Disenrollment Procedures

Rights & Responsibilities

When can you end your membership in our plan?

You can end your membership during the Annual Enrollment Period (October 15th - December 7th).

You can end your membership during the Medicare Advantage Open Enrollment Period (January 1st- March 31st).

In certain situations, you can end your membership during 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 (medicare.gov):

- Usually, when you have moved.
- If you have Medicaid.
- 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.

How do you end your membership in our plan?

The table below explains how you should end your membership in our plan:

If you would like to switch from our plan to:	This is what you should do:
Another Medicare health Plan	Enroll in the new Medicare health plan. You will automatically be disenrolled from our plan when your new plan ’s coverage begins.
Original Medicare with a separate Medicare prescription drug plan.	Enroll in the new Medicare prescription drug plan. You will automatically be disenrolled from our plan when your new plan ’s coverage begins.
Original Medicare without a separate Medicare prescription drug plan.	Send us a written request to disenroll. Contact Customer Service if you need more information on how to do this. You can also contact Medicare, at 1-800-MEDICARE (1-800-633-4227 ), 24 hours a day, 7 days a week, and ask to be disenrolled. TTY users should call 1-877-486-2048 . You will be disenrolled from our plan when your coverage in Original Medicare begins.

If you would like to switch from our plan to:

This is what you should do:

Another Medicare health Plan

Enroll in the new Medicare health plan.

You will automatically be disenrolled from our plan when your new plan ’s coverage begins.

Original Medicare with a separate Medicare prescription drug plan.

Enroll in the new Medicare prescription drug plan.

You will automatically be disenrolled from our plan when your new plan ’s coverage begins.

Original Medicare without a separate Medicare prescription drug plan.

Send us a written request to disenroll. Contact Customer Service if you need more information on how to do this.

You can also contact Medicare, at 1-800-MEDICARE (1-800-633-4227 ), 24 hours a day, 7 days a week, and ask to be disenrolled. TTY users should call 1-877-486-2048 .

You will be disenrolled from our plan when your coverage in Original Medicare begins.

Until your membership ends, you are still a member of our plan

If you leave our plan, 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 through our plan.

Our plan must end your membership in the plan in certain situations

If you do not stay continuously enrolled in 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.
- 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.
If you become incarcerated (go to prison).
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.

Our plan is not allowed to ask you to leave our plan for any reason related to your health. 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.

Last updated Nov 13, 2023

Disenrollment Procedures

Rights & Responsibilities

When can you end your membership in our plan?

How do you end your membership in our plan?

Until your membership ends, you are still a member of our plan

Our plan must end your membership in the plan in certain situations

Company

Resources

Compliance at ATRIO

Disclosures