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Post Office Boxes: If an individual puts a post office box as their place of residence on the enrollment form, the enrollment request is considered incomplete, and the plan must take additional steps to determine if the individual physically resides in the plan’s service area. If there is a dispute over where the individual permanently resides, the plan should refer to the law of the individual’s state to determine if the individual is considered a resident of that state.

A post office box, shelter or clinic address, or an address for receiving mail may be considered evidence of a permanent residence in the service area for homeless individuals.

Separate Mailing Address: Some individuals may have a mailing address that differs from their permanent residence address and may not be within the geographic plan service area. If an individual requests that mail be sent to an alternate address, the plan should make every effort to accommodate these requests and should use this alternate address to provide required notices and other plan mailings, as appropriate. Plans must accommodate an individual’s reasonable request to receive confidential communications, either at alternative locations or by alternative means, if the individual clearly states that not doing so could endanger them (See 45 CFR § 164.522(b)). Use of an alternate mailing address does not eliminate or change the requirement of residency for the purposes of plan eligibility, so the plan must still evaluate and make a determination as to residence.

For information regarding procedures for individuals that are auto-enrolled or facilitated-enrolled whose address is outside the plan’s service area, see § 60.2.1.

Conversion of Enrollment into MA: Consistent with § 422.66(d), an MAO must accept individuals who request enrollment during their ICEP and who are enrolled in non-Medicare health coverage offered by the MAO the month immediately preceding the MA plan enrollment effective date.

Individuals converting to Medicare who wish to elect an MA plan offered by the same MAO must meet MA eligibility criteria and may reside in the MAO’s continuation area, provided that an MAO chooses to offer this option and CMS determines that all applicable access requirements outlined in 42 CFR § 422.112 are met.

Enrollee Uses “Visitor/Traveler” Program in MA Plan: Consistent with § 422.74(d)(4)(iii), an enrollee may remain in the MA plan if the MAO offers “visitor” or “traveler” programs for enrollees who are consecutively out of the area for more than six months but less than 12 months, provided the MA plan includes the full range of services available to other enrollees. For more information on the “visitor/traveler” program, see § 60.2.1.