how to enroll someone in a medicare advantage program

• Use Medicare's Plan Finder.
• Visit the plan's website to see if you can join online.
• Fill out a paper enrollment form. Contact the plan to get an enrollment form, fill it out, and return it to the plan. All plans must offer this option.
• Call the plan you want to join. Get your plan's contact information.
• Call us at 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048.

Full Answer

What are the eligibility requirements for Medicare Advantage?

Medicare Advantage Eligibility Checklist. There are a few things you must do to qualify for a Medicare Advantage plan. You need to know your Part A and B effective date. Have your Medicare card number. You need to live in the plan’s service area. Those unsure of Medicare eligibility can always call Social Security to ask.

How and when you should enroll in Medicare?

Sign up for Parts A and B of Medicare

• I’m already receiving Social Security retirement benefits. ...
• I’m signing up during my initial enrollment period , the three months before to the three months after the month you turn 65. ...
• I’m signing up during a special enrollment period , a time you can enroll in Medicare outside the initial enrollment period when certain conditions are met. ...

More items...

Can you be enrolled in both Medicare Advantage and Medicaid?

You may also qualify for special Medicare Advantage enrollment periods in certain situations, such as if you move outside your plan’s service area or you become eligible for both Medicare and Medicaid. You might also get a Medicare Advantage Special Enrollment Period if your plan ends its relationship with Medicare, or moves out of your area.

How do you qualify for Medicare Advantage plans?

When can I enroll in a Part C plan?

• Initial Enrollment Period (IEP)
• Annual Enrollment Period (AEP)
• Special Enrollment Period (SEP)

When can you enroll in a Medicare Advantage plan?

Sign up for a Medicare Advantage Plan (with or without drug coverage) or a Medicare drug plan. During the 7‑month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

What are the criteria for Medicare Advantage?

Generally, you can get Medicare if one of these conditions applies: You are at least 65 years old. You are disabled and receive Social Security Disability Insurance (SSDI) or Railroad Retirement disability payments. You have End-Stage Renal Disease (ESRD) and require dialysis or a kidney transplant.

Can I be turned down for a Medicare Advantage plan?

Generally, if you're eligible for Original Medicare (Part A and Part B), you can't be denied enrollment into a Medicare Advantage plan. If a Medicare Advantage plan gave you prior approval for a medical service, it can't deny you coverage later due to lack of medical necessity.

Can you enroll in Medicare Advantage with pre existing conditions?

Medicare defines a pre-existing condition as any health problem that you had prior to the coverage start date for a new insurance plan. If you have Original Medicare or a Medicare Advantage plan, you are generally covered for all Medicare benefits even if you have a pre-existing condition.

What are the types of Medicare Advantage plans?

Medicare Advantage PlansHealth Maintenance Organization (HMO) Plans.Preferred Provider Organization (PPO) Plans.Private Fee-for-Service (PFFS) Plans.Special Needs Plans (SNPs)

What are the 3 requirements for Medicare?

Be age 65 or older; Be a U.S. resident; AND. Be either a U.S. citizen, OR. Be an alien who has been lawfully admitted for permanent residence and has been residing in the United States for 5 continuous years prior to the month of filing an application for Medicare.

What is excluded from a Medicare Advantage plan?

Non-medical services, including a private hospital room, hospital television and telephone, canceled or missed appointments, and copies of x-rays. Most non-emergency transportation, including ambulette services. Certain preventive services, including routine foot care.

Can you have Medicare and Medicare Advantage at the same time?

In most cases, yes. If you're planning to join a PPO and you want Medicare drug coverage (Part D), you must join a PPO plan that offers Medicare drug coverage. If you join a PPO plan without drug coverage, you can't join a separate Medicare drug plan.

Can you switch back to traditional Medicare from Medicare Advantage?

Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. Your coverage under traditional Medicare will begin January 1 of the following year.

Which statement is true about a member of a Medicare Advantage plan who wants to enroll in a Medicare Supplement insurance plan?

Which statement is true about members of a Medicare Advantage (MA) Plan who want to enroll in a Medicare Supplement Insurance Plan? The consumer must be in a valid MA election or disenrollment period. You just studied 21 terms!

What's considered a pre-existing condition?

As defined most simply, a pre-existing condition is any health condition that a person has prior to enrolling in health coverage. A pre-existing condition could be known to the person – for example, if she knows she is pregnant already.

What pre-existing conditions are not covered?

Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer, as well as pregnancy. They cannot limit benefits for that condition either.

Guide to Helping Someone Else Enroll in Medicare

To help you, we have designed an enrollment guide that includes important steps you can take to get your loved ones the health coverage they need, at a price they can afford.

1. Verified Authorized Representative

In order to help someone enroll in Medicare or a Medicare Advantage plan, you will need to be an authorized representative chosen by the enrolling individual with written consent, a court appointed legal guardian, a person having durable power of attorney for health care decisions, or an individual authorized to make health care decisions under state surrogate consent laws, provided he/she has the authority to act for the beneficiary in this capacity..

2. Identify Coverage Needs

When helping someone else enroll in a Medicare plan, it is helpful to first understand what their current medical needs are and whether they will need additional health coverage that Original Medicare does not cover.

3. Confirm Medicare Eligibility

Once you understand your loved one’s medical and financial needs, you need to find out if the individual you are enrolling is eligible for Medicare or Medicare Advantage.

4. Know Medicare Coverage Options

It's important to know that your loved ones have options for how they get Medicare coverage.

5. Know the Medicare Enrollment Deadlines

There are certain enrollment deadlines for Medicare that you will need to know and meet to avoid your loved ones not being covered.

6. How to Enroll

If you are an authorized representative, you can conveniently enroll your loved one in a Medicare Advantage plan online, via phone or by mail. View enrollment instructions. Medicare beneficiaries may also enroll in a Memorial Hermann Medicare Advantage HMO plan through the CMS Medicare Online Enrollment Center located at medicare.gov.

What is Medicare Advantage?

Medicare Advantage is private insurance's counterpart to Original Medicare. It's a great alternative for receiving your Medicare coverage. Rather than purchasing individual components through Original Medicare, Medicare Advantage bundles benefits from Part A and Part B and can even include drug coverage, vision, dental, hearing, ...

When is the open enrollment period for Medicare?

There’s also a Fall Open Enrollment Period (October 15 through December 7) during which you may sign up. Learn about enrollment periods and when they apply to you.

How long does Medicare Advantage last?

If you’re new to Medicare, you’ll want to enroll in an MA Plan during your Initial Enrollment Period (IEP). This period lasts for seven months— three months before the month when you turn 65, and three months after.

What is the lock in requirement for a health insurance plan?

Charges you’re responsible for. Lock-in requirement, which means you’re required to keep the plan for the rest of the year, unless you meet special circumstances or qualify for an enrollment period.

How to find a special needs plan?

If you're looking for a Special Needs Plan (SNP), use the drop down menu to answer questions about your needs. If you receive a lot of results, use the drop down menu to sort by lowest deductible or lowest premium. Select up to three plans you like best.

Is there more to Medicare Advantage than drug coverage?

But as you’ll soon see, there is much more to a Medicare Advantage plan than drug coverage. Don’t worry, though—we'll walk you through each step. By the time we’re through, you'll find the best Medicare Advantage plan for your needs.

How long does it take to get Medicare Advantage?

This is the period that begins three months before your birth month and ends three months after it. While there is no cost penalty for signing up at any time during this period, it is highly desirable to sign up as early in the period as possible. This is because any plan with a Part D component takes approximately three months to kick in, which means you could see a temporary gap in your drug coverage if you sign up any time after your birthday. This gap could last as long as three months after the time you lose the coverage you had before switching to Medicare, so it’s helpful to start your research before the ICEP and get the forms submitted prior to the first day of the month you turn 65.

What is Medicare Part A?

Medicare Part A is the basic coverage Medicare provides for its beneficiaries. This is a no-cost plan that covers the cost of inpatient hospitalization for eligible seniors. All U.S. citizens are automatically enrolled in Part A when they become eligible, since there is no out-of-pocket cost or monthly premium for this coverage. Services covered under Part A generally revolve around admissions to the hospital and treatments provided as part of regular inpatient care. Providers bill the Original Medicare program directly, which then pays for services according to a fixed or negotiated schedule. All Medicare-qualified providers are part of the Part A network, and they are required to bill only Medicare for covered services, unless the patient has a Medicare Advantage plan that provides the same coverage.

Is Medicare Supplement Part C?

Medicare supplements are not strictly part of the Medicare system, but they are a consequence of it. Whether you have Original Medicare or Medicare Advantage, there could easily be some gaps in coverage that leave certain services out. Many seniors also face high copayments and extra out-of-pocket expenses for services not covered by their Part C plan. Medicare supplement plans plug these gaps with various coverage options. These are highly variable, and each plan has to be discussed with an insurance agent to make sure the coverage is adequate for your situation.

Can you enroll in Medicare Advantage outside of the normal enrollment period?

Sometimes circumstances force beneficiaries to enroll in Medicare Advantage outside of the normal enrollment periods. This can be tricky to do without incurring a penalty rate, but there are special circumstances you can invoke to justify an out-of-period enrollment. Examples of special circumstances include:

What is Medicare Advantage?

Medicare Advantage is an alternative to Original Medicare. Medicare Advantage plans are offered by private insurance companies that contract with Medicare to provide your Part A and Part B benefits. Medicare Advantage plans can include: Health Maintenance Organization (HMO)

How long does Medicare enrollment last?

Initial Enrollment Period When you are enrolling in Medicare for the first time, you will have a seven-month Initial Enrollment Period. The Initial Enrollment Period starts three months before your 65 th birthday, includes the month you turn 65, and ends three months after you turn 65.

What does it mean to accept assignment?

To “accept assignment,” a medical provider must agree to be paid directly by Medicare, to accept the payment amount Medicare has approved for the service, and not to bill you for any more than the Medicare deductibles and coinsurance.

How much does Medicare pay for a service?

Medicare pays a share of the Medicare-approved amount of a service or supply, and you pay your share (generally 20%) in deductibles or coinsurance. While Original Medicare does help cover many costs, many Medicare beneficiaries find the out-of-pocket expenses overwhelming.

How much is Medicare out of pocket?

If you have Original Medicare, you will likely be responsible for 20% of Medicare approved services and supplies. There is no limit to your out-of-pocket expenses. Medicare Advantage plans, on the other hand, will have an annual maximum out-of-pocket limit.

When does the annual election period end for Medicare?

The Annual Election Period (AEP) starts October 15 and ends December 7.

When was Medicare Part C introduced?

Many things have changed since Medicare Part C was formally introduced by legislation in 1997. Medicare Advantage plans have evolved and with one third of all Medicare recipients enrolled in Part C, it is important for individuals approaching Medicare eligibility, or those who are reconsidering their coverage during the Annual Election Period ...

Who can sign up for Medicare Advantage?

Anyone who is enrolled in Original Medicare (Part A and Part B) may be eligible to sign up for a Medicare Advantage (Part C) plan. This includes people under the age of 65 who have qualified for Medicare because of a disability.

What are the requirements to qualify for Medicare Advantage?

There are 2 general eligibility requirements to qualify for a Medicare Advantage plan (Medicare Part C): 1. You must be enrolled in Original Medicare ( Medicare Part A and Part B). 2. You must live in the service area of a Medicare Advantage insurance provider that is accepting new users during your application period.

What percentage of Medicare Part C plans will be available in 2021?

89 percent of Part C plans available throughout the country in 2021 cover prescription drugs, and 54 percent of those plans feature a $0 premium. 2. 6 out of 10 Medicare Advantage Prescription Drug plan beneficiaries are enrolled in a $0 premium plan in 2021.2.

How much is Medicare Advantage 2021?

In 2021, the weighted average premium for a Medicare Advantage plan that includes prescription drug coverage is $33.57 per month. 1. 89 percent of Part C plans available throughout the country in 2021 cover prescription drugs, and 54 percent of those plans feature a $0 premium.

How long does Medicare IEP last?

Initial Enrollment Period (IEP) When you first become eligible for Medicare, you will be given an Initial Enrollment Period (IEP). Your IEP lasts for seven months. It begins three months before you turn 65 years old, includes the month of your birthday and continues on for three more months.

What are the benefits of Medicare Advantage?

Some Medicare Advantage plans may also offer a number of additional benefits that can include coverage for things like: Routine dental and vision care. Hearing care and allowances for hearing aids. Memberships to gyms and wellness programs like SilverSneakers. Some home health care services.

What is Medicare Part C?

Medicare Part C plans are sold by private insurance companies as an alternative to Original Medicare. Medicare Part C plans are required by law to offer at least the same benefits as Medicare Part A and Part B. There are several different types of Medicare Advantage plans, such as HMO plans and PPO plans. Each type of plan may feature its own ...

Key takeaways

An agent or broker will need information about you and your providers to help you choose a Medicare plan.

What information does an agent or broker need to help me enroll in Medicare?

An agent or broker can help you with the process of selecting a plan and completing the enrollment. In order to best assist you, they will need to know the names and dosages of any medications you take, as well as your preferred pharmacies, so that they can narrow down the options based on how your medications will be covered.

Can a friend or family member help me sign up for Medicare?

You always have the right to have a trusted friend or family member present while you’re discussing your health coverage needs with Medicare, your state’s Medicare SHIP, or with an agent or broker.

How can I authorize Medicare to discuss my coverage with someone else?

If you want Medicare to be able to directly share your personal health information with someone else, there’s an authorization form that you’ll need to complete. Once you have it on file with Medicare, you can add names to it or update it through your MyMedicare.gov account.

Can someone help me sign up for Medicare if I'm incapacitated?

If you’re incapacitated and unable to participate in your own plan selection process, someone else can act on your behalf as long as you’ve created a power of attorney (POA) and named that person as your legal representative.

Can a friend or family talk about my coverage with a private Medicare insurance company?

If you’re enrolled in a private Medicare plan (a Part D plan, a Medicare Advantage plan, or a Medigap plan ), the insurance company will have their own disclosure authorization form that you’ll need to complete so that they can discuss your coverage with a loved one.