CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan)
End My Membership
You have the right to end your membership in CareAdvantage CMC at any time for any reason. This is different from other Medicare plans that only allow you to end your membership at certain times of the year.
If you leave CareAdvantage CMC, your membership will end on the last day of the month that we get your request to change your plan. You will continue to get your Medi-Cal services through HPSM, but it may take some time before your new Medicare coverage begins.
There are three ways you can disenroll from CareAdvantage CMC:
- Call the CareAdvantage Unit:
- 1-866-880-0606 or 650-616-2174
- TTY: 1-800-735-2929 or 711
- Hours: Monday - Sunday, 8:00 a.m. to 8:00 p.m.
- Mail or fax a signed letter to the CareAdvantage Unit. HPSM staff will contact you if additional information is needed.
- Enroll in another Medicare plan, and you will be automatically disenrolled from CareAdvantage CMC. Your coverage will end when coverage under your new plan begins.
After you disenroll HPSM will send you a letter that specifies the date when your membership ends.
Getting care during transition
If you receive medical care from providers outside of the CareAdvantage CMC network before your effective date of disenrollment, you may be financially liable for the costs if the provider is not willing to bill HPSM. Call the CareAdvantage Unit to verify your disenrollment date before receiving medical services outside of the CareAdvantage CMC network.
When CareAdvantage CMC ends your membership
CareAdvantage CMC cannot ask you to leave for any reason related to your health. If you feel that you are being asked to leave our plan because of a health-related reason, call Medicare:
Hours: 24 hours a day, 7 days a week
In accordance with Centers for Medicaid and Medicare Services (CMS) regulations, HPSM must end your membership in CareAdvantage CMC if any of the following happen:
- You do not stay continuously enrolled in Medicare Part A and Part B.
- You lose your Medi-Cal eligibility through HPSM. (In that case, the State will automatically enroll you in original Medicare.)
- You move out of our service area (San Mateo County) for more than six months. (If you will be living outside of San Mateo County for more than six months, call the CareAdvantage Unit..)
- You become incarcerated (go to prison).
- You lie about or withhold information about other insurance you have that provides prescription drug coverage.
- You have retirement, veteran’s or other private health coverage.
- You receive services through one of the following waiver programs: Nursing Facility/Acute Hospital, HIV/AIDS, Assisted Living, and In Home Operations.
- You do not meet your Medi-Cal share of cost, if you have one.
- You live in one of the Veterans’ Homes of California.
HPSM can end your membership in CareAdvantage CMC for the following reasons only if we first get permission from Medicare and Medi-Cal:
- 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 for any of these reasons, Medicare may have your case investigated by the Inspector General.
How to Avoid Disenrollment
- If you will be outside of San Mateo County for more than six months, call the CareAdvantage Unit.
- If your address changes, contact your County Case Worker immediately to help prevent disenrollment.
- Renew your Medi-Cal coverage if you lose it. Call the San Mateo County Human Services Agency at 1-800-223-8383, or the CareAdvantage Unit for help.
CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Limitations and restrictions may apply. For more information, call the CareAdvantage Unit or read the CareAdvantage CMC Member Handbook.
Benefits and co-pays may change on January 1 of each year.
If you speak other languages other than English, language assistance services, free of charge, are available to you. Call 1-866-880-0606 (TTY: 1-800-735-2929). (Download this statement in multiple languages.)
Page updated January 01, 2019