When can you end your membership in our Medicare-Medicaid plan?

You can request to end your membership in Humana Gold Plus Integrated (Medicare-Medicaid Plan) at any time.

If you want to go back to getting your Medicare and Medicaid services separately:

  • Your membership will end on the last day of the month that we get your request to change your plan. Your new coverage will begin the first day of the next month. For example, if we get your request on January 18th, your new coverage will begin February 1st.

If you want to switch to a different Medicare-Medicaid Plan:

  • If you request to change plans before the 12th of the month, your membership will end on the last day of that same month. Your new coverage will begin the first day of the next month. For example, if we get your request on August 6th, your coverage in the new plan will begin September 1st.
  • If you request to change plans after the 12th of the month, your membership will end on the last day of the following month. Your new coverage will begin the first day of the month after that. For example, if we get your request on August 24th, your coverage in the new plan will begin October 1st.

For information on Medicare options when you leave our plan, see the table below.

For information about your Medicaid services when you leave our plan, see the table below.

These are ways you can get more information about when you can end your membership:

  • Call Illinois Client Enrollment Services at 1-877-912-8880, from 8 a.m. to 7 p.m. Monday through Friday and 9 a.m. to 3 p.m. on Saturday. TTY users should call 1-866-565-8576.
  • Call the Senior Health Insurance Program (SHIP) at 1-800-548-9034. TTY users should call 1-866-323-5321.
  • Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.

How do you end your membership in our plan?

If you decide to end your membership, tell Medicaid or Medicare that you want to leave Humana Gold Plus Integrated:

  • Call Illinois Client Enrollment Services at 1-877-912-8880, from 8 a.m. to 7 p.m. Monday through Friday and 9 a.m. to 3 p.m. on Saturday. TTY users should call 1-866-565-8576;
  • OR
  • Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users (people who are deaf, hard of hearing, or speech disabled) should call 1-877-486-2048. When you call 1-800-MEDICARE, you can also enroll in another Medicare health or drug plan.

How do you join a different Medicare-Medicaid plan?

If you want to keep getting your Medicare and Medicaid benefits together from a single plan, you can join a different Medicare-Medicaid plan.

To enroll in a different Medicare-Medicaid plan:

Call Illinois Client Enrollment Services at 1-877-912-8880, from 8 a.m. to 7 p.m. Monday through Friday and 9 a.m. to 3 p.m. on Saturday. TTY users should call 1-866-565-8576. Tell them you want to leave Humana Gold Plus Integrated (Medicare-Medicaid Plan) and join a different Medicare-Medicaid plan. If you are not sure what plan you want to join, they can tell you about other plans in your area.

If we get your request before the 12th of the month, your coverage with Humana Gold Plus Integrated (Medicare-Medicaid Plan) will end on the last day of that same month. If we get your request after the 12th of the month, your coverage with Humana Gold Plus Integrated (Medicare-Medicaid Plan) will end on the last day of the following month.

If you leave our plan and you do not want a different Medicare-Medicaid plan, how do you get Medicare and Medicaid services?

If you do not want to enroll in a different Medicare-Medicaid plan after you leave Humana Gold Plus Integrated, you will go back to getting your Medicare and Medicaid services separately.

How you will get Medicare services

You will have a choice about how you get your Medicare benefits.

You have three options for getting your Medicare services. By choosing one of these options, you will automatically end your membership in our plan.

How you will get Medicare services

1. You can change to:

A Medicare health plan, such as a Medicare Advantage plan or Programs of All-inclusive Care for the Elderly (PACE)

Here is what to do:

Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048 to enroll in the new Medicare-only health plan.

If you need help or more information:

  • Call the Senior Health Insurance Program (SHIP) at 1-800-548-9034.

You will automatically be disenrolled from Humana Gold Plus Integrated (Medicare-Medicaid Plan) when your new plan's coverage begins.

2. You can change to:

Original Medicare with a separate Medicare prescription drug plan

Here is what to do:

Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048

If you need help or more information:

  • Call the Senior Health Insurance Program (SHIP) at 1-800-548-9034.

You will automatically be disenrolled from Humana Gold Plus Integrated (Medicare-Medicaid Plan) when your new plan's coverage begins.

3. You can change to:

Original Medicare without a separate Medicare prescription drug plan

NOTE: If you switch to Original Medicare and do not enroll in a separate Medicare prescription drug plan, Medicare may enroll you in a drug plan, unless you tell Medicare you don't want to join.

You should only drop prescription drug coverage if you get drug coverage from an employer, union or other source. If you have questions about whether you need drug coverage, call your Senior Health Insurance Program at 1-800-548-9034.

Here is what to do:

Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.

If you need help or more information:

  • Call the Senior Health Insurance Program (SHIP) at 1-800-548-9034.

You will automatically be disenrolled from Humana Gold Plus Integrated (Medicare-Medicaid Plan) when your Original Medicare coverage begins.

How you will get Medicaid services

If you leave the Medicare-Medicaid plan, you will either get your Medicaid services through fee-for-service or remain in our plan to get your Medicaid services.

If you are in a nursing facility or are enrolled in a Home and Community Based Service (HCBS) waiver, you will remain in our plan to get your Medicaid services.

  • You will have 90 days to switch to another Medicaid-only health plan.
  • You will get a new member ID card, a new Member Handbook, and a new Provider and Pharmacy Directory.

If you are not in a nursing facility or enrolled in a HCBS waiver, you will be in Medicaid fee-for-service. This is how you received your Medicaid services before joining our plan. You can see any provider that accepts Medicaid and new patients.

Until your membership ends, you will keep getting your medical services and drugs through our plan

If you leave Humana Gold Plus Integrated (Medicare-Medicaid Plan) it may take time before your membership ends and your new Medicare and Medicaid coverage begins. During this time, you will keep getting your health care and drugs through our plan.

  • You should use our network pharmacies to get your prescriptions filled. Usually, your prescription drugs are covered only if they are filled at a network pharmacy including through our mail-order pharmacy services.

If you are hospitalized on the day that your membership ends, your hospital stay will usually be covered by our plan until you are discharged. This will happen even if your new health coverage begins before you are discharged.

Your membership will end in certain situations

Under certain circumstances, Humana Gold Plus Integrated (Medicare-Medicaid Plan) can ask Illinois Client Enrollment Services to disenroll you from our health plan. This is called “disenrollment for cause.” We can ask that you be disenrolled for cause for the following reason:

  • You move out of the service area. Humana Gold Plus Integrated (Medicare-Medicaid Plan) serves members in the following counties only:

    – Cook – DuPage – Kane – Kankakee – Lake – Will

  • The Member loses entitlement to either Medicare Part A or Part B
  • The Member loses Medicaid eligibility or additional State-specific eligibility requirements
  • The termination or expiration of this Contract terminates coverage for all Members with the Contractor. Termination will take effect at 11:59 p.m. on the last day of the month in which this Contract terminates or expires, unless otherwise agreed to, in writing, by the Parties.
  • When a Member remains out of the Service Area, or for whom residence in the plan Service Area cannot be confirmed, for more than six consecutive months.
  • When a Member no longer resides in the Service Area, except for an Enrollee living in the Service Area who is admitted to a Nursing Facility outside the Service Area and placement is not based on the family or social situation of the Member.

We can make you leave our plan for the following reasons only if we get permission from Medicare and Medicaid first:

  • When the Department or CMS determines that a Member has other significant insurance coverage or is placed in Spend-down status.
  • If a Member intentionally withholds or falsifies information about third-party reimbursement coverage
  • When CMS or the Department is made aware that a Member is incarcerated in any county jail, Illinois Department of Corrections facility, another state’s correctional facility, or federal penal institution.
  • 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 because of this reason, Medicare may have your case investigated by the Inspector General.

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 our plan for a health-related reason, you should call Medicare at 1 800 MEDICARE (1 800 633 4227). TTY users should call 1 877 486 2048. You may call 24 hours a day, seven days a week. You should also call Medicaid’s Health Benefits Hotline at 1-800-226-0768. TTY users should call 1-877-204-1012.

We cannot disenroll you from our plan for any of the following reasons:

  • because of an adverse change in a Member’s health status or
  • because of the Member’s utilization of Covered Services,
  • because of diminished mental capacity, uncooperative or disruptive behavior resulting from such Member’s special needs (except to the extent such Member’s continued enrollment with the Contractor seriously impairs the Contractor’s ability to furnish Covered Services to the Member or other Members) or
  • because the Member attempts to exercise, or is exercising, his or her Appeal or Grievance rights.

The Contractor, however, may submit a written request, accompanied by supporting documentation, to the Department and CMS, via the CMT, to disenroll a Member, for cause, if:

The Member’s continued enrollment seriously impairs the Contractor’s ability to furnish Covered Services to either this Member or other Members, provided the Member’s behavior is determined to be unrelated to an adverse change in the Member’s health status, or because of the Member’s utilization of medical services, diminished mental capacity, or uncooperative or disruptive behavior resulting from his or her special needs.

You have the right to make a complaint if we end your membership in our plan

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 make a complaint about our decision to end your membership.

Where can you get more information about ending your plan membership?

If you have questions or would like more information on when we can end your membership, you can call Customer Care at 1-800-787-3311 (TTY: 711). We’re available Monday-Friday, from 8 a.m. - 8 p.m. CST.

However, please note that our automated phone system may answer your call during weekends and holidays. You may leave your name and telephone number, and we’ll call you back by the end of the next business day. The call is free. For 24 hour access to information such as claims history, eligibility, Humana’s drug list, physician finder or health news and information, please visit www.humana.com.

For information on enrollment or disenrollment from Humana Gold Plus Integrated (Medicare-Medicaid Plan), call the Illinois Client Enrollment Services at 1-877-912-8880 (TTY: 1-866-565-8576), or visit http://enrollhfs.illinois.gov/. Hours of operation are Monday through Friday 8 a.m.-7 p.m. and Saturdays 9 a.m. -3 p.m.