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“Grandfathered” members are individuals who were automatically enrolled in an MA plan (then known as M+C plans) from a cost plan on January 1, 1999. These individuals may not have had Part A or did not reside in the plan’s service area or continuation area, but the MAO cannot disenroll these individuals for those reasons. For more information about continuation areas, see § 20.3.1.

“Grandfathered” members may enroll in other MA plans within the same MAO and state. These individuals are not eligible to enroll in any MA plan outside of their current MAO unless they meet all MA eligibility requirements (including entitlement to and enrollment in Part A). If the individual loses Part B, the plan must disenroll the individual, as described in § 60.2.2.

The MAO must identify all Medicare Part B-only “grandfathered” individuals and inform them of their status annually. This notification may be included as part of the Evidence of Coverage. The notice must inform these individuals that if they disenroll from the MAO, they cannot elect another MA plan unless they also have Medicare Part A and remain enrolled in Medicare Part B.

MAOs may provide Part A-equivalent benefits to Medicare Part B-only grandfathered members. If an MAO offers Part A-equivalent coverage as a supplemental benefit in an MA plan, then the MAO may disenroll a Medicare Part B-only grandfathered member who fails to pay the organization’s Part A-equivalent premiums. For more information on nonpayment of premiums, see § 60.3.1.

NOTE: Part B-only individuals currently enrolled in a cost plan are not “grandfathered” individuals and must get Part A to be eligible to enroll in an MA plan.

20.3 – Place of Permanent Residence 42 CFR §§ 422.2, 422.50, 422.54(b), 422.66(d), 422.74(b)(3)(ii), 422.74(d)(4)(iii), 423.4, 423.30, and 423.38(c)(7)

An individual is eligible to enroll in an MA or Part D plan if they permanently reside in the plan’s service area. Permanent residence is not: • A temporary move into the plan’s service area; • Living abroad; or • Incarceration—incarcerated individuals reside out of the plan service area, even if the correctional facility, institution, or other place of confinement is located within the geographic boundaries of the plan service area.

Generally, the individual’s primary residence establishes proof of permanent residence. There are instances where the individual has multiple residences or has a mailing address that is not the location of their permanent residence. A plan may request additional information that establishes the permanent residence address that is not the mailing address of the individual, such as: • Voter registration records; • Driver’s license records (where such records accurately establish current residence); • Tax records; or • Utility bills.