How to Disenroll from Clover

 

Here you’ll find answers to your questions about your Medicare coverage options after leaving our plan, and any rules that apply.

What is “disenrollment”?

"Disenrollment" from Clover means ending your membership in a Clover Medicare plan. Disenrollment can be voluntary (your own choice) or involuntary (not your choice).

Until your membership ends, you must keep receiving Medicare services through Clover—otherwise, you'll be personally responsible for healthcare payments.

If you request to be disenrolled from Clover, it may take time for your membership to end and your new method for receiving Medicare to begin (we'll discuss timing in more detail below). Before your Clover membership officially ends, you must continue receiving care through Clover.

If you get services from doctors or other medical providers who aren't plan providers before your Clover membership ends, neither Clover nor the Medicare program will pay for these services—with just a few exceptions. These exceptions include: urgently needed care, care for a medical emergency, out-of-area renal (kidney) dialysis services, and any other care we've specifically approved. Another exception is if you happen to be hospitalized on the day your membership ends. If this occurs, call Member Services at 1-888-778-1478 to find out if Clover will cover your hospital care. Also call Member Services if you have any questions at all about the process of disenrolling from Clover.

If I leave Clover, what are my choices for receiving Medicare services going forward?

If you leave Clover, one option for continuing to receive Medicare services is to enroll in a Medicare Advantage plan—if one is available in your area and accepting new members. You also have the option to join Original Medicare, but if you do so and still want prescription coverage, you’ll need to sign up for a separate Part D drug plan as well.

Medicare private fee-for-service plans are also available in some parts of the country. For these plans, you may visit any Medicare-approved doctor or hospital that accepts the plan’s payment. The private fee-for-service plan itself—as opposed to the Medicare program—decides how much it pays and what you pay for services. This may result in you paying more for Medicare-covered benefits. Or you may get extra benefits that Original Medicare doesn't cover, such as Medicare Part D prescription drug benefits. Please know that private fee-for-service plans aren't the same as Medigap (Medicare supplement insurance) policies.

When and how often can I make changes to my Medicare coverage, and what options do I have?

There are federal requirements in place about when and how often you can make changes to your Medicare coverage, as well as what options are available to you. Please refer to the chapter titled 'Ending your membership in the plan' in the Evidence of Coverage to see these rules.

If I want to disenroll from Clover, what actions should I take?

First, confirm the kind of change you'd like to make, and if the timing for this change is permitted by the above rules—otherwise you won’t be able to make a change to your Medicare coverage.

Your next action step for leaving Clover will depend on whether you’re switching to Original Medicare or one of the other options described above.

If I switch from Clover to Original Medicare, do I need to join a prescription drug plan?

Original Medicare doesn't cover many prescription drugs outside the hospital setting. So, if you want to switch from Clover to Original Medicare, you should consider joining a Medicare (Part D) prescription drug plan. To get information about prescription drug plans in your area, call 1-800-MEDICARE (1-800-633-4227), which is the national Medicare helpline. TTY users should call 1-877-486-2048. You can call 24 hours a day, 7 days a week.

If I switch from Clover to Original Medicare, do I need to buy a Medigap (Medicare supplement insurance) policy?

If you want to switch from Clover to Original Medicare, you should consider buying a Medigap policy to supplement your Original Medicare coverage. For Medigap advice, including how and when to buy a policy, contact your State Health Insurance Assistance Program (SHIP). SHIP can also let you know if you've got a guaranteed issue right to buy a Medigap policy.

If you want to buy a Medigap policy, follow the instructions below for shifting from Clover to Original Medicare. Buying a Medigap policy doesn't switch you from Clover to Original Medicare. In fact, while you're still enrolled in Clover, it's against the law for a Medigap insurance company to sell you a policy. A Medigap sales person or insurance agent isn't authorized to cancel your Clover membership and enroll you in Original Medicare.

How do I switch from Clover to Original Medicare?

1. Provide a written request that is dated and signed and mail or fax to:

   Mail: Clover Health
   P.O. Box 21164
   Eagan, MN 55121

   Fax: 1-866-508-0865

2. Next, we'll send you a letter informing you of your exact disenrollment date—the day your Clover membership ends. In most cases, this will be the first day of the month following the month we received your disenrollment request. For example, if we receive your disenrollment request in February, your disenrollment date will be March 1. Remember, while waiting for your Clover membership to end, you're still technically a Clover member and must continue getting your medical care through us.

3. Original Medicare without a separate Medicare prescription drug plan. Send us a written request to disenroll Contact Member Services if you need more information on how to do this. You can also contact Medicare, at 1-800- MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week, and ask to be disenrolled. TTY users should call 1-877-486-2048. You will be disenrolled from Clover Health Choice Value (PPO) when your coverage in Original Medicare begins.

4. On your disenrollment date, your membership in Clover ends and you'll be automatically enrolled in Original Medicare—you don't have to actively enroll in Original Medicare to get coverage. You also won't receive anything in writing confirming your enrollment in Original Medicare. Instead, you can simply start using your red, white, and blue Medicare card to get Medicare services right away. And if you need a new Medicare card, call Social Security at 1-800-772-1213.

How do I switch from Clover to another Medicare Advantage or private fee-for-service plan?

First, contact the plan you’d like to join and confirm they’re currently accepting new members. You should also ask whether the plan provides Medicare Part D drug coverage.

Your new plan will inform you of the date when your new coverage begins, which is your official “disenrollment date” from Clover. Remember: until this date arrives, you’re still technically a Clover member and must continue getting healthcare services through us.

How am I affected if Clover leaves either the Medicare program or the area where I live?

If Clover leaves the Medicare program or is no longer offering services in your area, we’ll alert you to this in writing. Clover is contracted by the government agency that runs Medicare—the Centers for Medicare and Medicaid Services (CMS). Each year, either Clover or CMS can decide to end this contract. If this happens, you’ll receive a 90-day notice of our departure from the Medicare program. However, our contract can also be ended throughout the year and, in cases like these, we’ll try to give you a 90 day notice, but may be forced to give you a 30-days-or-less notice.

On the day we leave Medicare or your service area, your enrollment in Clover officially ends. Remember that until this exact disenrollment date arrives, you must continue receiving healthcare services through Clover.

If we leave Medicare or your area, you’ll immediately be eligible for the Special Enrollment Period, which allows you to either enroll in Original Medicare or a separate Medicare Advantage or private fee-for-service plan—if they’re accepting new members and are available in your area. If enrolling in Original Medicare, consider additionallly enrolling as well in a separate Part D prescription drug plan. And if you choose Original Medicare, you have the right to buy a Medigap policy regardless of your health. This is called a “guaranteed issue right,” and is explained further in Chapter 10 of the Evidence of Coverage.

Can I live outside the Clover service area?

No, you'll be disenrolled from Clover if you permanently move outside our service area or are simply living outside our service area for more than six months at a time

Before moving out of town or leaving for six months or more at a time, call Member Services to see if Clover is available in the new community you’re relocated to or visiting. If you move to an area where our plan isn’t offered, or if you’re living outside our service area for more than 6 months at a time, we're required to end your Clover membership. Above is additional information about your options for acquiring Medicare coverage after your Clover membership ends.

 

Can Clover end my membership?

Under certain conditions, Clover can end your membership in our plan

We reserve the right to end your Clover membership if any of the following scenarios apply to you:

• You move out of our geographic service area or live outside the plan’s service area for more than six months at a time
• You don't stay continuously enrolled in both Medicare Parts A and B
• You give us information on your enrollment form that is false or deliberately misleading for the purposes of enrolling in Clover
• You behave in a disruptive way to the extent that your continued enrollment seriously impairs our ability to arrange or provide medical care for you or other Clover members (disenrolling you from Clover for this reason requires permission from the Centers for Medicare and Medicaid Services, the government agency that runs Medicare)
• You let someone else use your plan membership card to get medical care (if you're disenrolled for this reason, CMS may refer your case to the Inspector General for additional investigation)

Can I be asked to leave the plan because of my health?

No, we can't ask you to leave the plan because of your health

No member of any Medicare health plan can be asked to leave the plan for health-related reasons. If you ever feel you're being encouraged or asked to leave Clover because of your health, call 1-800-MEDICARE (1-800-633-4227), which is the national Medicare help line. TTY users should call 1-877-486-2048. This organization can be reached 24 hours a day, 7 days a week.

Can I make a complaint if I’m asked to leave Clover?

Yes, If we ask you to leave Clover, you have the right to make a complaint

If we ask you to leave Clover, we’ll explain our reasons for doing so in writing. We will also provide instructions to you for filing a complaint about this disenrollment, if you'd like to do so. 

For more information about how to disenroll from Clover, please refer to Chapter 10 of the Evidence of Coverage.

*For email disenrollment, the written disenrollment request with signature or the signed disenrollment request form must be emailed as an attachment