While other protections and avenues of relief also may be open to you, you should understand your basic right to:

Cancel

You have the right to cancel a Medicare HMO policy at any time before the effective date, but the HMO must receive your request before your enrollment is complete. Most plans take effect the first day of the month after your application has been received.

For example, if you sign up for an HMO on January 20 and later change your mind, you may cancel your policy without disrupting your existing coverage as long as the HMO receives your request by the last working day of the month. If your request is received on February 1 or later, you will be enrolled in the HMO plan for the remainder of the month and may return to fee-for-service or another HMO beginning March 1. (See "Disenroll" below.)

If your HMO denies payment for a particular service or refuses to provide you with a Medicare-covered service you believe you need, you should make a written appeal to the HMO following the grievance procedure outlined in your enrollment materials. The state Health Insurance Counseling and Assistance program known as APPRISE can assist you with filing an appeal in any of these situations.

If the complaint involves deceptive or misleading advertising, questionable enrollment or marketing practices, and related matters, you should send a written complaint to the Health Care Financing Administration (HCFA) Regional Office in Philadelphia.

Quality of care complaints may also be addressed to KePRO, the Medicare contracting Peer Review Organization in Pennsylvania. (See Key Contacts for address and phone number information for APPRISE, HCFA, and KePro.)

You may disenroll from an HMO at any time and return to traditional fee-for-service Medicare coverage by filling out a disenrollment form at your local Social Security office, or by notifying the Railroad Retirement board or your HMO in writing. The change is effective at the end of the month in which the HMO receives your request. You may want to send your disenrollment letter by certified mail, so that you have proof the HMO received it. If you send a notice to your HMO, you should also notify the Social Security Administration (1-800-772-1213) to make sure you are reentered in Medicare.

If you want to change from one Medicare contracting HMO to another, enrollment in the second plan automatically disenrolls you from the first.

...and return to traditional fee-for-service coverage with a Medigap policy, your choice of plans may be limited.

Open enrollment guarantees your right to Medigap coverage only during the first six months that you are eligible for Medicare, and at age 65 for all disabled or kidney-failure beneficiaries.

Many Medigap insurers will health screen members who enroll after age 65 and will impose a six-month waiting period before providing benefits related to a pre-existing condition.