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Changing HMOs

Q. My mother-in-law just moved from Southern to Northern California. Her Medicare HMO is not available in her new home area. Can she change HMOs even though it is not open enrollment at present? How does she go about changing?

A. Your mother-in-law is entitled to a special enrollment period (SEP) to join a plan serving her new home area, just like any other enrollee who moves permanently outside their Medicare health plan’s service area. This SEP can be used at any time of the year, but comes with time limits.

Since she’s already moved, your mother-in-law should call her old HMO to disenroll and then join a new plan as soon as possible. Her special enrollment period lasts two months from the date she informs the old plan of her move. Coverage from the new plan begins the first day of the month after she enrolls. (If she takes no action and the SEP time frame expires, she’d have to wait until the next open enrollment period at the end of the year to join another Medicare health plan. However, she’d still have coverage under traditional Medicare.)

Your mother-in-law can find out which plans are available to her in her new area by calling the Medicare help line at 1-800-633-4227 (or TTY 1-877-486-2048). She can also compare plans online by going to www.medicare.gov and clicking on “Compare Medicare Health Plans.” If her old plan included prescription drug coverage, she should be sure to check that her new plan does as well. Not all Medicare health plans cover prescription drugs.

Similar situations: Other rules about moving permanently out of a plan’s service area include:

* If you inform your current plan before you move, your SEP lasts three months—beginning the month before you move and ending two months after it.

* If you don’t tell your current plan that you’ve moved, but it finds out anyway, it will disenroll you after six months and you’d then get a SEP that lasts two months.

* Even if the company that sponsors your old plan offers the same plan or others in your new home area, you have the right to choose a different one if new plans are available there.

* You can also use this special enrollment period as an opportunity to change from a Medicare health plan to traditional Medicare. If you don’t join a new plan after disenrolling from the old one, you’re automatically covered by traditional Medicare.

Patricia Barry is a senior editor at the AARP Bulletin.

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