Disenrollment Rights & Responsibilities

What is Disenrollment?

“Disenrollment” means ending or canceling your membership in a Troy Medicare plan. Disenrollment can be voluntary (your own choice) or involuntary (not your own choice).

If you are leaving our plan, it may take time before your membership ends and your new Medicare coverage goes into effect. Until your membership ends, you are still a member of Troy Medicare. During this time, you must continue to get your medical care and prescription drugs through Troy Medicare. 

You should continue to use our network pharmacies to get your prescriptions filled until your membership in our plan ends.

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When can you end your membership? (Voluntary Disenrollment)

There may be a time you need to disenroll from, or leave, the plan. This means your membership in Troy Medicare is ending. You can generally end your membership in your Troy Medicare plan during certain times of the year:

You can disenroll from Troy Medicare during the Annual Enrollment Period (AEP) from October 15 through December 7 or during a Special Enrollment Period (SEP). If you are in a Medicare Advantage plan, you may also disenroll during the Open Enrollment Period (OEP) from January through March.

Special Enrollment Periods (SEP)

There may be certain situations that are outside of your control when Medicare may allow you to make changes to your health care coverage. This is known as a Special Enrollment Period.

Some of the circumstances that may qualify you for an SEP include:

• If you move outside of the service area
• Losing group Medicare employer coverage
• If you are eligible for “Extra Help” with paying for your Medicare prescription drugs
• Newly qualifying for a Special Needs Plan due to a chronic health condition
  

Please refer to Section 2 in your Evidence of Coverage for more information.

How to voluntarily end your membership in Troy Medicare

Usually, to end your membership in our plan, you simply enroll in another Medicare plan. However, if you want to switch from our plan to Original Medicare but you have not selected a separate Medicare prescription drug plan, you must ask to be disenrolled from Troy Medicare. There are two ways you can ask to be disenrolled:

• Make a request in writing to us at the address below. Please contact Member Services if you need more information on how to do this.
     Troy Medicare
      PO Box 1293
      Westborough, MA 01581
  

• Contact Medicare at 1‐800‐MEDICARE (1‐800‐633‐4227), 24 hours a day, 7 days a week. TTY/TDD users should call 1‐877‐486‐2048.

For more information, call Member Services at 1-888-494-8769 (TROY). TTY users call 711. From October 1 to March 31, we’re available 8 a.m. to 8 p.m., 7 days a week. And from April 1 to September 30, we’re available 8 a.m. to 8 p.m., Monday to Friday.

‍Important: If you disenroll from a Medicare prescription drug plan and go without creditable prescription drug coverage (coverage that is at least as good as Medicare drug coverage) for a period of 63 days or more, you may have to pay a penalty if you join a Medicare drug plan later. This penalty will be due as part of your monthly premium for the duration of any future PDP enrollment. See your Evidence of Coverage for more information.

When we must end your membership in our plan (Involuntary Disenrollment)

We must end your membership in our Troy Medicare plan if any of the following happen:

• If you do not stay continuously enrolled in Medicare Part A and Part B.
• If you move out of our service area.
• If you are away from our service area for more than six months.
• If you become incarcerated (go to prison).
• If you lie about or withhold information about other insurance coverage you have that provides prescription drug coverage.
• If you continuously behave in a way that is disruptive and makes it difficult for us to provide care for you and other members of our plan.
• 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 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.)
• If you fail to pay any premiums or late enrollment penalty.
• 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.
• The Troy Medicare contract is terminated or Troy discontinues offering Troy Medicare in any portion of the area where it had previously been available.
• If you are enrolled in our Special Needs plan ( D-SNP) and you lose your special needs status.

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

If you feel that you are being asked to leave a Troy Medicare plan because of your health, you should call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may call 24 hours a day, 7 days a week.

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 file a grievance or make a complaint about our decision to end your membership. 

If you have questions about disenrollment, call Member Services at 1-888-494-8769 (TROY). TTY users call 711. From October 1 to March 31, we’re available 8 a.m. to 8 p.m., 7 days a week. And from April 1 to September 30, we’re available 8 a.m. to 8 p.m., Monday to Friday.

Page last updated: October 2024