In a MA-part D plan, when will a member be disenrolled from their MA-PD?

In a Medicare Advantage Plan that includes prescription drug coverage, also known as MA-PD, a member may be disenrolled when they enroll in a stand-alone Prescription Drug Plan (PDP). This occurs as a result of Medicare's regulation that requires beneficiaries to be enrolled in either a Medicare Advantage plan with drug coverage or a stand-alone PDP, but not both simultaneously. Enrolling in a stand-alone PDP means that the member has opted to receive their drug coverage separately, thus automatically disqualifying them from participating in the MA-PD plan since they cannot be enrolled in two plans that offer drug coverage at the same time.

The other options do not necessarily lead to disenrollment from an MA-PD plan. For instance, non-PFFS MA-only plans, separate MA-only plans, and dual eligible plans can all coexist with the MA-PD plan under certain circumstances. These arrangements often focus on different aspects of coverage or specific eligibility criteria but do not trigger the same automatic disenrollment condition associated with enrolling in a stand-alone PDP.