Which items would be considered involuntary disenrollment from a Medicare Advantage plan? I. The enrollee dies. II. An individual materially misrepresents information to a PDP sponsor regarding reimbursement for third-party coverage. III. It is determined that the member is not lawfully present in the United States. IV. The member enrolls in another plan during the Annual Open Enrollment period.

• A. I, II, and III only
• B. I and II only
• C. II and III and IV
• D. I, II, III and IV

Answer: (A)

Disenrollment can be involuntary when the plan ends coverage due to events outside the member’s control or eligibility issues. If the enrollee dies, the contract ends automatically, so that’s involuntary. If it’s found that the member not only lacks eligibility but is not lawfully present in the United States, the plan must disenroll them—again, involuntary. If a member materially misrepresents information to a PDP sponsor regarding reimbursement for third-party coverage, that misrepresentation jeopardizes eligibility and can lead to involuntary disenrollment by the sponsor.

Enrolling in another plan during the Annual Open Enrollment period is a voluntary decision by the member to switch plans, not an involuntary action by the plan. So the first three items are involuntary, while the fourth is not.