Which of the following scenarios is considered involuntary disenrollment from a Medicare Advantage (MA) plan?

Prepare for the AHIP Fraud, Waste, and Abuse Exam. Study with multiple choice questions, flashcards, hints, and detailed explanations. Boost your confidence and pass your exam!

Involuntary disenrollment from a Medicare Advantage (MA) plan occurs when an enrollee is forced to leave the plan due to circumstances beyond their control. When an enrollee dies, they automatically lose coverage under the plan, as there is no option for enrollment continuation. This scenario is considered involuntary because the enrollee cannot influence or prevent their disenrollment due to death.

In contrast, when an enrollee moves to another state, while it typically requires a change in MA plans, it falls into a gray area that can sometimes be considered voluntary, depending on whether they choose a new plan or have no suitable option available. Voluntary disenrollment also applies when an enrollee actively decides to switch plans or requests to leave, as these actions illustrate a conscious choice made by the individual.

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