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Disenrollment Rights and Responsibilities
Ending your membership in KelseyCare Advantage 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.
- If so, 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. If you are leaving our plan, you must continue to get your medical care through our plan until your membership ends.
- 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 plan?
You may end your membership during certain times of the year, known as enrollment periods. All members have the opportunity to request to leave the plan during the Annual Enrollment Period and during the annual Medicare Advantage Open Enrollment Period. In certain situations, you may also be eligible to leave the plan at other times of the year.
You can request to end your membership during the Annual Enrollment Period.
- This is the time when you should review your health and drug coverage and make a decision about your coverage for the upcoming year. This happens every year between October 15 and December 7.
- If you enroll in a different plan during the Annual Enrollment Period, your membership with our plan will end when your new plan’s coverage begins on January 1.
You can end your membership during the annual Medicare Advantage Open Enrollment Period, but your choices are more limited.
- You have the opportunity to make one change to your health coverage during the annual Medicare Advantage Open Enrollment Period. This happens every year from January 1 to March 31.
- During this time, you may enroll in another Medicare Advantage plan or disenroll from our plan and return to Original Medicare.
- Your membership will end on the first day of the month after we get your request to disenroll.
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. The enrollment periods vary depending on your situation. These are just examples, for the full list you can contact the plan, call Medicare, or visit the Medicare website (http://www.medicare.gov):
- Usually, when you have moved.
- If you have 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.
Where can you get more information about when you can end your membership?
If you have any questions or would like more information on when you can end your membership:
- You can call Member Services (phone numbers are printed on the back cover of this booklet).
- You can find the information in the Medicare & You 2016 Handbook.
- 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.
Until your membership ends, you are still a member of our plan.
If you leave KelseyCare Advantage, 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.
- 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).
KelseyCare Advantage must end your membership in the plan in certain situations.
KelseyCare Advantage must end your membership in the plan if any of the following happen:
- 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 Member 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 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 do not pay the plan premiums for two calendar months.
- We must notify you in writing that you have two calendar months to pay the plan premium before we end your membership.
- 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.
Where can you get more information?
If you have questions or would like more information on when we can end your membership, you can call Member Services for more information. Phone numbers to contact Member Services can be found on the Contact Us page.
We cannot ask you to leave our plan for any reason related to your health.
KelseyCare Advantage is not allowed to 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.