CareAdvantage Dual Eligible Special Needs Plan (D-SNP) 2024

End My Membership

You have the right to end your membership in CareAdvantage 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, 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

1. Call the CareAdvantage Unit:
   • 1-866-880-0606 or 650-616-2174
   • TTY: 1-800-735-2929 or 7-1-1
     
   • Hours: Monday - Sunday, 8:00 a.m. to 8:00 p.m.
2. Mail or fax a signed letter to the CareAdvantage Unit. HPSM staff will contact you if additional information is needed.
3. Enroll in another Medicare or prescription drug plan, and you will be automatically disenrolled from CareAdvantage. 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 network before your effective date of disenrollment, you may be billed 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 network.

When CareAdvantage ends your membership

CareAdvantage 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:

In accordance with Centers for Medicaid and Medicare Services (CMS) regulations, HPSM must end your membership in CareAdvantage 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 and do not get it back within four (4) months.
• You move out of our service area (San Mateo County) for more than six (6) 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 are not lawfully present in the United States.
• You lie about or withhold information about other insurance you have that provides prescription drug coverage.
• CONFIRM [You have retirement, veteran’s or other private health coverage.]
• CONFIRM [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.
• CONFIRM [You live in one of the Veterans’ Homes of California.]

HPSM can end your membership in CareAdvantage 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 (6) months, call the CareAdvantage Unit.
• If your address changes, contact the San Mateo County Human Services Agency 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.