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Member Rights and Responsibilities Upon Disenrollment

  • Ending your membership in University of Maryland Health Advantage Complete 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 you do not choose to leave, but we are required to end your membership. Please refer to your Evidence of Coverage, which tells you about situations when we must end your membership.

If you are leaving our plan, you must continue to get your medical care through our plan until your membership ends. 

When can you end your membership/enrollment?

You may end your membership in our plan only during certain times of the year, known as enrollment periods. All members have the opportunity to leave the plan during the Annual Enrollment Period and during the annual Medicare Advantage Disenrollment Period. In certain situations, you may also be eligible to leave the plan at other times of the year.

Annual Enrollment Period

You can end your membership during the Annual Enrollment Period (also known as the “Annual Coordinated Election 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.

  • When is the Annual Enrollment Period? This happens from October 15 to December 7.
     
  • What type of plan can you switch to during the Annual Enrollment Period? During this time, you can review your health coverage and your prescription drug coverage. You can choose to keep your current coverage or make changes to your coverage for the upcoming year. If you decide to change to a new plan, 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.
           
  • 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.)
     
  • When will your membership end? Your membership will end when your new plan’s coverage begins on January 1.

Medicare Advantage Disenrollment Period

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

  • When is the annual Medicare Advantage Disenrollment Period? This happens every year from January 1 to February 14.
     
  • What type of plan can you switch to during the annual Medicare Advantage Disenrollment Period? During this time, 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.
     
  • When will your membership end? 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.

Special Election Periods

In certain situations, you may be eligible to end your membership at other times of the year. This is known as a Special Enrollment Period.

  • Who is eligible for 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 (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.
    • If you enroll in the Program of All-inclusive Care for the Elderly (PACE).
           
  • When are Special Enrollment Periods? The enrollment periods vary depending on your situation.
     
  • What can you do? To find out if you are eligible for a Special Enrollment Period, please call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users call 1-877-486-2048. 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.
           
  • 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.)
     
  • When will your membership end? Your membership will usually end on the first day of the month after your request to change your plan is received.

How to voluntarily end your membership

If you would like to switch from our plan to another Medicare Advantage plan simply enroll in the new Medicare Advantage plan during one of the enrollment periods. You will be automatically disenrolled from University of Maryland Health Advantage, when your new plan’s coverage begins.

If you would like 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 University Health Advantage. There are two ways you can asked to be disenrolled:

  • You can make a request in writing to us. (If you need more information on how to do this please call Member Services at 410-779-9932 or toll-free at 1-844-386-6762, or by dialing 711 for TTY services, 8:00 a.m. – 8:00 p.m. EST, 7 days a week, from October 1 through February 14 and Monday through Friday from February 15 through September 30.
     
  • 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 University of Maryland Health 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 including through our mail-order pharmacy services.
     
  • If you are hospitalized on the day that your membership ends, you will usually be covered by our plan until you are discharged (even if you are discharged after your new health coverage begins).

Involuntarily ending your membership

University of Maryland Health 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 permanently move out of our service area.
     
  • If you are away from our service area for more than 6 months.
     
  • If you become incarcerated. 
     
  • 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.
     
  • If you let someone else use your membership card to get medical care.
     
  • 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. 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.