How you will get Medicaid services
If you leave the Medicare-Medicaid plan, you will remain in our plan to get your Medicaid services. Your Medicaid services include most long-term services and supports and behavioral health care.
If you leave the Medicare-Medicaid plan, you will remain with Cigna-HealthSpring CarePlan to receive your Medicaid services.
You can choose to switch to another Medicaid-only health plan by contacting Maximus at 1 (877) 782-6440, Monday - Friday, 8:00 am - 8:00 pm Central Time. TTY users should call 1 (877) 486-2048. You will get a new member ID card, a new Member Handbook, and a new Provider and Pharmacy Directory.
Until your membership ends, you will keep getting your medical services and drugs through our plan
If you leave Cigna-HealthSpring CarePlan, it may take time before your membership ends and your new Medicare and Medicaid coverage begins. During this time, you will keep getting your health care 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.
Your membership will end in certain situations
These are the cases when Cigna-HealthSpring CarePlan must end your membership in the plan:
- If there is a break in your Medicare Part A and Part B coverage.
- If you no longer qualify for Medicaid. Our plan is for people who qualify for both Medicare and Medicaid.
- If you move out of our service area.
- If you are away from our service area for more than six months.
- If you move or take a long trip, you need to call Member Services to find out if the place you are moving or traveling to is in our plan’s service area.
- If you go to prison.
- If you lie about or withhold information about other insurance you have for prescription drugs.
We can make you leave our plan for the following reasons only if we get permission from Medicare and Medicaid first:
- 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, you should call Medicare at 1-800-MEDICARE (1 (800) 633-4227). TTY users should call 1 (877) 486-2048. You may call 24 hours a day, 7 days a week. You should also call Texas Medicaid at 1 (800) 252-8263 or 211 (TTY users should use 1 (800) 735-2989 or 711).
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.
Where can you get more information about ending your plan membership?
If you have questions or would like more information on when we can end your membership, you can call Member Services at 1 (877) 653-0327 (TTY 711) 8:00 am – 8:00 pm Central time, 7 days a week.