Disenrollment & Termination

Leaving or Switching Plans

“Disenrollment” from Blue Advantage (HMO) | Blue Advantage (PPO) means ending your membership in our plan. Disenrollment can be voluntary or involuntary:

  • You might leave Blue Advantage because you have decided that you want to leave. You can do this for any reason; however, there are limits to when you may leave, how often you can make changes, what your other choices are for receiving Medicare services and how you can make changes.
  • There are also a few situations where you would be required to leave our plan. For example, you would have to leave if you permanently move out of our geographic service area or if Blue Advantage leaves the Medicare program. We will not ask you to leave our plan because of your health.

Until your membership ends, you must keep getting your Medicare services through Blue Advantage, or you will have to pay for them yourself.

If you leave our plan, it may take some time for your membership to end and your new way of getting Medicare to take effect. While you are waiting for your membership to end, you are still a member and must continue to get your care as usual through our health plan.

If you are in a Blue Advantage (HMO) plan and you get services from doctors or other medical providers who are not plan providers before your membership in our plan ends, neither Blue Advantage nor the Medicare program will pay for these services, with just a few exceptions. The exceptions are: urgently needed care, care for a medical emergency, out-of-area renal dialysis services, and care that has been approved by us. Another possible exception is if you happen to be hospitalized on the day your membership ends. If this happens to you, call us to find out if your hospital care will be covered. If you have any questions about leaving Blue Advantage, please call us.

If you want to leave our health plan:

  • The first step is to be sure that the type of change you want to make (and when you want to make it) fits within the rules explained below about changing how you get Medicare. If the change does not fit with these rules, you won’t be allowed to make the change.
  • Then, what you must do to leave Blue Advantage depends on whether you want to switch to Original Medicare or to one of your other choices.

In general, there are only certain times during the year when you can change the way you get Medicare. Your plan’s Evidence of Coverage outlines these rules. Contact us for information.

Potential for Contract Termination

If we leave the Medicare program or change our service area so that it no longer includes the area where you live, we will tell you in writing. If this happens, your membership in Blue Advantage will end, and you will have to change to another way of getting your Medicare benefits. All of the benefits and rules described in the Evidence of Coverage will continue until your membership ends. This means that you must continue to get your medical care and prescription drugs in the usual way through our plan until your membership ends.

Your choices for how to get your Medicare coverage will always include Original Medicare and joining a Prescription Drug Plan to complement your Original Medicare coverage. Your choices may also include joining another Blue Cross and Blue Shield of Louisiana, and its subsidiary HMO Louisiana, Inc. plan, another Medicare Advantage plan, or a Private Fee-for-Service plan, if these plans are available in your area and are accepting new members. Once we have told you in writing that we are leaving the Medicare program or the area where you live, you will have a chance to change to another way of getting your Medicare benefits. If you decide to change from Blue Advantage to Original Medicare, you will have the right to buy a Medigap policy regardless of your health. This is called a “guaranteed issue right”.

Blue Cross and Blue Shield of Louisiana, and its subsidiary HMO Louisiana, Inc. has a contract with the Centers for Medicare & Medicaid Services (CMS), the government agency that runs Medicare. This contract renews each year. At the end of each year, the contract is reviewed, and either Blue Cross and Blue Shield of Louisiana, and its subsidiary HMO Louisiana, Inc. or CMS can decide to end it. You will get 90 days advance notice in this situation. It is also possible for our contract to end at some other time during the year. In these situations we will try to tell you 90 days in advance, but your advance notice may be as little as 30 or fewer days if CMS must end our contract in the middle of the year.

Whenever a Medicare health plan leaves the Medicare program or stops serving your area, you will be provided a special enrollment period to make choices about how you get Medicare coverage, including choosing a Medicare Prescription Drug Plan and guaranteed issue rights to a Medigap policy. Generally, we cannot ask you to leave the plan because of your health. If you ever feel that you are being encouraged or asked to leave our plan because of your health, you should call 1-800-MEDICARE (1-800-633-4227), which is the national Medicare help line. TTY users should call 1-877-486-2048. You can call 24 hours a day, 7 days a week.

We can ask you to leave the plan under certain special conditions. If any of the following situations occur, we will end your Blue Advantage membership:

  • If you are not a United States citizen or lawfully present in the United States
  • If you move out of the service area or are away from the service area for more than six months in a row. If you plan to move or take a long trip, please call us to find out if the place you’re moving to or traveling to is in our service area. If you move permanently out of our geographic service area, of if you’re away from our service area for more than six months in a row, you generally can’t remain a member of Blue Advantage. In these situations, if you don’t leave on your own, we must end your membership (“disenroll” you)
  • If you don’t stay continuously enrolled in both Medicare Part A and Medicare Part B
  • If you are required to pay the extra Part D amount because of your income and you do not pay it, Medicare will disenroll you from our plan and you will lose prescription drug coverage
  • If you give us information on your enrollment request that you know is false or deliberately misleading, and it affects whether or not you can enroll in our plan.
  • If you lie about or withhold information about other insurance you have that provides prescription drug coverage
  • If you behave in any way that is disruptive, to the extent that your continued enrollment seriously impairs our ability to arrange or provide medical care for you or for others who are members of a Blue Advantage plan. We can’t make you leave our plan for this reason unless we get permission first from the Centers for Medicare & Medicaid Services, the government agency that runs Medicare
  • If you let someone else use your plan membership card to get medical care. If you’re disenrolled for this reason, CMS may refer your case to the Inspector General for additional investigation
  • If you become incarcerated (go to prison)

You have the right to make a complaint if we ask you to leave our plan. If we ask you to leave, we will tell you our reason(s) in writing and explain how you can file a complaint against us if you so choose.