How to Enroll or Disenroll
How to Enroll or Disenroll
Enrolling in L.A. Care Health Plan Medicare Advantage (HMO SNP) is easy. Since L.A. Care Health Plan Medicare Advantage is a Dual Special Needs Plan (for Medicare Beneficiaries with Medicare and Full Medi-Cal Benefits), you can enroll anytime of the year. Simply...
- Call 1-888-522-1298 and a knowledgeable L.A. Care Health Plan representative will explain the plan and answer your questions. TTY/TDD users should call 1-866-522-2731. L.A. Care Health Plan representatives are available 24 hours a day, 7 days a week, including holidays.
You have options on how you may enroll in L.A. Care Health Plan Medicare Advantage. You may choose to enroll via phone, mail, the CMS Medicare Online Enrollment Center, or fax in your completed enrollment application, or schedule an appointment to meet with one of L.A. Care Health Plan Medicare Advantage representatives at your convenience.
- Medicare beneficiaries may enroll in L.A. Care Health Plan Medicare Advantage through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. To enroll in L.A. Care Health Plan Medicare Advantage click on this sentence.
- Beneficiaries who are eligible to join L.A. Care Health Plan Medicare Advantage may enroll at anytime.
- At your request, we will send you an information packet that includes an L.A. Care Health Plan Medicare Advantage Enrollment Form (PDF).
- Choosing your Primary Care Provider. To complete the Enrollment Form, you must pick a Primary Care Provider (PCP) and Medical Group/Clinic. You can use our "Find a Doctor or Hospital" online search or look at the L.A. Care Health Plan Medicare Advantage Provider Directory to choose the Doctor and Medical Group that best suits your needs.
- Be sure to include the Primary Care Provider (PCP) and Medical Group names and ID numbers on the Enrollment Form.
- Sign and date the Enrollment Form, keep a copy for yourself and mail the other copies to L.A. Care Health Plan in the envelope provided.
As your Enrollment Form is processed for approval, L.A. Care Health Plan will keep you informed in writing every step of the way. If you are approved for membership, your coverage will begin the first day of the month following the month we received your Enrollment Form. For example, if we received your Enrollment Form during the month of March, your coverage will begin April 1.
Disenrolling from Our Plan
Ending your membership in L.A. Care Health Plan Medicare Advantage may be voluntary (your own choice) or involuntary (not your own choice).
You might leave our Plan because you have decided that you want to leave.
- Because you have both Medicare and Medi-Cal, you may voluntarily end your membership in the Plan at any time. Chapter 10, Section 2 in the Evidence of Coverage tells you when you can end your membership in the Plan.
- The process for voluntarily ending your membership varies depending on what type of new coverage you are choosing. Chapter 10, Section 3 in the Evidence of Coverage tells you how to end your membership in each situation.
- There are also limited situations where you do not choose to leave, but we are required to end your membership. Chapter 10, Section 5 in the Evidence of Coverage tells you about situations when we must end your membership.
When can you end your membership in our Plan?
You may end your membership in our Plan anytime. All members have the opportunity to leave the Plan throughout the year. If you leave our Plan, your membership will end on the first of the month after we receive the request. Chapter 10, Sections 2 and 3 in the Evidence of Coverage tell you when and how you can end your membership in our Plan.
Until your membership ends, you are still a member of our Plan.
If you leave L.A. Care Health Plan Medicare Advantage, 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 and prescription drugs through our Plan.
When must we end your membership in the Plan?
L.A. Care Health Plan Medicare Advantage must end your membership in the Plan if any of the following happen:
- If you do not stay continuously enrolled in Medicare Part A and Part B.
- If you are no longer eligible for Medi-Cal. As stated in Chapter 1, Section 2.1 in the Evidence of Coverage (PDF), our plan is for people who are eligible for both Medicare and Medi-Cal. If you are no longer eligible for Medi-Cal, our plan gives you up to six months to regain Medi-Cal eligibility before disenrolling you. We will work with you to try and regain your eligibility. If you do not have Medi-Cal eligibility at the end of six months, we are required to disenroll you.
If you move out of 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 area.
- If you become incarcerated (go to prison).
- If you lie about or withhold information about other insurance you have that provides prescription drug coverage.
- 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.
- 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.
- 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 Plan for any reason related to your health.
You have the right to make a complaint if we end your membership in our Plan.
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. You can also look in Chapter 9, Section 11.3 in the Evidence of Coverage (PDF) for information about how to make a complaint.
For more information, call Member Services or see Chapter 10 in the Evidence of Coverage (PDF).
L.A. Care Health Plan is a Coordinated Care Plan with a Medicare contract and a contract with the California Medicaid program. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medi-Cal or by a third party. Individuals must have both Part A and Part B to enroll. You must use plan providers except in emergent or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-plan providers, neither Medicare nor L.A. Care Health Plan will be responsible for costs. You must use network pharmacies to fill your prescriptions, except under non-routine circumstances when you cannot reasonably use network pharmacies.
L.A. Care Health Plan has been approved by the National Committee for Quality Assurance (NCQA), a non-profit organization dedicated to improving health care quality until December 31, 2014.
This information is available for free in other languages. Please contact our customer service number at 1-888-522-1298 for additional information. TTY/TDD users should call 1-866-522-2731. We are available 24 hours a day, 7 days a week (including holidays).
Esta información está disponible de forma gratuita en otros idiomas. Por favor, comuniquese con el departamento de servicios para los miembros al 1-888-522-1298 para obtener información adicional. Los usuarios de TTY deben llamar al 1-866-522-2731. Estamos disponibles las 24 horas del día, los 7 días a la semana, (incluso los días festivos).
Plan member materials are available in a different language or format, including large print, audio, and Braille or upon request.
Los materiales para miembros del plan están disponible en otros idiomas o formatos como letra grande, audio, y braille a su solicitud.
For full information on L.A. Care Health Plan Medicare Advantage benefits, please call our Member Services department at 1-888-522-1298 (TTY/TDD 1-866-522-2731). L.A. Care Health Plan representatives are available 24 hours a day, 7 days a week, including holidays.