You are eligible to enroll in Humana Dual Integrated (HMO D-SNP) as long as you:

• Live in our service area, and
• Are a U.S. citizen or are lawfully present in the U.S., and
• Are at least 21 years of age or older at the time of enrollment, and
• Have Medicare Part A and Medicare Part B, and
• Are enrolled in Medicaid Aid to the Aged, Blind, and Disabled category of assistance

To apply for Medicaid:

1. Get Ready: You will need your Social Security number, birthdate, and income information.
2. You can apply:
   • Online: Go to www.michigan.gov/mibridges and make an account.
   • By Mail: Call 1-888-367-6557 to ask for a paper application, fill it out, and mail it back.
   • In Person: Visit your local Michigan Department of Health and Human Services (MDHHS) office and fill out an application there.
3. Fill Out the Form: Answer all the questions about you and your family.
4. Send Your Application: Give your application to MDHHS online, by mail, or in person.
5. Wait for a Letter: MDHHS will review your application. They will send you a letter to tell you if you can get Medicaid.

If you need help, you can call the Michigan Health Care Helpline at 1-855-789-5610.

Each year, Michigan checks to make sure you are still eligible for Medicaid coverage. To ensure a review of your Medicaid coverage, please update your information with the state.

• You will get a letter in the mail from the State of Michigan when it is time to renew your Medicaid. Read the letter carefully.
• Get your personal information ready. You may need papers like your pay stubs, bills, or proof of where you live.
• You can recertify by mail by completing the forms you receive with the letter and returning them to Michigan DHS before the deadline.
• You can also recertify online Visit newmibridges.michigan.gov and select “Login” to manage your case.
• Verify your mailing address under “Contact Us.”
• Locate your due date (the “redetermination” date) in your “Benefit Details.” You can opt-in for text and email alerts about your renewal date. Select the “Account Management” tab under “Manage your communications preferences.”
• Everyone’s renewal date is different, so it is critical that you get ready to renew.
• You will receive renewal information in the mail about 1 month before your renewal date. Please complete and return it right away. You can complete your renewal online by returning the form in the mail, or by calling 1-888-367-6557.

For help with your renewal, call Member Services at 866-274-9834 (TTY:711), Monday – Friday, 8 a.m. – 8 p.m., Central Time

 

To enroll in Humana Dual Integrated:

Call Humana at 1-800-457-4708 (TTY: 711) to talk with a licensed sales agent. 

Visit the Humana DSNP website

You can request to end your membership in Humana Dual Integrated (HMO D-SNP in Michigan at any time after your initial enrollment. Your disenrollment will be effective on the first calendar day of the month following receipt of request.

For more information about when you can end enrollment in Humana Dual Integrated, call:

• Member Services at 866-274-9834 (TTY:711), Monday – Friday, 8 a.m. – 8 p.m., Central Time
• Senior Health Insurance Program (SHIP) at 1-800-803-7174 (TTY:711),
• Medicare at 800-MEDICARE (633-4227) (TTY: 877-486-2048), 24 hours a day, 7 days a week

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

You have 3 options for getting your Medicare services. By choosing one of these options, you will automatically end your membership in our plan:

• Original Medicare with a separate Medicare prescription drug plan
• Original Medicare without a separate Medicare prescription drug plan

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 800-803-7174 (TTY: 711).

If you leave Humana Dual Integrated, you will either get your Medicaid services through fee-for-service or be required to enroll in a different Michigan program to get your Medicaid services.

To choose a different Michigan health plan:

• Call Michigan ENROLLS at 800-975-7630 (TTY: 1-888-263-5897), Monday – Friday, 8 a.m. – 7 p.m., Central time and
• Tell them that you want to leave our plan and join a Michigan Medicaid health plan

Upon enrollment in a new plan, you will get a new member ID card, Member Handbook, and Provider and Pharmacy Directory from that plan.

If you leave Humana HIDE SNP, it may take time before your membership ends and your new Medicare and Medicaid coverage begins. During this time, you will keep getting your healthcare 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.

Under certain circumstances, Humana Dual Integrated can ask CMS 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 reasons:

• You move away from Michigan
• You lose entitlement to either Medicare Part A or Part B
• You lose 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
• You remain out of the service area, or we cannot confirm your residence in the plan service area, for more than 6 consecutive months
• When you no longer live in the service area, except for a member 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 the Centers for Medicare & Medicaid Services (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
• 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, call:

• Medicare at 800-MEDICARE (633-4227) (TTY: 877-486-2048), 24 hours a day, 7 days a week, to enroll in the new Medicare-only health plan
• Medicaid’s Health Benefits Hotline at 800-226-0768 (TTY: 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
• Because of the member’s utilization of covered services
• Because of diminished mental capacity or 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)
• Because the member attempts to exercise, or is exercising, his or her appeal or grievance rights

We may, however, submit a written request, accompanied by supporting documentation, to the department and CMS 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.

Please note that Humana Dual Integrated (HMO-DSNP) may terminate or not renew our contract or reduce our service areas. We will notify members of any changes to our contract or service area at least 30 days in advance of the change.

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.

If you believe that Humana has treated you unfairly, you can call the MI Ombudsman Program at 1-888-746-6456 (TTY: 711),  Monday - Friday, 8 a.m. - 5 p.m.  The MI Health Link Ombudsman is an independent program and the services are free.

Visit our Grievance and appeals webpage for more information about how to file a complaint.