Member Rights Upon Disenrollment

Ending your membership with Alterwood Advantage may be voluntary (your own choice) or involuntary (not your own choice):

• Voluntary Disenrollment: You might request to disenroll from our plan because you have decided that you want to leave.
• Involuntary Disenrollment: There are also limited situations where you do not choose to leave, but the plan is 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 will continue to get your medical care through our plan until your membership ends.

You may end your membership in our plan only during certain times of the year, known as enrollment periods. All members get the opportunity to leave the plan during the Annual Enrollment Period and during the Open Enrollment Period. In certain situations, you may also be eligible to leave the plan at other times of the year (known as Special Enrollment Periods).

Annual Enrollment Period (AEP)

You can end your membership during the Annual Enrollment Period (also known as the “Open Enrollment Period for Medicare Advantage AND Medicare prescription drug coverage”). During this annual window, you can reevaluate your current Medicare Advantage coverage and make decision to enroll into new plans for the upcoming year.

• When is the Annual Enrollment Period? The AEP is from October 15 through December 7 of every year.
•  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.
• When will your membership end? Your membership will end when your new plan’s coverage begins on January 1.

Medicare Advantage Open Enrollment Period (MA OEP)

Each year, there’s a Medicare Advantage Open Enrollment Period from January 1 – March 31. During this time, if you’re in a Medicare Advantage Plan and want to change your health plan, you’ll have a one-time opportunity to:

• Switch to a different Medicare Advantage Plan
• Go back to Original Medicare, Part A and Part B, and a stand-alone Medicare Prescription Drug Plan

Special Election Periods (SEP)

There are some special situations that are outside of your control, and in these types of situations, Medicare allows you to make changes other times of the year, outside of the AEP. 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. Few examples:
  • If you have moved out of service area
  • If you’re no longer eligible for Medicaid
  • If you are eligible for “Extra Help” with paying for your Medicare prescriptions.
  • If you’ve moved into or out of an institution, such as a nursing home or long-term care (LTC) hospital.For the full list of SEPs, you can contact our plan, call Medicare, or visit the Medicare website (http://www.medicare.gov).
• 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.
• 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.

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 Alterwood 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 Alterwood Advantage. There are two ways you can asked to be disenrolled:

• You can send a written disenrollment request to Alterwood Advantage, by mailing it to Alterwood Advantage, Attention: Enrollment Department, PO Box 4175, Timonium, MD 21094-4175 or faxing it to Medicare Enrollment Department at 1(410) 801-5706.
• You can contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY/TDD users should call 1-877-486-2048.

If you need more information, please contact our Member Services Department at 1-667-262-9412 or toll-free at 1-866-675-3944, 8AM to 8PM EST, 7-days a week from October 1 through March 31, and 8AM to 8PM EST, Monday through Friday from April 1 through September 30.  TTY users please call 711.

If you leave Alterwood Advantage, it may take time before your membership ends and your new Medicare coverage goes into effect. Until your membership ends you are still a member of our plan and 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).

Alterwood Advantage must end your membership in the plan if any of the following happen:

• If you lose your Medicare Part A and Part B entitlement
• If you permanently move out of our plan service area
• If you are away from our service area for more than 6 months.
• If you become incarcerated
• If you are not lawfully present in the United States
• If you owe Part D-IRMAA and you fail to pay your Part D-IRMAA to the government and CMS notifies the plan to effectuate the disenrollment
• 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 intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan.

• If you lie about or withhold information about other insurance, you have that provides prescription drug coverage.

• If you let someone else use your membership card to get medical care.
• If as SNP enrollee, you lose special needs status and do not reestablish SNP eligibility prior to the expiration of the period of deemed continued eligibility
• If Alterwood Advantage’s contract is terminated or if our plan discontinues offering the plan everywhere or to your service area.

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), 24 hours per day, 7 days per week. TTY/TDD users should call 1-877-486-2048.

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.