What happens if a beneficiary enrolled in a MA-only HMO also signs up for a PDP plan?

When a beneficiary enrolled in a Medicare Advantage (MA) plan, specifically a Health Maintenance Organization (HMO), also enrolls in a stand-alone Prescription Drug Plan (PDP), they face a significant consequence. The correct answer indicates that they will automatically be dropped from their MA plan. This is due to the regulations governing Medicare Advantage plans, which require that beneficiaries either have their prescription drug coverage included within the MA plan or not at all.

Medicare Advantage plans typically include coverage that integrates both medical services and prescription drugs. If a beneficiary opts for a separate PDP while already enrolled in an MA plan, this action is seen as a violation of the rules associated with the MA plan. Consequently, the beneficiary will lose their enrollment in the MA plan, losing not just prescription coverage but potentially other services as well unless they take specific steps to adjust their coverage.

This regulatory framework exists to streamline the benefits and prevent confusion that could arise from having multiple coverage sources. Understanding this aspect of Medicare Advantage helps beneficiaries navigate their options more effectively and avoid unintentional gaps in coverage.