Revision: Medicare Advantage & Part D Disenrollment

Notice Item 4 The collection updates: 1. Continue to allow Medicare beneficiaries to disenroll from Medicare Advantage plans by calling CMS' toll-free call center; 2. Continue to allow Medicare beneficiaries enrolled in Medicare Prescription Drug (Part D) Plans to request disenrollment from Medicare Prescription Drug Plans, and 3. Retire the CMS-R-257 Medicare Advantage Disenrollment Form given limited (zero) requests for the paper form since 2005. The information collected in the disenrollment process will be used to update the Medicare beneficiary's Health Insurance Master Record System in order to disenroll the beneficiary from a Medicare Advantage managed care plan or a Medicare prescription drug plan on a timely basis. Form Number: CMS-R-257 (OMB 0938-0741); Frequency: Occasionally; Affected Public: Individuals or households; Number of Respondents: 117,000; Total Annual Responses: 117,000; Total Annual Hours: 19,539.