If you wish to disenroll from the plan, you may do so by mailing or faxingMeridian Advantage Plan
a signed written notice expressing your intent to disenroll (you may use the disenrollment form provided below to serve as your written notice). Additionally, if you enroll in another Medicare Advantage or Medicare Prescription Drug Plan, Medicare will cancel your current membership inMeridian Advantage Plan
on the effective date of your new enrollment.
There are limited times during the year in which individuals are able to disenroll and/or join other Medicare Advantage or Medicare prescription drug plans, unless you qualify for special circumstances, known as Special Enrollment Periods.
Meridian Advantage Plan
will notify you of your disenrollment effective date after we receive approval of your disenrollment from the Centers for Medicare & Medicaid Services (CMS). You must continue to get all medical care fromMeridian Advantage Plan
until the effective date of disenrollment. You can contact us at the phone number provided below to verify your disenrollment before you seek medical services outside of theMeridian Advantage Plan
If you disenroll fromMeridian Advantage Plan
you will be disenrolling from your Medicare Advantage and your Medicare prescription drug coverage If you do not enroll in another Medicare prescription drug plan or Medicare Advantage plan with prescription drug coverage, or have other coverage as good as Medicare, you may have to pay a penalty for this coverage in the future.
If you have questions about your disenrollment, or if you would like more information about your rights and responsibilities upon disenrollment, please contact Member Services at877-902-6784 (TTY 711), Monday - Sunday from 8 a.m. - 8 p.m.
Meridian Advantage Plan of Michigan is a HMO SNP with a Medicare Contract and a Contract with the State Medicaid Program. Enrollment in Meridian Advantage Plan of Michigan depends on contract renewal.
This plan is available to anyone who has both Medicare and receives full Medicaid assistance from the State.
Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
Premium, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
You must continue to pay your Medicare Part B premium. Meridian Advantage Plan of Michigan
members who are full-dual enrollees (enrolled with both Medicare and Medicaid) may have their Part B premiums paid for by a Medicare Savings Program offered through Medicaid.
The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
For certain kinds of drugs, you can use the plan’s network mail-order services. We also have an optional automatic mail-order delivery program under which we will automatically fill all new prescriptions your health care provider sends to us, as well as refills for prescriptions that have already been filled but are running out. Usually a mail-order pharmacy order will get to you in no more than 5 days. If you experience any problems receiving your mail order prescription, call Member Services at877-902-6784 (TTY users should call 711)
Medicare beneficiaries may also enroll in Meridian Advantage Plan of Michigan through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.
Page Last Modified: 10/9/2015 8:51:21 AM