CareMore Cal MediConnect

Ending Your Membership

If you leave our plan and do not want to enroll in a different Cal MediConnect plan, you will go back to getting your Medicare and Medi-Cal services separately.

How you will get Medicare services

You will have a choice about how you get your Medicare benefits.

You have three options for getting your Medicare services. By choosing one of these options, you will automatically end your membership in our Cal MediConnect plan.

1. You can change to:

A Medicare health plan, such as a Medicare Advantage plan or Programs of All-inclusive Care for the Elderly (PACE)

Here is what to do:

Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048 to enroll in the new Medicare-only health plan.

If you need help or more information:

Call the California Health Insurance Counseling & Advocacy Program (HICAP) at 1-800-824-0780 (TTY: 711).

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

2. You can change to:

Original Medicare with a separate Medicare prescription drug plan

Here is what to do:

Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.

If you need help or more information:

Call the California Health Insurance Counseling & Advocacy Program (HICAP) at 1-800-824-0780 (TTY: 711).

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

3. You can change to:

Original Medicare without a separate Medicare prescription drug plan

NOTE: 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 tell Medicare you don’t want to join.

You should only drop prescription drug coverage if you get drug coverage from an employer, union or other source. If you have questions about whether you need drug coverage, call the California Health Insurance Counseling & Advocacy Program (HICAP) at [1-800-824-0780 (TTY: 711)].

Here is what to do:

Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.

If you need help or more information:

Call the California Health Insurance Counseling & Advocacy Program (HICAP) at 1-800-824-0780 (TTY: 711).

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

How you will get Medi-Cal services

If you leave our Cal MediConnect plan, you will continue to get your Medi-Cal services through L.A. Care Health Plan unless you select a different plan for your Medi-Cal services.

Your Medi-Cal services include most long-term services and supports and behavioral health care.

If you want to choose a different plan for your Medi-Cal services, you need to let Health Care Options know when you request to end your membership with our Cal MediConnect plan.

Call Heath Care Options at 1-844-580-7272, Monday through Friday from 8:00 am to 5:00 pm. TTY users should call 1-800-430-7077. Tell them you want to leave our plan and join a different Medi-Cal plan. If you are not sure what plan you want to join, they can tell you about other plans in your area.

Until your membership ends in our Cal MediConnect plan, you will keep getting your medical services and drugs through our plan

If you leave CareMore Cal MediConnect Plan, it may take time before your membership ends and your new Medicare and Medi-Cal coverage begins. See Chapter 10 of the EOC for more information. During this time, you will keep getting your health care and drugs through our plan.

You should use our network pharmacies to get your prescriptions filled.

Usually, your prescription drugs are covered only 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, your hospital stay will usually be covered by our Cal MediConnect plan until you are discharged.

This will happen even if your new health coverage begins before you are discharged.

Your membership in our Cal MediConnect plan will end in certain situations

These are the cases when CareMore Cal MediConnect Plan must end your membership in the plan:

  • If there is a break in your Medicare Part A and Part B coverage.
  • If you no longer qualify for Medi-Cal. Our plan is for people who qualify for both Medicare and Medi-Cal. The State or the Centers for Medicare and Medicaid Services (CMS) may disenroll you if it is determined that you are not eligible for the program.
  • If you move out of our service area.
  • If you are away from our service area for more than six months.
    • If you move or take a long trip, you need to call Member Services to find out if the place you are moving or traveling to is in our plan’s service area.
  • If you go to prison.
  • If you lie about or withhold information about other insurance you have for prescription drugs.

We can make you leave our plan for the following reasons only if we get permission from Medicare and Medi-Cal first:

  • 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 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 let someone else use your ID card to get medical care. If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.

We cannot ask you to leave our Cal MediConnect plan for any reason related to your health

If you feel that you are being asked to leave our plan for a health-related reason, you should call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may call 24 hours a day, seven days a week.

You should also call the Cal MediConnect Ombuds Program at 1-855-501-3077.

You have the right to make a complaint if we end your membership in our plan

If we end your membership in our Cal MediConnect 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. You can also see Chapter 9, Section 10 for information about how to make a complaint.