Leaving an Aetna Medicare Plan
Leaving a plan
Stay informed about the reasons why your Aetna Medicare coverage could be terminated or why you might be disenrolled. Moving out of the service area, not paying your plan premium, and enrolling in another plan are just a few of the reasons. Choose from the topics below and read on to learn how your benefits would be affected.
- Potential for Coverage Termination
- Potential for Aetna Medicare Contract Termination
- Rights and Responsibilities upon Disenrollment
- Medicare Advantage Disenrollment Period
Potential for Coverage Termination
Your coverage may be terminated for nonpayment of plan premiums (including the applicable plan premium for any Optional Supplemental Benefits you may have chosen). Prior to disenrolling you, Aetna will advise you that failure to pay these premiums within a 3-month grace period will result in disenrollment from the Aetna Medicare plan you are enrolled in, and you would return to Original Medicare. Aetna may require you to pay any past-due premium amounts.
Coverage may also end for other reasons, including but not limited to:
- Terminating employment or losing your group membership (for group members only).
- Permanently moving out of Aetna's service area.
- Fraud or material misrepresentation in enrollment or in the use of services or facilities.
See your plan documents for a complete list of termination of coverage provisions.
Potential for Aetna Medicare Contract Termination
Aetna Medicare has a contract with the Centers for Medicare and Medicaid Services (CMS), the government agency that runs Medicare. This contract may be renewed each year. However, our plan or CMS can decide to end the contract at any time. You will generally be notified in writing 90 days in advance if this situation occurs. However, your advance notice may be as little as 30 days, or even fewer days if CMS must end our contract in the middle of the year.
If Aetna Medicare's contract with CMS ends:
- The benefits and rules described in your Evidence of Coverage will continue until your membership ends.
- You would go back to Original Medicare.
- You will qualify for a special election period so you can enroll in another Medicare plan to continue your coverage.
See your plan documents for a complete list of termination of coverage and disenrollment provisions.
Rights and Responsibilities upon Disenrollment
"Disenrollment" from an Aetna Medicare plan means ending your membership with us. Disenrollment can be voluntary (your choice) or, in limited circumstances, involuntary (not your choice).
- You might leave one of our plans because you decide that you want to leave. During specified times (October 15 – December 7), you can choose to disenroll from your current Medicare plan.
- Some situations require you to leave. For example, if you move out of our geographic service area, are absent from our service area for more than six consecutive months or if we no longer offer the plan in your geographic area. You could then go back to Original Medicare or, if you qualify for a Special Election Period, choose a new plan.
Usually, to end your membership in our plan, you simply enroll in another health plan during one of the election periods. One exception is when you want to switch from our plan to Original Medicare without a Medicare prescription drug plan. In this situation, you must contact Aetna Member Services and ask to be disenrolled from our plan.
If you have questions about ending your membership with us, call 1-800-529-5586 (TTY/TDD 1-888-760-4748), Monday – Sunday, 8 a.m. – 8 p.m.
Medicare Advantage Disenrollment Period
Medicare Advantage plan enrollees are provided with an opportunity to prospectively disenroll from their Medicare Advantage (MA) plan and return to Original Medicare between January 1 and February 14 of every year. If you choose to use this disenrollment period, your effective date of disenrollment will be the first of the month following receipt of the disenrollment request. A request made in January will be effective February 1, and a request made in February will be effective March 1. The MAPD disenrollment period does not provide an opportunity to join or switch MA plans.
Regardless of whether your Medicare Advantage plan included Part D drug coverage, as a Medicare Advantage plan enrollee you can disenroll from January 1 through February 14 (the Medicare Advantage Disenrollment Period (MADP)). You can then use the coordinating Part D Special Election Period (SEP) to enroll in a standalone Medicare Prescription Drug Plan (PDP). You may use this SEP to:
- request enrollment in a PDP after requesting disenrollment from your current Medicare Advantage plan during the MADP, or
- you may simply request enrollment in the PDP, which will automatically disenroll you from your existing Medicare Advantage plan.
Individuals enrolled in MA-only PFFS plans must request disenrollment from their MA-only plan in order to be eligible for this Part D SEP, as enrollment in a PDP will not result in automatic disenrollment from the MA-only plan.
Your coverage under Original Medicare resumes on the effective date of your disenrollment from your Aetna Medicare plan.