Medicare

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Member Disenrollment Rights

When can you end your membership in our plan?

1. You can end your membership during the Annual Enrollment Period.

​The Annual Enrollment Period takes place from October 15 to December 7. During this time you can:

  • Enroll in another Medicare health plan. (You can choose a plan that covers prescription drugs or one that does not cover prescription drugs.)
  • Enroll in Original Medicare with a separate Medicare prescription drug plan. —OR—
  • Enroll in Original Medicare without a separate Medicare prescription drug plan.

Your membership will end when your new plan’s coverage begins on January 1.

2. You can end your membership during the annual Medicare Advantage Disenrollment Period, but your choices are more limited.

You have the opportunity to make one change to your health coverage during the annual Medicare Advantage Disenrollment Period.

The Annual Medicare Advantage Disenrollment Period takes place every year from January 1 to February 14.

During the Annual Medicare Advantage Disenrollment Period, you can cancel your Medicare Advantage Plan enrollment and switch to Original Medicare. If you choose to switch to Original Medicare during this period, you have until February 14 to join a separate Medicare prescription drug plan to add drug coverage.

Your membership will end on the first day of the month after we get your request to switch to Original Medicare. If you also choose to enroll in a Medicare prescription drug plan, your membership in the drug plan will begin the first day of the month after the drug plan gets your enrollment request.

3. In certain situations, you can end your membership during a Special Enrollment Period.

If any of the following situations apply to you, you are eligible to end your membership during a Special Enrollment Period. (These are just examples; for the full list you can contact the plan, call Medicare, or visit the Medicare website.)

  • Usually, when you have moved.
  • If you have the Oregon Health Plan (Medicaid).
  • If you are eligible for “Extra Help” with paying for your Medicare prescriptions.
  • If we violate our contract with you.
  • If you are getting care in an institution, such as a nursing home or long-term care (LTC) hospital.
  • If you enroll in the Program of All-inclusive Care for the Elderly (PACE).

The dates of the Special Enrollment Periods vary depending on your situation.

To find out if you are eligible for a Special Enrollment Period, please call Medicare at 800-MEDICARE (800-633-4227), 24 hours a day, 7 days a week. TTY/TDD users call 877-486-2048. If you are eligible to end your membership because of a special situation, you can choose to change both your Medicare health coverage and prescription drug coverage. This means you can choose any of the following types of plans:

  • Another Medicare health plan. (You can choose a plan that covers prescription drugs or one that does not cover prescription drugs.)
  • Original Medicare with a separate Medicare prescription drug plan. —OR—
  • Original Medicare without a separate Medicare prescription drug plan.

4. Where can you get more information about when you can end your membership?

You can call FamilyCare Health Navigation Services at the numbers listed below. 

You can find the information in the Medicare & You 2016 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.
  • You can order a printed copy by calling Medicare at the number below.

You can contact Medicare at 800-MEDICARE (800-633-4227), 24 hours a day, 7 days a week. TTY/TDD users should call 877-486-2048.

How do you end your membership in our plan?

1. Usually, you end your membership by enrolling in another plan.

If you want to switch from our plan to Original Medicare without a 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 FamilyCare Health Navigation Services at the numbers listed below. —OR—
  • You can contact Medicare at 800-MEDICARE (800-633-4227), 24 hours a day, 7 days a week. TTY/TDD users should call 877-486-2048.
  • You will be disenrolled from your plan with FamilyCare Health when your coverage in Original Medicare begins.

Your membership will usually end on the first day of the month after your request to change your plan is received.

If you receive “Extra Help” from Medicare to pay for your prescription drugs: If you switch to Original Medicare and do not enroll in a separate Medicare prescription drug plan, Medicare may enroll you in a drug plan, unless you have opted out of automatic enrollment.

Note: If you disenroll from Medicare prescription drug coverage and go without creditable prescription drug coverage, you may need to pay a 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.) 

Until your membership ends, you must keep getting your medical services and drugs through our plan.

1. Until your membership ends, you are still a member of our plan.

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 (even if you are discharged after your new health coverage begins).

FamilyCare Health must end your membership in the plan in certain situations.

1. When must we end your membership in the plan?

If you do not stay continuously enrolled in 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 FamilyCare Health Navigation Services to find out if the place you are moving or traveling to is in our plan’s area. (Phone numbers for Navigation Services are below.)

If you become incarcerated (go to prison).

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.

2. 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 800-MEDICARE (800-633-4227). TTY/TDD users should call 877-486-2048. You may call 24 hours a day, 7 days a week.

3. 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. You can look in your Evidence of Coverage, “What to do if you have a problem or complaint,” for information about how to make a complaint.

4. Where can you get more information?

You can call FamilyCare Health Navigation Services at 1-866-798-2273.

Calls to this number are free.

Hours are:

October 1–February 14: Seven days a week, 8 a.m.–8 p.m

February 15–September 30: Monday–Friday, 8 a.m.–8 p.m., and Saturdays and Sundays, 9 a.m.–5 p.m.

Member Services also has free language interpreter services available for non-English speakers.

For more detailed information on your disenrollment rights as a member of our plan, please read your Evidence of Coverage chapter entitled “Ending your membership in the plan.”

Y0103_WEB_00317v2 — Approved (Updated 06/12/2017)

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