Ending your membership in our Plan 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 also limited situations where we are required to end your membership. For example, if you move permanently out of our geographic service area.
Voluntarily ending your membership. There are only certain times during the year when you may voluntarily end your membership in our Plan. The key time to make changes is the Medicare fall open enrollment period (also known as the “Annual Enrollment Period”) which occurs from October 15 through December 7. This is the time to review your health care and drug coverage for the following year and make changes to your Medicare health or prescription drug coverage. Any changes you make during this time will be effective January 1. Certain individuals, such as those with Medicaid, those who get extra help, or who move, can make changes at other times. For more information on when you can make changes see the enrollment period table later in this section.
If you want to end your membership in our plan during this time, this is what you need to do:
If you are planning on enrolling in a new Medicare Advantage plan: Simply join the new plan. You will be disenrolled from our plan when your new plan’s coverage begins on January 1.
If you are planning on switching to the Original Medicare Plan and joining a Medicare Prescription drug plan: Simply join the new Medicare Prescription drug plan. You will be disenrolled automatically from our plan when your new coverage begins on January 1.
If you are planning on switching to the Original Medicare Plan without a Medicare Prescription drug plan: Contact Member Services for information on how to request disenrollment. You can contact Touchstone Health Member Services at
.
You may also call 1-800-MEDICARE (1-800-633-4227) to request disenrollment from our plan. TTY users should call 1-877-486-2048. You may call 24 hours a day, 7 days a week. Your enrollment in Original Medicare will be effective January 1.
| Enrollment Period |
When? |
Effective Date |
Annual Enrollment Period (AEP)
Time to review health and drug coverage and make changes.
|
Every year from October 15 to December 7
|
January 1 |
Medicare Advantage Disenrollment Period (MADP)
The Medicare Advantage 45-Day Medicare Advantage Disenrollment Period (MADP) runs from January 1 through February 14th.
During the ADP, beneficiaries who are enrolled in a Medicare Advantage (MA) plan (either MA-only or MAPD) have one election available and may disenroll from that plan back to Original Medicare. Beneficiaries may also use the ADP to pick up a stand-alone Part D plan, regardless of whether or not they have had Part D coverage previously.
|
Every year from January 1 to February 14th |
The first day of the next month. |
Special Enrollment Periods for limited special exceptions, such as:
- You have a change in residence
- You have Medicaid
- You are eligible for extra help with Medicare prescriptions
- You live in an institution (such as a nursing home)
|
Determined by exception |
Generally, first day of next month after plan receives your enrollment request |
For more information about the options available to you during these enrollment periods, contact 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. Additional information can also be found in the “Medicare & You” handbook. This handbook is mailed to everyone with Medicare each fall. You may view or download a copy from www.medicare.gov - under “Search Tools,” select “Find a Medicare Publication.”
Until your membership ends, you must keep getting your Medicare services and/or prescription drug coverage through our Plan. If you leave our Plan, it may take some time for your membership to end and your new way of getting Medicare to take effect (we discuss when the change takes effect earlier in this section). While you are waiting for your membership to end, you are still a member and must continue to get your care and/or prescription drugs as usual through our Plan. If you happen to be hospitalized on the day your membership ends, generally you will be covered by our Plan until you are discharged. Call Member Services for more information and to help us coordinate with your new plan. You can contact Touchstone Health Member Services at
.
Until your prescription drug coverage with our Plan ends, use our network pharmacies to fill your prescriptions. While you are waiting for your membership to end, you are still a member and must continue to get your prescription drugs as usual through our Plan’s network pharmacies. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or our mail-order-pharmacy service, are listed on our formulary, and you follow other coverage rules.
We cannot ask you to leave the Plan because of your health
We cannot ask you to leave your health plan for any health-related reasons. If you ever feel that you are being encouraged or asked to leave our Plan because of your health, you should call 1.800.MEDICARE (1.800.633.4227), which is the national Medicare help line. TTY users should call 1.877.486.2048. You may call 24 hours a day, 7 days a week.
Involuntarily ending your membership
If any of the following situations occur, we will end your membership in our Plan.
- If you do not stay continuously enrolled in Medicare A or B (or both)
- If you move out of the service area or are away from the service area for more than 6 months you cannot remain a member of our Plan. And we must end your membership (“disenroll” you)”. If you plan to move or take a long trip, please call Member Services to find out if the place you are moving to or traveling to is in our Plan’s service area. Section 10 gives more information about getting care when you are away from the service area. You can contact Touchstone Health Member Services at .
- If you knowingly falsify or withhold information about other parties that provide reimbursement for your prescription drug coverage.
- If you intentionally give us incorrect information on your enrollment request that would affect your eligibility to enroll in our Plan.
- If you behave in a way that is disruptive, to the extent that you continued enrollment seriously impairs our ability to arrange or provide medical care for you or for others who are members of our Plan. We cannot make you leave our Plan for this reason unless we get permission first from Medicare.
- If you let someone else use your plan membership card to get medical care. If you are disenrolled for this reason, CMS may refer your case to the Inspector General for additional investigation.
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 will tell you our reasons in writing and explain how you may file a complaint against us if you want to.
For additional information, please contact Touchstone Health Member Services at
.
