TN 6 (10-07)

HI 00208.071 Disenrollment from Medicare Advantage (MA) and 1876 Cost Plans Through Social Security Field Offices

A. Background

From 1987 through November 14, 2005, Medicare beneficiaries enrolled in managed care plans were able to disenroll from those plans at Social Security field offices (FOs). The Sixth Omnibus Budget Reconciliation Act passed in 1986 included this provision to allow Medicare beneficiaries the opportunity to go to a “neutral” third party to disenroll from Managed Care Plans. Beneficiaries could also disenroll directly from the plans during that timeframe. (Refer to HI 00208.069B.)

Beginning November 15, 2005, these disenrollments are handled by 1-800-MEDICARE, not SSA. In addition, 1-800-MEDICARE is able to accept enrollment requests for Medicare prescription drug plans and Medicare Advantage plans offering Medicare prescription drug coverage. Individuals may submit enrollment requests through the new CMS Online Enrollment Center as well. In addition, 1-800-MEDICARE (TTY 1-877-486-2048) serves as a centralized resource to provide individuals information on Medicare health plan options, based on the needs of the beneficiary.

Beginning November 15, 2005, SSA representatives cannot input or transmit Medicare managed care disenrollment requests into the SSA system, i.e. via the Post Entitlement System (POS) and TC 24015.040.

B. Policy — disenrollment from MA and 1876 cost plans

Beneficiaries enrolled in Medicare health plans may not disenroll at a Social Security FO.

C. Procedures — general

Beneficiaries seeking disenrollment must contact 1-800-MEDICARE (TTY 1-877-486-2048), or their plans directly, as follows:

  • Beneficiaries enrolled in MA plans (HMOs, PPOs, PFFS, PSOs, RFBs) may contact 1-800-MEDICARE or their plan directly

  • Beneficiaries enrolled in 1876 Cost Plans or MA MSA plans must disenroll directly with their plan; they may not request disenrollment via 1-800-MEDICARE

D. FO procedures

FO representatives should direct ALL beneficiaries requesting disenrollment – including telephone, mail and walk-in - to call Medicare directly at 1-800-MEDICARE (1-800-633-4227; TTY users should call 1-877-486-2048) to request disenrollment.

FOs may assist walk-in requests in SSA office by calling 1-800-MEDICARE in office. It is important that the beneficiary understands that he/she does not have to make the call at the SSA field office; rather, beneficiaries may call 1-800-MEDICARE on their own.

FOs ceased mailings and distribution of the CMS-566 form effective November 15, 2005).

FOs will forward to the appropriate CMS regional contacts all disenrollment requests received through the mail, including previously distributed CMS-566 forms. See HI 00208.073A for the CMS RO address.

E. What the beneficiary will need to process the disenrollment request via 1-800-Medicare

FOs can advise beneficiaries they will need to have the following information on hand to process the disenrollment:

  • Full Name

  • Medicare # from the red, white and blue card

  • Date of Birth

For the protection of their identity, beneficiaries will need to provide one additional piece of information such as:

  • Phone# (if beneficiary called 1-800-MEDICARE previously)

  • SSN

  • Address

  • City, State, Zip

  • Part A/Part B Coverage (Yes/No)

  • Part A/Part B Effective Date

F. Instructions for calling 1-800-Medicare

Beneficiaries should:

  1. Dial 1-800-MEDICARE; TTY users should call 1-877-486-2048.

  2. Select English or Spanish.

  3. Wait for the introduction to finish and say (i.e. speak aloud) “Agent.”

  4. When an agent answers, state that you wish to Disenroll from a Medicare Health Plan.

  5. The agent will transfer you to a disenrollment customer service representative (CSR).

  6. The CSR will ask a few questions (e.g. Name, Medicare #, Date of Birth, etc.) as previously described to verify identity.

    NOTE: If the individual does not have this information at the time of the call, the individual will be asked to call back when he/she has this information available.

  7. After this information is provided, the CSR will verify the plan you are currently enrolled in (and would like disenrollment from).