (OEP) – January 1 to March 31: If you are already in a Humana PPO Medicare Advantage plan, you can switch back to Original Medicare.
- Special Enrollment Periods (SEP): Certain life events, such as moving out of your plan’s service area or losing other healthcare coverage, may qualify you for an SEP to switch back to Original Medicare.
Steps To Switch Back To Original Medicare
If you have decided to transition from Humana PPO to Original Medicare, follow these essential steps:
1. Contact Medicare to Disenroll from Humana PPO
You must first notify Medicare or your current Humana PPO provider about your decision to disenroll. You can do this by:
- Calling Medicare at 1-800-MEDICARE (1-800-633-4227)
- Contacting Humana directly to request disenrollment
- Submitting a written request to Humana PPO
2. Enroll in Original Medicare
Once you are disenrolled from Humana PPO, you will be automatically placed back into Original Medicare (Part A and Part B). However, if you had previously opted out of Part B, you may need to re-enroll by contacting the Social Security Administration.
3. Consider Enrolling in a Medigap Policy
Since Original Medicare does not cover all out-of-pocket expenses, you may want to purchase a Medigap (Medicare Supplement) plan. Medigap helps cover costs such as copayments, deductibles, and coinsurance. The best time to enroll in a Medigap policy is during the six-month Medigap Open Enrollment Period, which starts when you are 65 and enrolled in Part B.
4. Evaluate Prescription Drug Coverage (Part D)
Humana PPO plans often include prescription drug coverage, but Original Medicare does not. To maintain prescription drug coverage, you will need to enroll in a Medicare Part D plan. Be sure to select a Part D plan during the AEP or OEP to avoid potential late enrollment penalties.
5. Verify the Transition with Healthcare Providers
Once you switch back to Original Medicare, inform your healthcare providers to ensure they accept Medicare and update your billing information accordingly.
Considerations When Switching Back
Switching back to Original Medicare involves several factors to consider:
- Medigap Guaranteed Issue Rights: If you switch back, you may not always qualify for a Medigap plan without undergoing medical underwriting unless you qualify for guaranteed issue rights.
- Coverage Gaps: Original Medicare does not include dental, vision, or hearing coverage, which may have been included in your Humana PPO plan.
- Timing and Processing Delays: Ensure that the disenrollment process is completed before your new coverage period begins to avoid any lapse in healthcare coverage.
- Part D Late Enrollment Penalties: If you do not enroll in a Part D plan when first eligible, you may have to pay a penalty for late enrollment.
Conclusion
Switching back to Original Medicare from a Humana PPO plan is a strategic decision that requires careful planning. Understanding the enrollment periods, ensuring continuous coverage, and considering supplemental options like Medigap and Part D are crucial steps in the process. By following these guidelines, you can make an informed decision and transition smoothly back to Original Medicare to meet your healthcare needs effectively.
