TN 6 (10-07)
HI 00208.069 Disenrollment From A Medicare Advantage or 1876 Cost Plan
A. Policy — when a request for disenrollment may be filed
1. Specific periods for disenrollment
Beneficiaries may disenroll from an MA plan only during the following election periods:
Refer to HI 00208.067B for a description of election periods.
Members of 1876 cost plans may disenroll at any time during the year.
2. Special rules for MA MSA plans
Disenrollment from an MA MSA plan may only occur during the Annual Election Period or during a Special Election Period that may apply.
B. Policy — disenrollment request
Individuals enrolled in an MA plan may disenroll by:
Giving or faxing a signed written notice to the MA organization, or through their employer, where applicable;
Submitting a request via the Internet to the MA organization (if the MA organization offers such an option); or
Calling 1-800-MEDICARE (TTY 1-877-486-2048).
A request for disenrollment from an 1876 cost plan must:
be made in writing,
be signed by the beneficiary or representative,
be in the form required by the organization or CMS, and
be filed with the organization.
NOTE: SSA does not accept disenrollment requests for Medicare Advantage or 1876 cost plans (see HI00208.071B).
C. Policy — effective date of disenrollment for MA plans
1. Disenrollment Request Filed During the Open Enrollment Period
A disenrollment request filed during the open enrollment period is effective the first day of the month following the month the election is received by the MA organization. For example, a disenrollment request received on 03/03/07 will be effective 04/01/07. CMS intends “receipt” to mean when the organization comes into the actual possession of the request — NOT the postmark date of the disenrollment request.
2. Disenrollment request filed during annual election period
A disenrollment request filed during the annual election period is effective January 1st of the following year.
3. Disenrollment request filed during special election periods
The effective date of disenrollment requests filed during special election periods is dependent upon the specific circumstances.
D. Policy — effective date of disenrollment in 1876 cost plan
The effective date of disenrollment is generally the first day of the month following the month in which the disenrollment request is received. The beneficiary can select a prospective disenrollment date up to 3 months into the future.
E. Policy — effect date of disenrollment from an MA plan
1. Default to original Medicare
Beneficiaries who disenroll from an MA plan and do not elect another plan are automatically covered by the Original Medicare plan.
2. Automatic disenrollment
CMS has established an automatic disenrollment process for beneficiaries who change plans. A beneficiary who elects another plan is automatically disenrolled from the previous plan in which he/she was a member. When a beneficiary elects a different MA plan, he/she does not have to submit a request to disenroll from the previous plan.
F. Process — notification of disenrollment
1. Notification to CMS
The MA organization must promptly submit a beneficiary’s disenrollment request to CMS.
2. Notification to beneficiary
Organizations must notify beneficiaries as follows:
The 1876 cost organization must furnish the beneficiary with a copy of his /her request for disenrollment.
MA organizations must send the member a written notice acknowledging the request for disenrollment.
MA and 1876 cost organizations are strongly encouraged to send written confirmation of the disenrollment to the beneficiary once the individual is disenrolled.