When must a Medicare Advantage Plan or stand-alone PDP disenroll a member?

A Medicare Advantage Plan or stand-alone Prescription Drug Plan (PDP) must disenroll a member when the eligibility requirements are no longer met. This is crucial because these plans are designed for individuals who qualify based on specific criteria such as age, residency, and enrollment in Medicare Part A and B. If a member no longer meets these eligibility conditions—perhaps due to moving out of the service area or losing Medicare eligibility—the plan has an obligation to disenroll them.

The other options do not reflect necessary conditions for disenrollment. A member’s request for disenrollment is a voluntary action, allowing them to leave the plan at their discretion. While plan changes may lead a member to choose to disenroll, they do not obligate the plan to do so. Lastly, a member having a medical emergency does not automatically trigger disenrollment; in fact, plans are required to provide coverage in emergencies regardless of the member's status, until the situation is resolved.