MDwise Medicare
Rights and Responsibilities Upon Disenrollment

Rights and Responsibilities Upon Disenrollment

We recognize that you have choices when it comes to your Medicare coverage. While we hope you don’t choose to leave MDwise Medicare, if you do make that choice, you have some rights and responsibilities.

• You may only end your membership in our plan during certain times of year, known as enrollment periods (Annual Enrollment Period, the Medicare Advantage Open Enrollment Period, or Special Election Periods).
• When you end your membership in our plan, you are also ending your prescription drug coverage.
• Your membership in our plan will end on the first day of the month after you enroll in a different Medicare Advantage plan or we get your written request to switch to Original Medicare. Until your new coverage takes effect, you should continue to get your medical care and prescription drugs through our plan.
• If you are returning to Original Medicare and want prescription drug coverage, you must also enroll in a Medicare prescription drug plan. If you don’t enroll in another Medicare Advantage plan with prescription drug coverage or a Medicare prescription drug plan, or you do not have creditable coverage as good as Medicare prescription drug coverage, you may have to pay a late enrollment penalty the next time you enroll in a Medicare prescription drug plan.
• You may have a guaranteed special temporary right to buy a Medigap policy (also known as Medicare supplement 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 last 6 months or if you move out of the service area, you may this this special right. Federal law requires the protections described above. Your State may have laws that provide more Medigap protections. If you have questions about Medigap or Medigap rights in your state, you should contact your State Health Insurance Assistance Program at 800-452-4800. You can also call 1-800-MEDICARE (1-800-633-4227) anytime, 24 hours a day, 7 days a week for more information. TTY users should call 1-877-486-2048.

There are situations when we must end your membership in our plan:

• 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 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.

If we end your membership in our plan, we must tell you our reasons in writing. We cannot ask you to leave our plan for any reason related to your health. We must also provide you with information on how to file a grievance about our decision to end your membership.

For more information, see your Evidence of Coverage or call Member Services at 833-358-2140 (TTY: 711).