Medicare Advantage Ending My Membership (Disenrollment)
Ending your membership in Provider Partners Health Plans may be voluntary (your own choice) or involuntary (not your own choice):
You might leave our plan because you have decided that you want to leave.
- There are only certain times during the year, or certain situations, when you may voluntarily end your membership in the plan.
- The process for voluntarily ending your membership varies depending on what type of new coverage you are choosing.
- There are also limited situations where you do not choose to leave, but we are required to end your membership.
When can you end your membership in our PPHP?
You can end your membership in Provider Partner Health Plans at any time. Most people with Medicare can end their membership only during certain times of the year. However, because you live in a nursing home or need a level of care that is usually provided in a nursing home, you can end your membership at any time.
For more information about ending your membership see Chapter 10 Section 2 of your Evidence of Coverage.
How do you end your membership in PPHP?
Usually, you end your membership by enrolling in another plan. For more information about how to end your membership see Chapter 10 Section 3 of your Evidence of Coverage.
Until your membership ends, you are still a member of our plan
If you leave PPHP, it may take time before your membership ends and your new Medicare coverage goes into effect. During this time, you must continue to get your medical care and prescription drugs through our plan.
- You should continue to use our network pharmacies to get your prescriptions filled until your membership in our plan ends. Usually, your prescription drugs are only covered if they are filled at a network pharmacy including through our mail-order pharmacy services.
- 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 (even if you are discharged after your new health coverage begins).
PPHP must end your membership in the plan in certain situations
PPHP must end your membership in the plan if any of the following happen:
- If you no longer have Medicare Part A and Part B.
- 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 Member Services to find out if the place you are moving or traveling to is in our plan’s area. (Phone numbers for Member Services are printed on the back cover of this booklet).
- You do not meet the plan’s special eligibility requirements as stated in Chapter 1, Section 2.1 as noted in the EOC.
- To be eligible for our plan, you must live in a nursing home available through our plan. Please see the plan’s Provider Directory for a list of our contracted nursing homes or call Member Services and ask us to send you a list (phone numbers 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 and you will lose prescription drug coverage.
We cannot ask you to leave our plan for any reason related to your health. If you feel that you are being asked to leave our plan because of a health-related reason, you should call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may call 24 hours a day, 7 days a week.
You have the right to make a complaint if we end your membership in our plan. 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 make a complaint about our decision to end your membership.
Contact our Member Services number at 1-800-405-9681 for additional information. (TTY users should call 711). We are open 8:00 A.M. to 8:00 P.M., seven days a week from October 1 through March 31; 8:00 A.M. to 8:00 P.M. Monday to Friday from April 1 through September 30.