Disenrollment Rights

Disenrollment from Senior Whole Health means ending your membership in Senior Whole Health.

Ending your membership in our plan may be voluntary (your own choice) or involuntary (not your own choice):
  • You might leave Senior Whole Health because you have decided that you want to leave. You can do this for any reason.
  • There are also a few situations where you would be required to leave. For example, you would have to leave Senior Whole Health if you move permanently out of our geographic service area or if Senior Whole Health leaves the Medicare program. Also, you may leave Senior Whole Health if you become ineligible for MassHealth Standard (Medicaid).
  • We are not allowed to ask you to leave the plan because of your health.
Whether leaving the plan is your choice or not, this section explains your coverage choices after you leave and the rules that apply.

Voluntarily ending your membership

Most people can end their membership only during certain times of the year. However, because you get assistance from Medicaid, you can end your membership in Senior Whole Health at any time. Your membership will usually end on the last day of the month after we receive your request to change your plans. Your enrollment in your new plan will also begin on this day.

Usually, to end your membership in our plan, you simply enroll in another Medicare plan. However, if you want to switch from our plan to Original Medicare but you have not selected a separate Medicare prescription drug plan, you must ask to be disenrolled from our plan. There are two ways you can ask to be disenrolled:
  • You can make a request in writing to us. Contact Member Services at 1-888-794-7268 (TTY/TDD users please call 711) if you need more information on how to do this.


  •  You can contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
If you leave Senior Whole Health, it may take some time for your membership to end and your new way of getting Medicare and MassHealth to take effect. While you are waiting for your membership to end, you are still a member and must continue to get your care as usual through Senior Whole Health.

If you receive services from doctors or other medical providers who are not plan providers before your membership with Senior Whole Health ends, neither we nor the Medicare program will pay for these services, with just a few exceptions. The exceptions are urgently needed care, care for a medical emergency, and care that has been approved by us. There is another possible exception; if you happen to be hospitalized on the day your membership ends your hospital stay will usually be covered by our plan until you are discharged. If you have any questions about leaving Senior Whole Health, please call us at Member Services.

We cannot ask you to leave your health plan for any health-related reasons. If you ever feel that you are being encouraged or asked to leave Senior Whole Health because of your health, you should call 1-800-MEDICARE (1-800-633-4227), which is the national Medicare help line. TTY users should call 1-877-486-2048. You may call 24-hours-a-day, 7-days-a-week.

Involuntarily ending your membership

Senior Whole Health must end your membership in the plan if any of the following happen:
  • If you do not stay continuously enrolled in Medicare Part A and Part B.
  • If you are no longer eligible for MassHealth Standard (Medicaid). We will send you a letter if you lose your MassHealth Standard (Medicaid) or other special eligibility requirements.
  • 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 area.
  • If you become incarcerated (go to prison).
  • If you lie about or withhold information about other insurance you have that provides prescription drug coverage.
  • If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
  • 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. (We cannot make you leave our plan for this reason unless we get permission from Medicare and MassHealth (Medicaid) first.)
  • If you let someone else use your membership card to get medical care. (We cannot make you leave our plan for this reason unless we get permission from Medicare and MassHealth (Medicaid) first.)
  • If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.
  • If you are required to pay the extra Part D amount because of your income and you do not pay it, Medicare will disenroll you from 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. Please call Member Services for more information: We are open from 8 A.M. to 8 P.M., seven (7) days a week. Interpreter services are available upon request.

1-888-794-7268 Toll free


Last Updated 10/11/2019