What will cause a member to be disenrolled from their stand-alone PDP?

A member will be disenrolled from their stand-alone Prescription Drug Plan (PDP) primarily due to enrollment in a non-Prescription Drug Plan (non-PDP) Medicare Advantage (MA) plan. This is because the rules governing Medicare enrollment stipulate that an individual cannot simultaneously be enrolled in two separate Medicare plans that provide similar benefits.

When a member enrolls in a non-PFFS (non-Private Fee-for-Service) MA-only plan, that plan typically includes drug coverage, which replaces the need for the stand-alone PDP. Thus, enrollment in the MA plan leads to automatic disenrollment from the stand-alone PDP to avoid duplicating coverage.

While expiration of the current plan, failure to make the required payment, and moving out of state can lead to disenrollment under certain circumstances, they are not as straightforwardly tied to the enrollment in another plan like the non-PFFS MA plan is. Expiration may occur at the end of the plan year, and non-payment could lead to a lapse in coverage, but these situations are contingent upon specific actions or deadlines. Moving out of state usually requires the member to reevaluate their coverage options but doesn’t automatically result in disenrollment.