Enrollment & Disenrollment in Medicare Advantage Plans

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Enrollment

If you want to join a Medicare Advantage (MA) plan, you must have Medicare Parts A and B. Your Part B premium will continue to be taken out of your Social Security or Railroad Retirement benefits check, unless you are enrolled in a Medicare Savings Program (MSP) or have full Medi-Cal (see our section on Low-Income Help).

You cannot be denied enrollment in an MA plan due to a pre-existing condition, unless you have end-stage renal disease (ESRD) — permanent kidney failure (contact your local Health Insurance Counseling and Advocacy Program (HICAP) for more information). If you develop ESRD while enrolled in an MA plan, the plan cannot disenroll you.

If you want to join an MA plan, you must reside in the plan's service area and the plan you choose must be accepting new members.

You can only join MA plans during certain periods:

To enroll, submit your application directly to the plan via the plan’s website or a plan sales representative. You can also call 1-800-MEDICARE or enroll on the Medicare website at Medicare.gov. The date your coverage starts depends on the period in which you enroll.

Remember not to drop your existing coverage, if any, until your coverage with your MA plan has started.

In addition, there are Special Election Periods (SEPs) during which you may be able to enroll in or disenroll from your MA plan, depending on your situation. For example, if you move out of your plan’s service area, you have a Special Election Period (of up to 3 months) to disenroll from your plan and join a plan available in your new location. See Special Election Periods (SEPs).

For enrollment information on other parts of Medicare, see:

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Disenrollment

As enrollment in an MA plan is limited to certain periods, disenrollment is also limited to certain periods:

During the Annual Election Period (AEP) or in a Special Election Period (SEP), if you want to leave your MA plan and don't want to join another MA plan, you must send a written request to the plan or call 1-800-MEDICARE during the enrollment period.  

If you want to switch from one MA plan to another, simply submit an enrollment application to the new plan and once you are accepted, you will be automatically disenrolled from your current plan. Again, in general, you can only make changes such as this during the AEP or an SEP.

Note: This method of disenrollment also applies to Part D prescription drug coverage. For example, if you are in an MA plan with Part D coverage (MA-PD) and wish to switch to a stand-alone prescription drug plan (PDP), enrolling in a PDP automatically disenrolls you from your previous MA-PD plan, and vice versa.

Medicare Advantage Disenrollment Period (MADP)

The Medicare Advantage Disenrollment Period allows you to leave a Medicare Advantage plan and return to Original Medicare; you cannot join or switch MA plans. This period is from January 1 – February 14 of each year.

If you want to disenroll from an MA plan without drug coverage (MA-only plan) or an MA plan with Part D coverage (MA-PD) and return to Medicare during this time, you have a special election period (SEP) to join a Part D prescription drug plan.

  • If you're in an MA-PD, you can either submit a disenrollment request to your MA-PD plan and then enroll in a Part D plan, or simply enroll in a Part D plan, which automatically disenrolls you from your MA-PD.
  • If you're in an MA only plan, you must first request disenrollment from your MA plan to trigger your SEP to join a Part D plan.

If you use your SEP to enroll in a stand-alone Part D plan, your SEP ends as soon as you enroll into a Part D plan. Your new Part D plan becomes effective the first day of the following month.

Effective Date of DisenrollmentThe effective date of your MA plan disenrollment depends on when you make your request.

Example 1: If you disenroll during the Annual Election Period, the change will be effective the following January 1.

Example 2: If you disenroll during an SEP or the Medicare Advantage Disenrollment Period (MADP), (January 1 –February 14), the change will be effective the first day of the following month.

Remember, if you are disenrolling from an HMO or SNP plan during any of the disenrollment periods, you must continue to use providers and services in the plan’s network until the date your disenrollment becomes effective. Otherwise, the plan will not pay and Medicare will not pay, because HMOs and SNPs require you to use providers in your plan’s network.

Similarly, if you are disenrolling from a PFFS plan before the effective disenrollment date, you must see providers who accept the plan’s payment terms and conditions.

See also:

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Updated Nov 4, 2013

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