Disenrollment

Disenrolling From One Of Our Medicare Plans


Ending Your Membership in the Plan

You can end your membership with one of our Medicare plans at any time.

Usually, to end your membership in our plan, you simply enroll in another Medicare plan. However, 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 Customer Service if you need more information on how to do this
  • --or--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

If you choose to leave one of our Medicare plans, here are some items to remember:

  • Please remember, if you disenroll and do not enroll in another Medicare Advantage Plan with prescription drug coverage (or Medicare Prescription Drug Plan) or if you do not obtain other creditable coverage as good as Medicare, you may have to pay a penalty if you enroll in Medicare prescription drug coverage in the future
  • Please be patient. It will take a few weeks for us to process your disenrollment and update Medicare's records. If your doctors need to send Medicare claims, you may want to tell them that you just disenrolled from our plan and there may be a short delay in updating your records
  • If you are leaving our plan, you must continue to get your medical care through our plan until your membership ends. Your Medicare membership will usually end on the first day of the month after we receive your request to change your plan

A NOTE ABOUT MEDIGAP RIGHTS: If you will be changing to the Original Medicare Plan you might have a special temporary right to buy a Medigap policy, also known as Medicare supplemental insurance, even if you have health problems. For example, if you are age 65 or older and you enrolled in Medicare Part B within the past 6 months or if you move out of the service area, you may have this special right. Federal law requires the protections described above. Your State may have laws that provide more Medigap protections. For information, you can contact the Wisconsin Board on Aging and Long-Term Care at 1042 Pankratz Street, Suite 111, Madison, WI, 53704 or call the Medigap Helpline, a service of the Board on Aging and Long-Term Care at 1-800-242-1060 or the Medicare Counseling Service, provided by Southeastern Wisconsin Area Agency on Aging at 1-877-333-0202. You can also find the website for the Wisconsin Board on Aging and Long-Term Care at www.medicare.gov on the web. Under "Search Tools," select "Helpful Phone Numbers and Websites." The state of Wisconsin also has Ombuds who can help you with questions or problems. Call 1-800-760-0001 to speak to an Ombuds.

Call 1-800-MEDICARE (1-800-633-4227) for more information about trial periods. TTY users should call 1-877-486-2048. If you need any help, please call us at 1-855-818-1129. TTY users should dial 1-800-947-3529.

Involuntary Disenrollment

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 are no longer eligible for Medicaid. If you lose your Medicaid eligibility, you have 90 days to get reinstated before we cancel your membership in our Medicare plan
  • 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 Customer Service to find out if the place you are moving or traveling to is in our plan’s area. (Phone numbers for Customer Service are printed on the back cover of this booklet.)
  • 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.

We are 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.

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 file a grievance or make a complaint about our decision to end your membership.

Notification:
By clicking the links above, you may be leaving the icarehealthplan.org website. Independent Care Health Plan (iCare) only provides these links and pointers for your information and convenience. When you select a link to an outside website, you are leaving the icarehealthplan.org website. These external links are not the responsibility of, or under the control of iCare. Independent Care Health Plan disclaims responsibility for the content and privacy policies of the owners/sponsors of the outside websites.

Modified: 7/7/2017
 

Independent Care Health Plan (iCare) is a Medicare Advantage HMO SNP organization with a Medicare contract and a contract with the Wisconsin Medicaid program. Enrollment in any iCare plan depends on contract renewal. Plans are available to anyone who has both Medical Assistance from the State and Medicare. 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 co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The Part B premium is covered by the State if you are a full-dual member. Premiums, co-pays, co-insurance, 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.

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