When must an MA Plan or stand-alone PDP disenroll a member?

When must an MA Plan or stand-alone PDP disenroll a member?

• A. When eligibility requirements are no longer met.
• B. At the member’s request only after a full year.
• C. If the member misses a premium payment.
• D. Only during open enrollment periods.

Answer: (A)

Plans must disenroll a member as soon as they no longer meet the eligibility requirements. This means if a person loses Medicare entitlement, moves out of the plan’s service area, or otherwise stops qualifying for the plan, the enrollment must be terminated. The other scenarios described—a member voluntarily requesting disenrollment, actions tied to premium payment, or enrollment-period timing—do not create an automatic mandatory disenrollment in all cases. The essential rule is that eligibility loss triggers disenrollment.

Plans must disenroll a member as soon as they no longer meet the eligibility requirements. This means if a person loses Medicare entitlement, moves out of the plan’s service area, or otherwise stops qualifying for the plan, the enrollment must be terminated. The other scenarios described—a member voluntarily requesting disenrollment, actions tied to premium payment, or enrollment-period timing—do not create an automatic mandatory disenrollment in all cases. The essential rule is that eligibility loss triggers disenrollment.