Disenrollment Rights and Responsibilities
You may end your membership in our plan only during certain times of the year, known as election periods. All members have an opportunity to leave the plan during the Annual Enrollment Period (October 15 – December 7) or Medicare Advantage Open Enrollment Period (January 1 – March 31). In certain situations, you may be eligible to leave the plan at other times of the year.
Annual Election Period (AEP)
You can end your membership during the AEP. This is the time when you should review your health and drug coverage about your coverage for the upcoming year.
When: October 15th through December 7th, every year.
Where: During this time, you can review your health coverage and prescription drug coverage.
You can choose to keep your current coverage (by making no action) or make changes to any of the following types of plans.
- Another Medicare health plan
- Original Medicare with a separate Medicare prescription drug plan (or without, but you may receive a Late Enrollment Penalty)
- 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.
What is a Late Enrollment Penalty?
If you disenroll from Medicare prescription drug coverage and go without credible coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. (“Credible” coverage means the coverage is expected to pay, on average, as much of Medicare’s standard prescription drug coverage).
If you enroll into another plan during AEP, your membership will end when your new plan’s coverage begins on January 1.
Medicare Advantage Open Enrollment Period (MA-OEP)
You have the opportunity to make one change to your health coverage during the annual MA-OEP.
When: January 1st – March 31st, every year
Where: During this time, you can cancel your Medicare Advantage Plan enrollment and switch to:
- Another Medicare health plan
- Original Medicare with a separate Medicare prescription drug plan (or without, but you may receive a Late Enrollment Penalty)
- 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.
What is a Late Enrollment Penalty?
If you disenroll from Medicare prescription drug coverage and go without credible coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. (“Credible” coverage means the coverage is expected to pay, on average, as much of Medicare’s standard prescription drug coverage).
If you enroll into another plan during MA-OEP your membership will end on the first day of the month after we get your request to switch to another plan.
Special Enrollment Period (SEP)
In special situations, you may be eligible to end your membership at other times of the year. This is known as a SEP.
Who: If any of the following situations apply to you, you are eligible to end your membership during an SEP. These are just examples, for the full list you can contact Health Plan Services at 303-602-2111 or toll-free 1-877-956-2111. TTY users call 711. You may also contact Medicare (1-800-633-4227) or visit the Medicare website
- You have moved
- You have Medicaid
- You are eligible for Extra Help with paying for your Medicare prescriptions
- If we violate our contract with you
- If you are getting care in an institution, such as a nursing home or long-term care hospital.
When: The enrollment period may vary depending on your situation.
What can you do? To find out if you are eligible for an SEP, 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 enrollment because of a special situation, you would be disenrolled from your DHMP health coverage and prescription drug coverage. This means you can choose any of the following types of plans:
- Another Medicare health plan
- Original Medicare with a separate Medicare prescription drug plan (or without, but you may receive a Late Enrollment Penalty)
- 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.
What is a Late Enrollment Penalty?
If you disenroll from Medicare prescription drug coverage and go without credible coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. (“Credible” coverage means the coverage is expected to pay, on average, as much of Medicare’s standard prescription drug coverage).
If you enroll into another plan due to an SEP, your membership will end on the first day of the month after we get your request to switch to another plan.
Usually, to end your membership in our plan, you enroll into another Medicare plan during one of the enrollment periods. However, if you want to switch from our plan to Original Medicare without a Medicare prescription drug plan, you may 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 Health Plan Services at 303-602-2111 or toll-free 1-877-956-2111. TTY users call 711.
- -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.
Your rights and responsibilities during disenrollment:
- You must continue to use network pharmacies (if you have prescription drug coverage) until you are disenrolled from our plan.
- You may only disenroll or switch Medicare Advantage plans or prescription drug plans under certain circumstances.
- You have the right to make a complaint if we ask you to leave our plan.
Our rights and responsibilities upon your disenrollment
We will let you know, in writing, the date your coverage ends. We have the right to disenroll you for the following reasons:
- Loss of Medicare Parts A and/or B
- You permanently moved from our service area permanently, or for more than six consecutive months
- We are no longer contracting with Medicare or we leave your service area
- You fail to pay your plan premium
- You provide fraudulent information when you enroll or let someone else use your membership card to get services
- Disruptive behavior
- Denver Health Medicare Choice (HMO D-SNP) only: You lose your Medicaid eligibility for more than six months.