Dear Pastor D.M.,

I have been a member of my HMO insurance plan for years. And for years, I lived in the same county and was on the same plan. It was a plan that offered a little something extra compared to those other plans available in the same county. I was told when I enrolled that the HMO plan I selected was a special, exclusive plan that not everyone could have, which made me feel as though I was a special customer to the insurance company. I felt like I was getting more for my money, which is something everyone wants when selecting an insurance plan.

Well, life happens, and so I recently found myself moving to another county in order to be near family. Though I am still able to get around, I am getting older — and my neighbors have died and life has changed. I didn’t recognize those I lived around anymore (as my former neighbors died and new neighbors moved into the neighborhood), and I wanted to be near familiar faces. So I decided to move closer to family in order to have someone I know check in on me each day.

Unfortunately, I went for my routine eye exam (offered only once a year) this year and was told that I was disenrolled from my insurance and that I had no vision, dental, or additional benefits. It was a complete shock to me because it happened so quickly. Of course, in line with Medicare policy, I reported that I had moved to a new location and my address was changed on my account. Several weeks later I tried to get a routine vision exam and was given the worst news. I could’ve never seen it coming.

I moved to a new county; why was I disenrolled from my HMO plan? Any advice you can offer would be greatly appreciated.

Thanks, a concerned reader

Why You Were Disenrolled From Your HMO Plan

Dear Concerned Reader,

I understand that this may seem odd to you. In fact, you may easily believe that something wrong happened and that the insurance company has let you down. Someone got something wrong in the computer; perhaps you think that the insurance company has disenrolled the wrong person and that they should apologize and rectify the mistake. But unfortunately, that is very unlikely the case.

The reason why you were disenrolled from your HMO plan pertains to the nature of HMOs. When you joined the HMO, did you ask any questions? I ask this because it’s important to know what you’re getting yourself into when you join any insurance plan — not just an HMO plan. HMO plans, as I’ve said before, are built around affordability. Unfortunately, this means that HMO plans, by nature, have a more limited provider network than PPO plans, not to mention a smaller number of plans and a limited amount of flexibility.

Along with all these limitations come the nature of the plans themselves. You said you enrolled in a special, exclusive plan. Did anyone tell you that the company has the power to terminate that special plan at any time? To be honest, HMO plans have the right to terminate any plan at any time, without prior warning or discussion with members. The reason pertains to the sovereign nature of HMO companies to make decisions over their offerings. Rest assured, they can’t just offer anything without consideration and deliberation; after all, they do have Medicare to answer to if they’re a Medicare Advantage (or MA) plan. But still, even within their reporting to Medicare, they have leeway with regard to what they offer, what they give, and what they take away without a moment’s notice.

If you find yourself being “crosswalked” into another plan (“crosswalk” is the word often used), then it means that your plan could assume a new name but still retain all the old benefits. At the same time, it may not be worthwhile to hang onto the old plan because a new plan for the same price could offer better benefits. Or, it could offer better benefits at a greater price. It all depends on the whim of the HMO company offering benefits and whether or not you find those benefits work better for you.

Now, back to this special, exclusive plan. Maybe you were disenrolled, first, because the company stopped offering the plan in the new county you moved to. Maybe they offered it but decided the plan wasn’t as popular in the new county you moved to as it is in the county you left. As I said above, HMO plans have the right to remove plans based on what seems right to those in charge.

But there’s another reason why you were disenrolled.

Disenrollment By Default: That Exclusive Plan Doesn’t Exist In The New County

The reason comes down to this: when you enrolled in the new HMO plan, that exclusive plan that you thought gave you better benefits than the other plans in the county, you didn’t know that the plan was exclusive to that county only. That is, the exclusive plan is so exclusive it only exists in the county you left. It doesn’t exist in the new county.

So when you moved to the new county, you basically moved out of the insurance company and disenrolled yourself. You cannot have an HMO insurance policy (or any insurance policy, for that matter) without benefits. And to lose access to the exclusive plan you had in the previous county was, in effect, losing your benefits. No benefits, no enrollment. Lose your benefits, get disenrolled. Automatic disenrollment happens when your plan doesn’t exist in the new county to which you move. In effect, you disenrolled yourself because you needed to change your plan before moving to the new county.

Those exclusive county-specific plans work to your advantage, as long as you stay in the county. Move to a new one and you may find yourself disenrolled if you don’t change plans and ask questions beforehand.

The New County Is Outside The HMO Plan’s Network

There’s another reason why you could find yourself disenrolled if you move to a new county: the new county is outside the HMO plan’s network. The HMO plan doesn’t service residents in that particular county you live in.

I’ve seen it happen before. Someone went out of a particular state on vacation to their vacation home. While there, a relative got sick (a relative who had the same insurance plan as the caller). The caller had the same plan and assumed that the plan worked the same way his previous HMO plan worked. “The last HMO plan was in all 50 states, so this new one should be, too.” Unfortunately, it wasn’t. The new HMO plan was specific to one state and one state only, so the relative in the hospital didn’t have benefits in the vacation state because the insurance company didn’t service residents of that state.

The example above involves two different states, but rest assured, the issue also pertains to counties. Just because you move across county lines doesn’t mean that the new county is a part of the HMO plan’s service area. HMO plans have the right to pick particular counties to service, if they like, and there’s nothing illegal about it. Just because their county selections are an inconvenience to you doesn’t mean the company is wrong to do as it pleases. The insurance company can service 10 counties, all 100 miles apart, and that’s up to the company itself. The insurance company just has to make sure that it’s taking care of its members — whether they be 100 miles apart or 1,000 miles apart.

As I’ve written before, HMO plans can be so picky that they choose to have a hospital in its network with doctors as employees that are out of network. It may seem illogical to a number of patients, but it’s well within the insurance company’s right to continue partnering with a hospital where some doctors choose not to affiliate with the HMO plan. Some employees believe it’s insane for this circumstance to exist, but if you were an employee who didn’t like the insurance your company offered, wouldn’t you want the right to select your own health insurance plan — even if it was different from everyone else?

If you move to a county that doesn’t have access to the HMO network, consider yourself disenrolled as soon as you cross county lines. It won’t take long for the actual disenrollment letter to arrive.

How To Avoid Disenrollment When Moving To A New County

Here are some tips on how to avoid disenrollment when moving to a new county.

First, ask whether or not the special plan you enroll in is specific to the county you’re in, or whether it’s offered in other counties. Never assume the plan you have is offered in other counties. You may just find yourself disappointed to just assume the best. Ask the question to an insurance agent over the phone or your insurance agent in person. If you need to enroll in a new plan because the new county doesn’t offer that exclusive plan, your insurance agent can get on it right away before you make an official move. Asking the right question can prevent you from experiencing an interruption in your benefits or service. It can’t hurt to ask the question, even if you don’t like the answer. Better to be safe than sorry.

Next, ask whether or not the HMO plan services the new county or state you move to. Even if you don’t ask about a particular plan, you can still check to see if you can re-enroll in the county you move to. Sure, you may be disappointed about losing your plan in the new county, but imagine if you had to lose your HMO plan altogether and find a new one. Be sure to ask. At least, that way, you can go ahead and start looking before you move so that you can be proactive. You don’t want to find yourself in a new county without an insurance plan to help with your medical expenses.

There is no harm in asking questions. If you don’t ask questions, you can’t find or discover the answers. The crime is not in asking too many questions, but rather, in asking too few questions or none at all.