Grand Junction · Involuntary disenrollment

Can a Medicare Advantage Plan Drop You in Colorado?

Two different fears hide inside that question. One is the letter Mesa County mailboxes are getting this week: a plan that will not be offered here next year. The other is quieter and older: that a plan can decide you have become too expensive and let you go. The first is real and comes with rights. The second is prohibited by regulation. Here is the full list of ways an Advantage plan can end your membership, what each one legally owes you, and the one exit on the list that leaves you with nothing.

Medicare On Main Data Desk

Published September 26, 2026 · 9 min read · Reviewed by Brian Penner, 22+ years in Medicare

Start with the sentence that answers the question. 42 CFR § 422.74(a) opens with a prohibition, not a permission: "Except as provided in paragraphs (b) through (d) of this section, an MA organization may not— (1) Disenroll an individual from any MA plan it offers; or (2) Orally or in writing, or by any action or inaction, request or encourage an individual to disenroll." Everything else in the section is an exception to that rule, and the exceptions are a closed list. If the reason you are worried about is not on it, the plan cannot use it. Of Mesa County's 41,709 Medicare beneficiaries in June 2026, 19,155 were in Medicare Advantage or another Medicare health plan, so this list applies to just under half the county.

What a plan can never do

The fear that a plan will drop a member who got sick is the one I hear most, and it is the one the regulations address most directly. 42 CFR § 422.110(a): an MA organization "may not deny, limit, or condition the coverage or furnishing of benefits to individuals eligible to enroll in an MA plan offered by the organization on the basis of any factor that is related to health status, including, but not limited to the following: (1) Medical condition, including mental as well as physical illness. (2) Claims experience. (3) Receipt of health care. (4) Medical history. (5) Genetic information. (6) Evidence of insurability ... (7) Disability."

"Claims experience" and "Receipt of health care" are the two items that matter here. A member with a cancer diagnosis, a transplant, or four hospital stays in a year has generated claims experience and received health care. Neither is a lawful basis for anything the plan does, including disenrollment. And the one exit that sounds like it could be stretched to cover a difficult patient, disruptive behavior, has its own fence in § 422.74(d)(2)(i): "An individual cannot be considered disruptive if such behavior is related to the use of medical services or compliance (or noncompliance) with medical advice or treatment." Even then, the plan cannot act alone; § 422.74(d)(2)(ii) allows disenrollment "only after it meets the requirements described in this section and CMS has reviewed and approved the request."

Every exit on the list, and what it leaves you with

Sources: 42 CFR § 422.74(b)–(d); § 422.62(b); § 422.506(a)(2); Medicare.gov, Special Enrollment Periods; Medicare.gov, When can I buy Medigap. Medigap rights describe federal guaranteed-issue situations; a Colorado application outside them can be underwritten.

Read the table by its last column. Five of the seven exits open a door: a Special Enrollment Period, a Medigap guaranteed-issue window, or both. Two do not, and one of those two, non-payment, is the one people walk into by accident. Medicare.gov's plain-language version of the list is shorter but says the same thing: "A Medicare Advantage Plan can disenroll you for several reasons, like if you move outside the plan's service area, lose Medicare or Medicaid eligibility, join a drug plan (in some cases), or if the plan's contract with Medicare ends." The "join a drug plan" clause is a reminder that enrolling in a stand-alone Part D plan while you are in an Advantage plan that includes drug coverage disenrolls you from the Advantage plan. It is a self-inflicted exit, and it happens every fall to someone who thought they were adding coverage.

The Mesa County version: six months in the desert

Grand Valley retirees leave for Arizona, southern Utah, and Texas in numbers, and an Advantage plan is tied to the county you live in. § 422.74(d)(4)(ii) draws the line: if you have not moved but have "left the service area (or residence) for more than 6 months, the MA organization must disenroll the individual from the plan." The word is "must." The plan has no discretion to keep a member it knows has been gone seven months.

There is one stretch, and it belongs to the plan, not to you. Under (d)(4)(iii), a plan "may elect" to offer a visitor/traveler benefit for an absence "longer than 6 months but less than 12 months," and a member who uses it is "disenrolled on the first day of the 13th month after the individual left the service area." The benefit has to deliver "all Medicare Parts A and B services ... at the same cost sharing levels as apply within the plan's service area," and it must be available to every enrollee who is away, although the plan may limit it to certain areas and providers. Ask whether your plan has one before you assume. A PPO's out-of-network coverage is not the same thing; it changes what you pay for care in Tucson, not how long you are allowed to be in Tucson.

Two practical details decide how this plays out. First, the clock counts consecutive days away, not days in a calendar year; leaving October 15 and returning April 10 is under six months, and leaving October 1 and returning April 15 is over. Second, the plan finds out through the mail: (d)(4)(ii)(A) says you are "considered to be temporarily absent" when a required mailing "is returned to the MA organization by the U.S. Postal Service as undeliverable and a forwarding address is not provided." Forwarding your mail to a winter address is what starts the plan's count. Once the six months are up, the notice has to arrive "within the first 10 calendar days of the sixth month," and what follows is treated like a move: a Special Enrollment Period and the Medigap guaranteed-issue situation Medicare.gov labels "I'm moving out of my Medicare Advantage Plan's coverage area." Our out-of-state care post covers what a plan pays while you are away; this is the separate question of whether you are still a member when you get home.

Non-payment: the exit with no safety net

A plan may drop you for an unpaid premium, but only after a process. § 422.74(d)(1) requires the plan to show CMS it made "reasonable efforts to collect," including "Alerting the individual that the premiums are delinquent," a grace period that must "Be at least 2 whole calendar months," and a warning "that failure to pay the premiums by the end of the grace period will result in termination of MA coverage." The written notice then has to explain the reason and your right to file a grievance.

What makes this exit different is what is missing afterward. § 422.62(b)(2) grants a Special Enrollment Period for losing eligibility through a change of residence "or other change in circumstances as determined by CMS but not including terminations resulting from a failure to make timely payment of an MA monthly or supplemental beneficiary premium, or from disruptive behavior." Medicare.gov's Special Enrollment Period page has no entry for it, and its Medigap tool has no situation for it. Someone disenrolled for non-payment in May is in Original Medicare with no drug plan, no Medigap right, and no way back in until Open Enrollment for a January 1 start. The Medicare Advantage Open Enrollment Period in the new year does not help either, because it is for people who are already in an Advantage plan.

There are two ways back. Paragraph (d)(1)(v) allows reinstatement "without interruption of coverage" if you ask "within 60 calendar days of the disenrollment effective date," pay everything owed "within 3 calendar months," and show the non-payment "was due to circumstances for which the individual had no control, or which the individual could not reasonably have been expected to foresee." A hospitalization qualifies; forgetting does not. The better way is not to need one: (d)(1)(iv) says a plan "may not disenroll an individual who had monthly premiums withheld" from Social Security. If your plan has a premium, having it deducted from your check removes this exit from the list entirely. A $0-premium plan removes it a different way, though the Part B premium behind it still has to be paid.

When the plan is the one leaving

This is the exit Mesa County is actually living through this fall, and it is the most protected one. § 422.74(b)(3) requires a plan that "discontinues offering the plan in any portion of the area where the plan had previously been available" to disenroll everyone there, and (d)(7) requires "a written notice of the effective date of the plan termination or area reduction and a description of alternatives for obtaining benefits under the MA program," sent in the § 422.506(a)(2) timeframe of at least 90 days. Medicare.gov: "If a plan decides to stop participating in Medicare, you'll have to join another Medicare health plan or return to Original Medicare." You get Open Enrollment, a Special Enrollment Period from December 8 to February 28, and a Medigap guaranteed-issue window from 60 days before to 63 days after the coverage ends. We have written the rest of that path already: how to tell a real non-renewal from a plan merger, the Colorado Medigap rights, and why December 31 is the real deadline.

One line in the table deserves its own sentence. A plan cannot do this mid-year. Terminations and county exits take effect at the end of a contract year with 90 days' notice, which is why the letters come in late September and the change lands on January 1. A mid-year end to your coverage is always about your circumstances, never the plan's.

What I would do

If a notice arrives, find the reason in it and match it to the table. A move or a long absence comes with a Special Enrollment Period that starts the month you tell the plan, so tell the plan early and use the two months. A plan exit comes with the longest set of rights on the list, and the calm path is still Open Enrollment. If the notice says non-payment, act inside the grace period; once it lapses, the 60-day good-cause request is the only door, and it needs a reason a reviewer will accept. If you have never received a notice and are simply worried the plan will drop you over a diagnosis, stop worrying about that and worry about the two things that actually end coverage in Mesa County: a forwarded mailbox and a missed premium. In a county where 26.6% of adults live with high blood pressure and 8.1% with diabetes, per CDC PLACES, the diagnosis is the reason to keep the coverage, not the reason you would lose it.

How we know all this: the Medicare On Main Data Desk frames every article with public data — here, 42 CFR § 422.74 for the general prohibition, the optional and required grounds, the grace period, the disruptive-behavior guardrails, the six-month and visitor/traveler rules, the notice timing and the good-cause reinstatement; § 422.110 for the health-status prohibition; § 422.62(b) for the Special Enrollment Periods and the non-payment exclusion; § 422.506 for the 90-day notice, all quoted as published on Cornell LII; Medicare.gov's health-plan-options, Special Enrollment Period and Medigap tool pages; the CMS Medicare Monthly Enrollment file for Mesa County (June 2026); and CDC PLACES county data (2023). No 2027 plan, premium or carrier is named, because CMS has not released the 2027 landscape; no plan that exits a county is criticized. This is education, not advice; confirm your plan's rules with the plan, and plans, costs and eligibility with a licensed agent or Medicare.gov. We take no payment from any carrier to feature a plan.