Enrollment and Disenrollment in Medicare Advantage plans
Enrollment
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. If you develop end-stage renal disease while enrolled in an MA plan, the plan cannot disenroll you.
If you want to join a MA plan, you must:
- reside in the plan’s service area and
- enroll during an applicable enrollment period (see below).
Submit your application directly to the plan or a plan sales representative. Enrollment is usually effective on the first of the month following the month you submitted your enrollment application. You cannot receive coverage for medical care by the MA plan providers until enrollment takes effect. In general, you should not drop your existing coverage until your coverage with your preferred MA plan is in effect.
You are only allowed to enroll into and disenroll from MA plans during certain times of the year, including:
- the Annual Election Period (from November 15th through December 31st each year); and
- the Open Enrollment Period (from January 1st through March 31st each year). Note: During this OEP, you can not drop or add Part D coverage. If you are in an MA plan with Part D coverage (MA-PD), you can either switch to another MA-PD or to Original Medicare and enroll into a stand-alone prescription drug plan (PDP). If you are in an MA only plan without Part D coverage, you can either join another MA only plan or switch to Original Medicare with no PDP.
There are exceptions to these 2 periods if you are new to Medicare. For example: you may be eligible to enroll in a Medicare Advantage plan if you just turned 65, or your COBRA coverage ended, or you are younger than 65 but are now eligible for Medicare Part A and B due to a disability, or you or your spouse’s health coverage ended. You also have Special Enrollment Periods that may apply. For example, you may be able to change plans mid-year if you move out of the service area or if you are on Medicare and Medi-Cal.
Disenrollment
If you want to get out of an MA plan, and you don’t want to join another Medicare Advantage plan, you must send a written request to the plan or call 1-800-MEDICARE during the allowable enrollment periods mentioned above. Your disenrollment generally will be effective the first of the month following the month in which you made your request to disenroll. Medicare will not pay if you use providers and services outside of the MA plan’s network until the effective date of your disenrollment.
Remember that Medicare pays MA plans for your care at the beginning of each month. If you require medical care prior to the end of the month in which you requested disenrollment from your MA plan, you must seek treatment from this same MA plan, or you will be responsible for paying for out-of-network services.
If you want to switch from one Medicare Advantage plan to another, simply submit an enrollment application to the new plan and you will automatically be disenrolled from your current plan. Remember that, in general, you can only make these changes during the Annual Election Period and the Open Enrollment period.
Note: This way of disenrolling also applies to Part D 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.
In general you can only make plan changes involving drug coverage during Part D’s Annual Election Period (between November 15th and December 31st of each year) with coverage beginning January 1st of the next year.
For more information, see our sections on Prescription Drugs.
Page updated October 6, 2008
