Under what circumstance must a Medicare Advantage organization disenroll a member from an MA plan?

A Medicare Advantage organization must disenroll a member from an MA plan if the member loses entitlement to either Medicare Part A or B. This is a critical regulatory requirement because eligibility for Medicare Advantage relies on being enrolled in both Parts A and B of Medicare. If a member no longer has entitlement to these parts—for example, due to loss of citizenship, aging out of specific eligibility criteria, or other qualifying changes—then legally, they cannot remain enrolled in a Medicare Advantage plan.

When a member voluntarily chooses to leave or relocates to a different area, they may have options for disenrollment, but these are not mandatory circumstances for the organization to remove them. Additionally, if a member has not utilized any services, this does not affect their eligibility or the organization’s obligation to keep them enrolled in a plan if they still meet the basic criteria. Thus, the answer correctly identifies a specific situation that triggers a mandatory disenrollment process by the Medicare Advantage organization, emphasizing the importance of continued eligibility in relation to Parts A and B of Medicare.