Leaving or Switching Plans

“Disenrollment” from Essence Healthcare means ending your membership in our plan. Disenrollment can be voluntary or involuntary:

  • You might leave Essence Healthcare 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 Essence Healthcare 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 Essence Healthcare, 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 get services from doctors or other medical providers who are not plan providers before your membership in our plan ends, neither Essence Healthcare 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 Essence Healthcare, 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 Essence Healthcare 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 Customer Service Team.

Y0027_18-330 - Last updated 12/20/2018