DISENROLLMENT DONE RIGHT

Failure to follow the proper disenrollment procedures for Medicare Part C and D can cause beneficiaries an array of problems. Elderly benefit specialists are often left to pick up the pieces after these improper disenrollments. This article is designed to provide you [benefit specialists] with information on proper voluntary disenrollment procedures so you can help clients understand their disenrollment problems or avoid them in the first place.

The most common disenrollment problem involves a beneficiary who has attempted to disenroll from his or her Medicare Advantage (MA) or Prescription Drug Plan (PDP) by calling the MA plan or PDP. This is not a proper way to disenroll from either an MA or PDP. The following methods are the only proper ways to disenroll from an MA plan or PDP. Of course, in order to properly disenroll, a beneficiary must also be in a valid enrollment/ disenrollment period (i.e. AEP, OEP, or SEP).

1) A member may disenroll by enrolling in another plan.

2) A member may disenroll by giving or faxing a signed written notice to the plan, or through their employer/union group if applicable.

3

) A member may disenroll by

submitting a disenrollment request via the Internet if the plan offers this option. Plans are not required to offer this option.

4) A member may disenroll by calling 1-800-MEDICARE.

If a person does call the MA plan or PDP to disenroll, the plan must instruct the person on how to make the request via one of the approved methods listed above. The plan may send a disenrollment form to the member upon request, but is not required to do so.

If the plan representative says the person can disenroll by phone, the beneficiary should still choose another method to avoid problems.

If the person chooses to disenroll in writing, the disenrollment request will be dated when it is received by the plan.

If a person calls the plan first to request a disenrollment form, the date the person called will not be considered the person’s disenrollment date.

What is the best method of disenrollment?

The answer will depend on the person’s situation. Factors such as what type of enrollment period the person is in, when the disenrollment request is being made, and what the person plans to do for coverage after disenrollment should be considered. The closer the person is to the end of an enrollment/ disenrollment period, the more important it will be to choose a method such as calling 1-800-MEDICARE, disenrolling via the Internet, or faxing a disenrollment request. Remember, plans are not required to accept disenrollment via the Internet.

If the plan isn’t recognizing a Special Enrollment Period (SEP), disenrolling via 1-800-MEDICARE is the better choice. Knowing the type of disenrollment methods available to you as a beneficiary early on can be helpful in planning an effective disenrollment when the time comes.

Beneficiaries should always document a disenrollment request carefully. If the person is disenrolling by enrolling in another plan, he or she should keep a copy of all enrollment documents and/or contacts with the new plan. If disenrolling in writing or via the Internet, always keep a copy of the request, confirmation that it was mailed, faxed, or submitted online, and any subsequent plan contacts. If disenrolling by calling 1-800-MEDICARE, keep good notes of all contact with Medicare including dates, times, names, confirmation numbers, etc.

If a client comes to you with a disenrollment problem, you will need to figure out what exactly has happened. How did the person disenroll? When did he or she disenroll? What type of disenrollment confirmation does the person have? What is the current problem? Is the current problem due to an actual problem with the disenrollment or is it just a problem in the person’s records?

Asking these types of questions will help you, and your supervising attorney, figure out how to proceed. Including some helpful guidance on the proper ways to disenroll from an MA plan or PDP will hopefully help your clients avoid future problems.

If you have any additional questions, you may call Pat Hafermann, elderly benefits specialist with the Aging and Disability Resource Center, at (920) 459- 4389.

Resource: “The Specialist” May 2009