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Abou t 1 4 p e r c ent of the Medicare population is now enrolled in health maintenance organizations (HMOs).1 In contrast to most private, employmentbased policies, Medicare allows beneficiaries to disenroll from their plan at any time. Unrestricted disenrollment provides a “safety valve” for beneficiaries who enroll and then change their minds or who become dissatisfied with some aspect of their plan. In the early years of Medicare’s risk-contracting program, disenrollment rates were high.2