Medicare Advantage (MA) plan members have an annual opportunity to disenroll from any MA plan and return to Original Medicare between January 1and February 14 of every year. Guide to medicare advantage plans.
The effective date of a disenrollment request made using the MADP will be the first of the month following receipt of the disenrollment request. Example: a request made in January will be effective February 1, and a request made in February will be effective March 1.
The MADP does not provide an opportunity to join or switch MA plans.
Regardless of whether the MA plan included Part D drug coverage, MA members using the MADP to disenroll from MA from January 1 through February 14 are eligible for a coordinating Part D Special Election Period (SEP) to enroll in a Prescription Drug Plan (PDP) and may request enrollment in a PDP during the same time frame. A consumer may use this SEP to request enrollment in a PDP subsequent to having submitted a disenrollment request from the MA plan during the MADP or may simply request enrollment in the PDP, resulting in automatic disenrollment from the MA plan. Medigap Insurance.
Consumers enrolled in MA-only PFFS plans must request disenrollment from the MA-only plan in order to be eligible for this SEP, as enrollment in a PDP will not result in automatic disenrollment from the MA-only plan.
Required Involuntary Disenrollment
The Medicare Advantage (MA) organization must disenroll a member from an MA plan in the following cases:
1. A change in residence (includes incarceration) makes the individual ineligible to remain enrolled in the plan.
2. The member loses entitlement to either Medicare Part A or Part B.
3. The Special Needs Plan (SNP) member loses special needs status and does not reestablish SNP eligibility prior to the expiration of the period of deemed continued eligibility.
4. The member dies.
5. The MA organization contract is terminated, or the MA organization reduces its service area to exclude the member.
Optional Involuntary Disenrollment
An MA organization may disenroll a member from an MA plan it offers if:
1. Premiums are not paid on a timely basis.
2. The member engages in disruptive behavior.
3. The member provides fraudulent information on an enrollment request.
4. The member permits abuse of an enrollment card in the MA plan.
In situations where the MA organization disenrolls the member involuntarily for any of the reasons addressed above, the MA organization must send notice of the upcoming disenrollment that meets the following requirements:
Advises the member that the MA organization is planning to disenroll the member and why such action is occurring.
Provides the effective date of termination.
Includes an explanation of the member’s right to a hearing under the MA organization’s Grievance procedures.
Notices must be mailed to the member before submission of the disenrollment transaction to CMS.