Information on Disenrollment

What is "disenrollment"?


"Disenrollment" from Central Health Medicare Plan means ending your membership in Central Health Medicare Plan. Disenrollment can be voluntary (your own choice) or involuntary (not your own choice).


Whether leaving the plan is your choice or not, this section explains your Medicare coverage choices after you leave and the rules that apply.

Until your membership ends, you must keep getting your Medicare services through Central Health Medicare Plan or you will have to pay for them yourself
If you leave Central Health Medicare 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 later in this section). While you are waiting for your membership to end, you are still a member and must continue to get your care as usual through Central Health Medicare Plan.


If you get services from doctors or other medical providers who are not plan providers before your membership in Central Health Medicare Plan ends, neither Central Health Medicare Plan or the Medicare program will pay for these services, with just a few exceptions. The exceptions are urgently needed care, care for a medical emergency, out-of-area renal (kidney) dialysis services, and care that has been approved by us. There is another possible exception, if you happen to be hospitalized on the day your membership ends. If this happens to you, call Member Services to find out if your hospital care will be covered by Central Health Medicare Plan. If you have any questions about leaving Central Health Medicare Plan, please call Member Services.


What are your choices for receiving your Medicare services if you leave Central Health Medicare Plan?

If you leave Central Health Medicare Plan, one choice for continuing with Medicare is to join a Medicare Advantage plan or other Medicare Health Plan if any of these types of plans are available in your area, and if they are accepting new members. You can also choose the Original Medicare plan. If you choose Original Medicare, you must choose a Prescription Drug Plan if you wish to continue to have Medicare prescription drugs coverage.


Medicare Private Fee-for-Service Plans are available in some parts of the country. In Private Fee-for-Service plans, you may go to any Medicare-approved doctor or hospital that accepts the plan’s payment. The Private Fee-for-Service plan, rather than the Medicare program, decides how much it pay and what you pay – for the services you will get. You may pay more for Medicare-covered benefits. You may get extra benefits that Original Medicare does not cover, like prescriptions drugs as part of the Medicare Part D (Prescription Drug) benefit. Private Fee-for-Service plans are not the same as Medigap (Medicare supplement insurance) policies.


When and how often can you change your Medicare choices, and what choices can you make?

Starting in 2006, there are limits to when and how often you can change the way you get Medicare and what choices you can make when you make the change.


Please refer to Chapter 10 of the Evidence of Coverage for the new rules.


What should you do if you decide to leave Central Health Medicare Plan?

If you want to leave Central Health Medicare Plan:

  • The first step is to be sure that the type of change you want to make and when you want to make it fit with the new rules explained above about changing how you get Medicare. If the change does not fit with these rules, you won’t be allowed to make the change.

  • Then, what you must do to leave Central Health Medicare Plan depends on whether you want to switch to Original Medicare or to one of your other choices.

How to change from Central Health Medicare Plan to Original Medicare

Do you need to join a Prescription Drug Plan?

Original Medicare does not cover very many prescription drugs outside of a hospital. So, if you want to change from Central Health Medicare Plan to Original Medicare, you should think about whether you want to also join a Medicare Prescription Drug Plan. It is important to know that if you are eligible to join a prescription drug plan and you do not, you may have to pay a higher premium when you do join. To get information about Prescription Drug Plans that you can join, you can call 1-800-MEDICARE (1-800-633-4227), which is the national Medicare help line. TTY Users should call 1-877-486-2048. You can call 24 hours a day, 7 days a week.


Do you need to buy a Medigap (Medicare supplement insurance) policy?

If you want to change from Central Health Medicare Plan to Original Medicare, you should think about whether you need to buy a Medigap policy to supplement your Original Medicare coverage. For Medigap advice, you should contact the Health Insurance Counseling and Advocacy Program (HICAP). You can ask HICAP about how and when to buy a Medigap policy if you need one. HICAP can tell you if you have a guaranteed issue right to buy a Medigap policy.


If you do want to buy a Medigap policy, you have to follow the instructions below for changing from Central Health Medicare Plan to Original Medicare. (Buying a Medigap policy does not switch you from Central Health Medicare Plan to Original Medicare. In fact, while you are still enrolled in Central Health Medicare Plan, it is against the law for a Medigap insurance company to sell you a policy. A Medigap sales person or insurance agent cannot cancel your Central Health Medicare Plan membership and put you in Original Medicare.)


How to change from Central Health Medicare Plan to Original Medicare

If you decide to change from Central Health Medicare Plan to Original Medicare, you must tell us or Medicare that you want to leave Central Health Medicare Plan. You do not have to enroll in Original Medicare, because you will automatically be in Original Medicare when you leave Central Health Medicare Plan. Here is how it works:

  1. First, use any of the following ways to tell us that you want to leave Central Health Medicare Plan:
    • You can write or fax a letter to us or fill out a disenrollment form and send it to:
      Central Health Medicare Plan
      ATTN: Member Services
      PO Box 14244, Orange, CA 92863
      Fax :1-626-388-2361
      Be sure to sign and date your letter. To get a disenrollment form, call us at Member Services.
    • You can call 1-800-MEDICARE (1-800-633-4227), which is the national Medicare help line. TTY Users should call 1-877-486-2048. You can call 24 hours a day, 7 days a week.
  2. We will then send you a letter that tells you when your membership will end. This is your disenrollment date – the day you officially leave Central Health Medicare Plan. In most cases, your disenrollment date will be the first day of the month that comes after the month we receive your request to leave. For example, if we receive your request to leave during the month of February, your disenrollment date will be March 1. Remember, while you are waiting for your membership to end, you are still a member of Central Health Medicare Plan and must continue to get your medical care as usual through Central Health Medicare Plan.

  3. On your disenrollment date, your membership in Central Health Medicare Plan ends and you can start using your red, white, and blue Medicare card to get services under Original Medicare. You will not get anything in writing that tells you that you have Original Medicare, because you will automatically be in Original Medicare when you leave Central Health Medicare Plan. (Call Social Security at 1-800-772-1213 if you need a new red, white, and blue Medicare card.)

How to change from Central Health Medicare Plan to another Medicare Advantage Plan or to a Private Fee-for-Service Plan

If you want to change from Central Health Medicare Plan to a different Medicare Advantage plan, including a Private Fee-for-Service plan, here is what to do:

  • Contact the plan you want to join to be sure it is accepting new members. Also ask the plan if it offers the Medicare Part D prescription drug benefit.

Your new plan will tell you the date when your membership in that plan begins, and your membership in Central Health Medicare Plan will end on that same day (this will be your "disenrollment date"). Remember, you are still a member until your disenrollment date, and must continue to get your medical care as usual through Central Health Medicare Plan until the date your membership ends.


What happens to you if Central Health Medicare Plan leaves the Medicare program or Central Health Medicare Plan leaves the area where you live?

If we leave the Medicare program or change our service area so that it no longer includes the area where you live, we will tell you in writing. If this happens, your membership in Central Health Medicare Plan will end, and you will have to change to another way of getting your Medicare benefits. All of the benefits and rules described in this booklet will continue until your membership ends. This means that you must continue to get your medical care in the usual way through Central Health Medicare Plan until your membership ends.


Your choices for how to get your Medicare will always include Original Medicare and joining a Prescription Drug Plan to complement your Original Medicare coverage. Your choices may also include joining another Medicare Advantage Plan, or a Private Fee-for-Service plan, if these plans are available in your area and are accepting new members. Once we have told you in writing that we are leaving the Medicare program or the area where you live, you will have a chance to change to another way of getting your Medicare benefits. If you decide to change from Central Health Medicare Plan to Original Medicare, you will have the right to buy a Medigap policy regardless of your health. This is called a "guaranteed issue right", and it is explained in chapter 10 of the Evidence of Coverage.

Central Health Medicare Plan has a contract with the Centers for Medicare & Medicaid Services (CMS), the government agency that runs Medicare. This contract renews each year. At the end of each year, the contract is reviewed, and either Central Health Medicare Plan or CMS can decide to end it. You will get 90 days advance notice in this situation. It is also possible for our contract to end at some other time during the year, too. In these situations we will try to tell you 90 days in advance, but your advance notice may be as little as 30 or fewer days if CMS must end our contract in the middle of the year.


Whenever a Medicare health plan leaves the Medicare program or stops serving your area, you will be provided a special enrollment period to make choices about how you get Medicare, including choosing a Medicare Prescription Drug Plan and guaranteed issue rights to a Medigap policy.


You must leave Central Health Medicare Plan if you move out of the service area or are away from the service area for more than six months in a row

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 Central Health Medicare Plan’s service area. If you move permanently out of our service area, or if you are away from our service area for more than six months in a row, you generally cannot remain a member of Central Health Medicare Plan. In these situations, if you do not leave on your own, we must end your membership ("disenroll" you). An earlier part of this section tells about the choices you have if you leave Central Health Medicare Plan and explains how to leave.


Under certain conditions Central Health Medicare Plan can end your membership and make you leave the plan

We cannot ask you to leave the plan because of your health


No member of any Medicare health plan can be asked to leave the plan for any health-related reasons. If you ever feel that you are being encouraged or asked to leave Central Health Medicare 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 can call 24 hours a day, 7 days a week.


We can ask you to leave the plan under certain special conditions


If any of the following situations occur, we will end your membership in Central Health Medicare Plan.

  • If you move out of our geographic service area or live outside the plan’s service area for more than six months at a time.

  • If you do not stay continuously enrolled in both Medicare Part A and Medicare Part B.

  • If you give us information on your enrollment form that you know is false or deliberately misleading, and it affects whether or not you can enroll in Central Health Medicare Plan.

  • If you behave in a way that is disruptive, to the extent that your continued enrollment seriously impairs our ability to arrange or provide medical care for you or for others who are members of Central Health Medicare Plan. We cannot make you leave Central Health Medicare Plan for this reason unless we get permission first from the Centers for Medicare & Medicaid Services, the government agency that runs 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 ask you to leave Central Health Medicare Plan


If we ask you to leave Central Health Medicare Plan, we will tell you our reasons in writing and explain how you can file a complaint against us if you want to.


Please refer to Chapter 9 of the Evidence of Coverage for complete details on disenrolling from Central Health Medicare Plan.