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Policy Details

Your Rights and Responsibilities Upon Disenrollment

If we end your membership in our plan, we must tell you our reason 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. For more information, visit Problems, Concerns, & Complaints.

We cannot ask you to leave our plan for any reason related to your health

We are not allowed to ask you to leave any of our plans 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.

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

If you leave one of our Medicare Advantage plans, 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).

When must we end your membership in the plan

We 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 Navigation Services to find out if the place you are moving or traveling to is in our plan’s area.
  • 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.

When can you end your membership in our plan?

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. 
  • 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.

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 this period, you can cancel your Medicare Advantage Plan enrollment and switch to Original Medicare. If you choose to switch to Original Medicare, 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.

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 situations include but are not limited to the following:

  • You have moved out of the service area.
  • You have the Oregon Health Plan (Medicaid).
  • You receive “Extra Help."
  • You leave coverage from your employer or union.

How do you end your membership in our plan?

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

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 Navigation Services at 866-798-2273 (TTY/TDD: 711) if you need more information on how to do this. —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.

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

You can call Navigation Services at 866-798-2273 (TTY/TDD: 711) or review your Evidence of Coverage.

FamilyCare Health is an HMO with a Medicare and Oregon Health Plan (Medicaid) contract. Enrollment in FamilyCare Health Medicare Advantage plans depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. If you enroll in FamilyCare Community (HMO SNP), the Oregon Health Plan will pay your Part B premium for you. FamilyCare Community (HMO SNP) is available to people who qualify for Medicare and the Oregon Health Plan (Medicaid). Premiums, copays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

Y0103_WEB_00354 — Approved (Updated 10/05/2017)

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