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Information for Essence Members
Leaving Essence or Switching Medicare Plans
What is "Disenrollment"?
"Disenrollment" from Essence means ending your membership in Essence. Disenrollment can be voluntary or involuntary:
- You might leave Essence 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, and 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. For example, you would have to leave Essence if you move permanently out of our geographic service area or if Essence leaves the Medicare program. See Potential for Contract Termination. We are not allowed to ask you to leave the plan because of your health.
Until your membership ends, you must keep getting your Medicare services through Essence, or you will have to pay for them yourself.
If you leave Essence, 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 Essence.
If you get services from doctors or other medical providers who are not plan providers before your membership in Essence ends, neither Essence 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 Member Services to find out if your hospital care will be covered by Essence. If you have any questions about leaving Essence, please call Member Services.
What should I do if I decide to leave Essence?
If you want to leave Essence:
- The first step is to be sure that the type of change you want to make and when you want to make it, fit with the new 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 depends on whether you want to switch to Original Medicare or to one of your other choices.
When and how often can I change my Medicare choices?
In general, there are only certain times during the year when you can change the way you get Medicare. Here are the rules:
- From November 15 through December 31, during the Annual Coordinated Election Period (AEP), anyone with Medicare may switch from one way of getting Medicare to another for the following year. Your change will take effect on January 1. During the AEP, you are not limited in the type of change you may make to your coverage. See your Evidence of Coverage for more information.
- From January 1 until March 31, during the Medicare Advantage Open Enrollment Period (OEP), anyone eligible for Medicare Advantage has another chance to review the coverage they have, and make one change. Your new enrollment will be effective the first day of the month that comes after the month we receive your request to leave. However, with this chance, you are limited in the type of plan you may join. You may not use this chance to add or drop Medicare prescription drug coverage. See your Evidence of Coverage for more information.
Read about switching plans in your Evidence of Coverage if you want to change from Essence to a different Medicare Advantage Plan, Other Medicare Health Plan, or to Original Medicare between November 15 and December 31.
Generally, you can't make any other changes during the year unless you meet special exceptions, such as if you move or if you have Medicaid coverage. Contact us for information.
Do I need to buy a Medigap (Medicare Supplement Insurance) policy?
If you want to change from Essence to Original Medicare, you should think about whether you want to buy a Medigap policy to supplement your Original Medicare coverage. See your Evidence of Coverage for information about this.
For Medigap advice, you should contact SHIP (State Health Insurance Assistance Program) in your state. You can ask SHIP about how and when to buy a Medigap policy if you need one. SHIP can tell you if you have a guaranteed right to buy a Medigap policy.