When is it permissible for a Medicare Advantage organization to disenroll a member?

A Medicare Advantage organization can disenroll a member when that member loses their entitlement to Medicare Part A or B because eligibility for Medicare Advantage plans is contingent upon maintaining enrollment in Original Medicare. If a member is no longer entitled to either Part A or Part B, they do not meet the necessary criteria to remain in the Medicare Advantage plan, which is designed to provide supplemental benefits in conjunction with Original Medicare coverage.

Maintaining eligibility for Medicare Parts A and B is a fundamental requirement, as Medicare Advantage plans are essentially a way for members to receive their Medicare benefits through private insurers. Hence, if their entitlement ceases, they must be disenrolled.

The other options provided do not align with the criteria for disenrollment. Changes in coverage plans, failing to report address changes, and moving out of the county may result in changes to coverage or choices available to the member, but they do not automatically authorize disenrollment from the Medicare Advantage plan.