Rapid disenrollment checker

The rule

When a client makes any plan change within the first three months of enrollment, the plan must recover the entire compensation paid for that enrollment (42 CFR 422.2274(d)(5)). It does not apply in some cases, including:

• Enrollment effective October 1, November 1 or December 1, then a change during the Open Enrollment Period effective January 1
• Moving into or out of an institution, or out of the service area
• Gaining or losing employer or union coverage, or other creditable coverage
• Becoming eligible for Extra Help or for both Medicare and Medicaid
• Plan termination, non-renewal or a CMS sanction
• Moving into a 5-star plan, death, or non-payment of premium

See the regulation for the full list. Each carrier applies the rule and makes the final decision.