CMS Pub. 100-16, ch. mc86c17d, § 10

Conversions - For individuals who are enrolled in a health plan offered by the managed

care organization the month immediately before the month of their entitlement to

Medicare Parts A and B, or Part B only, their enrollment in a cost plan offered by the

same organization is referred to as a “conversion” from commercial status to Medicare

cost enrollee status. The effective date of conversion enrollments is the first of the month

of initial Medicare entitlement.

Evidence of Medicare Part A and/or Part B Coverage – Acceptable forms of evidence

are:

1. A Medicare card;

2. Social Security Administration (SSA) award notice;

3. A Railroad Retirement Board (RRB) letter of verification;

4. A statement from SSA or RRB verifying the individual’s entitlement to Medicare

Part A and enrollment in Part B;

5. Verification of Medicare Part A and Part B through one of CMS’s systems,

including CMS data available through CMS subcontractors; or

6. For individuals enrolling when they first become entitled to Medicare, an SSA

application for Medicare Part A and/or B showing the effective date for both

Medicare Parts A and B or Part B only.

Evidence of Permanent Residence - A permanent residence is normally the enrollee’s

primary residence. A Medicare Cost organization may request additional information

such as voter’s registration records, driver’s license records, tax records, or utility bills to

verify the primary residence. Such records must establish the permanent residence

address, and not the mailing address, of the individual.

Involuntary Disenrollment - Refers to when a Medicare Cost organization, as opposed

to the member, initiates disenrollment from the plan. Procedures regarding involuntary

disenrollment are found in §50.2 of this chapter.

Medicare +Choice Organization (M+C organization) - Refer to Chapter 1 (General

Administration of the Managed Care/Medicare+Choice Program) of the Medicare

Managed Care Manual for a definition of a M+C organization.