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Disenrollment Rights and Responsibilities

Ending Your Membership in a Medicare plan

You may end your membership in one of our Medicare plans only during certain times of the year, known as enrollment periods. All members have the opportunity to leave the plan during the Annual Enrollment Period and during the Medicare Advantage Open Enrollment Period. In certain situations, you may also be eligible to leave the plan at other times of the year. Most people with Medicare can end their membership only during certain times of the year. Because you have Medicaid, you may be able to end your membership in our plan or switch to a different plan one time during each of the following Special Enrollment Periods:

  • If you are leaving our plan, you must continue to get your medical care through our plan until your membership ends
  • You should continue to use our network pharmacies to get your prescriptions filled until your membership in our plan ends.
  • If you are hospitalized on the day that your membership ends, your hospital stay will usually be covered by our plan until you are discharged.

If you have any questions or would like more information on when you can end your membership:

  • You can call Customer Service at 1-800-777-4376 (TTY 1-800-947-3529)
  • You can find the information in the Medicare & You Handbook
    • Everyone with Medicare receives a copy of Medicare & You each fall. Those new to Medicare receive it within a month after first signing up.
    • You can also download a copy from the Medicare website (https://www.medicare.gov). Or, you can order a printed copy by calling Medicare at the number below.
    • You can contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

Usually, to end your membership in our plan, you simply enroll in another Medicare plan. However, if you want to switch from our plan to Original Medicare but you have not selected a separate Medicare prescription drug plan, you must ask to be disenrolled from our plan. There are two ways you can ask to be disenrolled:

  • You can make a request in writing to us. Contact Customer Service if you need more information on how to do this.
  • --or--You can contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
  • Note: If you disenroll from Medicare prescription drug coverage and go without creditable prescription drug coverage for a continuous period of 63 days or more, you may have to pay a Part D late enrollment penalty if you join a Medicare drug plan later. (“Creditable” coverage means the coverage is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.)

Involuntary Disenrollment

We must end your membership in our Medicare plan if any of the following happen:

  • If you no longer have Medicare Part A and Part B
  • If you are no longer eligible for Medicaid. If you lose your Medicaid eligibility, you have 90 days to get reinstated before we cancel your membership in our Medicare plan
  • If you move out of our service area
  • If you are away from our service area for more than six months
    • If you move or take a long trip, you need to call Customer Service to find out if the place you are moving or traveling to is in our plan’s area. (Phone numbers for Customer Service are printed on the back cover of this booklet.)
  • If you become incarcerated (go to prison)
  • If you are not a United States citizen or lawfully present in the United States
  • If you lie about or withhold information about other insurance you have that provides prescription drug coverage
  • If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
  • If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
  • If you let someone else use your membership card to get medical care. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
    • If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General
  • If you are required to pay the extra Part D amount because of your income and you do not pay it, Medicare will disenroll you from our plan.
  • If you have questions or would like more information on when we can end your membership, call Customer Service at 1-800-777-4376 (TTY 1-800-947-3529)

We are not allowed to ask you to leave our plan for any reason related to your health

If we end your membership in our plan, we must tell you our reasons in writing for ending your membership. We must also explain how you can file a grievance or make a complaint about our decision to end your membership.

Click here to learn more about Complaints and Grievances

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Last Updated 10/1/19

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