42 CFR 422.50 - Eligibility to elect an MA plan.
(a) An individual is eligible to elect an MA plan if he or she meets all of the following:;
(1) Is entitled to Medicare under Part A and enrolled in Part B (except that an individual entitled only to Part B and who was enrolled in an HMO or CMP with a risk contract under part 417 of this chapter on December 31, 1998 may continue to be enrolled in the MA organization as an MA plan enrollee).
(2) Has not been medically determined to have end-stage renal disease, except that -
(ii) An individual with end-stage renal disease whose enrollment in an MA plan was terminated or discontinued after December 31, 1998, because CMS or the MA organization terminated the MA organization's contract for the plan or discontinued the plan in the area in which the individual resides, is eligible to elect another MA plan. If the plan so elected is later terminated or discontinued in the area in which the individual resides, he or she may elect another MA plan; and
(3) Meets either of the following residency requirements:
(ii) Resides outside of the service area of the MA plan and is enrolled in a health plan offered by the MA organization during the month immediately preceding the month in which the individual is entitled to both Medicare Part A and Part B, provided that an MA organization chooses to offer this option and that CMS determines that all applicable MA access requirements of § 422.112 are met for that individual through the MA plan's established provider network. The MA organization must furnish the same benefits to these enrollees as to enrollees who reside in the service area;
(4) Has been a member of an Employer Group Health Plan (EGHP) that includes the elected MA plan, even if the individual lives outside of the MA plan service area, provided that an MA organization chooses to offer this option and that CMS determines that all applicable MA access requirements at § 422.112 are met for that individual through the MA plan's established provider network. The MA organization must furnish the same benefits to all enrollees, regardless of whether they reside in the service area.
(6) Agrees to abide by the rules of the MA organization after they are disclosed to him or her in connection with the election process.
- 42 CFR 422.66 — Coordination of Enrollment and Disenrollment Through MA Organizations.
- 42 CFR 422.74 — Disenrollment by the MA Organization.
- 42 CFR 422.110 — Discrimination Against Beneficiaries Prohibited.
- 42 CFR 422.53 — Eligibility to Elect an MA Plan for Senior Housing Facility Residents.
- 42 CFR 422.111 — Disclosure Requirements.
- 42 CFR 422.2 — Definitions.
- 42 CFR 422.52 — Eligibility to Elect an MA Plan for Special Needs Individuals.