E. What the beneficiary will need to process the disenrollment request via 1-800-Medicare

FOs can advise beneficiaries they will need to have the following information on hand to process the disenrollment:

• Full Name

• Medicare # from the red, white and blue card

• Date of Birth

For the protection of their identity, beneficiaries will need to provide one additional piece of information such as:

• Phone# (if beneficiary called 1-800-MEDICARE previously)

• SSN

• Address

• City, State, Zip

• Part A/Part B Coverage (Yes/No)

• Part A/Part B Effective Date