Enrollment and Disenrollment
Eligibility Requirements
Eligibility Requirements for Health Alliance Medicare HMO Plans
- Individuals must have both Part A and Part B to enroll, and you must continue to pay your Medicare Part B premiums, if not otherwise paid for under Medicaid or by another third party.
- Individuals with End Stage Renal Disease are generally not eligible to enroll in Health Alliance Medicare unless they are members of our organization and have been since their dialysis began.
- You must live in the Health Alliance Medicare HMO service area.
- If you obtain care from out-of-network plan providers neither Medicare nor Health Alliance Medicare will be responsible for the costs.
Eligibility Requirements for Health Alliance Medicare PPO Plans
- Individuals must have both Part A and Part B to enroll, and you must continue to pay your Medicare Part B premiums, if not otherwise paid for under Medicaid or by another third party.
Individuals with End Stage Renal Disease are generally not eligible to enroll in Health Alliance Medicare unless they are members of our organization and have been since their dialysis began. - You must live in the Health Alliance Medicare PPO service area.
You will not be refused enrollment based on:
- Your age
- Your health status
- Your prior use of or anticipated use of health services
- Any pre-existing medical conditions
Enrollment Procedure
To apply for a Health Alliance Medicare Advantage plan, you must enroll by filling out an enrollment request form.
You can print the enrollment request form and mail it to:
Health Alliance Medical Plans
Attn: Medicare and Individual Services
301 S. Vine St.
Urbana, IL 61801-3347
Medicare beneficiaries may enroll in Health Alliance Medicare plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. Or request more information from Health Alliance Medicare.
You will be notified of your proposed effective date, which will be the first day of the month following the date we receive your enrollment request form, unless you choose a later date.
Enrollment in a Health Alliance Medicare Advantage plan results in your automatic disenrollment from any other Medicare Advantage plan, but does not automatically disenroll you from a Medicare Supplement plan.
Disenrollment
Voluntary Disenrollment
We are confident you will be happy with your Health Alliance Medicare Advantage plan. However, if you should decide to disenroll and return to Original Medicare, you must complete a Health Alliance Medicare disenrollment form. You may also give a signed and dated written disenrollment request to any Social Security or Railroad Retirement Board office (if you are an annuitant).
If you are disenrolling so that you can enroll in another Medicare Advantage plan, your enrollment in that plan will automatically result in disenrollment from your Health Alliance Medicare Advantage plan. Disenrollment is effective on the first day of the month following the month your written request is received. You may disenroll during one of the election periods described below under “Additional Important Information.”
If you choose to enroll in a stand-alone Prescription Drug Plan, a prescription drug plan without medical coverage, you will be automatically disenrolled from your Medicare Advantage plan.
Involuntary Disenrollment
There may be situations where we would end your membership in our plan. Examples include, but are not limited to: if you do not stay continuously enrolled in Medicare A and B or if you would move out of our service area or are away for more than six months, you cannot remain a member of our plan. Please refer to the chapter titled “Ending Your Membership in the Plan” in your Evidence of Coverage for more information.
Health Alliance Medicare cannot ask you to leave our plan because of your health.
Additional Important Information
Health Alliance is a health plan with a Medicare contract. This contract renews each year. At the end of each year, the contact is reviewed and either Health Alliance or CMS can decide to end it. You will get 90 days advance notice in this situation. It is possible for our contract to end at some other time, too. If the contract is going to end, we will generally tell you 90 days in advance. 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 Health Alliance leaves the Medicare program or changes our service area so that it no longer includes the area where a beneficiary lives, we will tell you in writing. If this happens, your membership in Health Alliance Medicare will end, and you will have to change to another way of getting your Medicare benefits.
Health Alliance Medicare pharmacy benefits are only available to members who enroll in a Health Alliance Medicare plan. If you are already enrolled in a Medicare Advantage plan that offers pharmacy benefits, you must get your pharmacy coverage from that plan.
You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help call:
- 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/seven days a week).
- The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call, 1-800-325-0778.
- Your State Medicaid Office.