If you are becoming eligible for Medicare, please note that the Annual Election Period (AEP) is October 15 to December 7, 2014. During this period, you can enroll in or change your Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD) plan. This is also the period you can enroll in, change or disenroll from a stand-alone Prescription Drug (Part D) plan. You may also switch to Original Medicare. New coverage will begin January 1, 2015.
You may enroll online, by phone, by mail or by fax. The following instructions describe how to complete an enrollment form that you download and print.
Make sure you are eligible to enroll
There are a few things to go over before you begin the enrollment process.
Know for sure you're eligible for a Medicare Advantage (MA) or Medicare Advantage Prescription Drug plan (MAPD):
If you have Original Medicare Part A and Part B (or will have Original Medicare Part A and Part B as of the effective date) and you enroll during one of the following enrollment periods, you are eligible to join a Medicare Advantage plan:
- Initial enrollment period: 7 months surrounding your Medicare eligibility: This is the 3 months before you turn 65, the month when you turn 65, and the 3 months after.
- Annual election period (AEP): October 15 to December 7, 2014. The period you can enroll in or change your MA or MAPD plan. This is also the period you can enroll in, change or disenroll from a Part D plan. You may also switch to Original Medicare. New coverage will begin January 1, 2015.
- Special enrollment period (SEP): A common SEP is for those covered under their employer's health plans who retire after 65. In this case, you can enroll with no penalty during the three months before your Part B takes effect. Other more common examples include: if you qualify for Medicare's Extra Help for Part D, if you qualify for both Medicaid and Medicare, or if you have moved outside of the plan's service area.
To be eligible for our plans, you must also reside in our service area. If you are any age with end-stage renal disease (ESRD), you are eligible for Original Medicare Part A and Part B, but generally not eligible for our plans.
If you already have a Medicare Advantage plan and are looking to switch plans, please keep the following in mind when you are ready to enroll:
- Medicare Advantage-only plans generally do not cover prescribed drugs. Enrollment in a Medicare Advantage-only plan will cause Medicare to automatically disenroll you from any Part D coverage you currently have. This includes stand-alone Part D plans, as well as Medicare Advantage plans that include Part D coverage (MAPD plans).
- The last enrollment request you make during the Annual Election Period (AEP) from October 15 through December 7, 2014, will be accepted as the plan for which you intend to enroll. So if you enroll in a stand-alone Part D plan and then enroll in a Medicare Advantage stand-alone plan, you will lose your prescription drug plan coverage and will not be eligible to enroll in a Part D plan until next year's AEP.
- There is a Medicare Advantage Disenrollment Period. The next disenrollment period is January 1 through February 14, 2015. If you choose to disenroll from a Medicare Advantage plan during the disenrollment period and your plan includes a drug plan, you will be allowed to sign up for a stand-alone Part D plan to replace the drug coverage that was in your Medicare Advantage plan and go back to Original Medicare. This means that if you shop around for another Medicare Advantage plan, you will need to consider changing your plan during AEP (October 15 through December 7, 2014). This is because after January 1, 2015, you will not be able to change from your current Medicare Advantage plan to another Medicare Advantage plan unless you qualify for a Special Enrollment Period.
Know for sure if you are eligible for a stand-alone Medicare Prescription Drug plan (PDP):
If you meet the following criteria, you are eligible for Medicare Prescription Drug coverage, and membership in our plan:
- You are entitled to Medicare Part A or are enrolled in Part B.
- Your permanent residence is within our service area.
- You are currently eligible for Medicare Part D.
Please keep the following in mind when you are ready to enroll in a PDP plan:
Eligible individuals may only enroll in one Medicare Prescription Drug plan at a time and may not be enrolled in a Medicare Advantage plan at the same time, unless they are a member of a Medicare Private-Fee-For-Service plan or are enrolled in an 1876 Cost Plan which does not have Part D coverage built in. If you are currently enrolled in a Medicare Advantage plan that does not include prescription drug coverage, or if you are currently enrolled in a Medicare Advantage prescription drug plan, you will be disenrolled from that plan if you join a stand-alone Medicare Part D prescription drug plan.
Tips for enrolling:
When you have chosen a plan, you are ready to enroll. You don't need to get a physical exam to sign up. You will need information from your Original Medicare card to fill out your enrollment form. Be sure to fill out the form carefully and completely. Your sales agent can help! When you are done, you can give a copy to your agent.
To complete and mail a printed copy of the Enrollment Form for your selected Medicare Advantage plan, or Medicare Advantage with prescription drug plan, or Medicare Prescription Drug plan:
- Download and print the enrollment form. Be sure to complete all information on the form, sign the form, and date the enrollment form. Please be sure that when you enter the Permanent Residence Street Address, you enter a Street Address. You cannot enter a P.O. Box.
- Determine how to pay your monthly plan premium.
- You can pay your monthly plan premium (including any late enrollment penalty that you currently have or may owe) by mail or electronic funds transfer (EFT) each month. Selecting the electronic funds transfer (EFT) option means that you will pay your Medicare Advantage or Part D premium by having the premium taken directly from a checking account, or even from a savings account (in certain circumstances), at regular intervals. To designate a checking account for EFT, fill out that part of the plan application and return it with a voided check. Some, but not all, savings accounts also allow EFT, although this may require a letter from the bank.
- You can also choose to pay your premium by automatic deduction from your Social Security or Railroad Retirement Board benefit check each month. If you would like your premium deducted from your Social Security check or Railroad Retirement Board check, select the option "Automatic Social Security or Railroad Retirement Board (RRB) Deduction." If you want to use our other convenient payment options, select the option you want in "Paying your Plan Premium."
(Note that direct bills will continue until Electronic Funds Transfer or Social Security/Railroad Retirement Board forms have been processed.)
Note: If you forget to designate on your application that you want to pay your premium by automatic deduction from your Social Security or Railroad Retirement Board benefit check, or that you want to set up electronic funds transfer, but you want to do it later, please call Customer Service to sign up. Once you join our plan, you can register and then log in to the secure member portal and download the Automatic Payment Option form from the Forms Library. It may take one or two billing cycles to get established. During this time, you should continue to pay any bills you receive at home through the mail. Whenever you want to make changes, please contact us immediately.
Return the form(s) by mail to the address listed below. You will receive an acknowledgement letter from us after we process your application.
All Medicare Advantage PPO plans in ME and NH:
Enrollment Processing Center
P.O. Box 659403
San Antonio, TX 78265-9403
Fax #: 1-877-391-3877
All Medicare Advantage HMO plans in CT, IN, KY, MO, NH, OH, ME, WI and all Medicare Advantage PPO plans in CT, IN, KY, MO, OH, VA and WI:All Medicare Advantage HMO and HMO SNP plans in VA:
Enrollment Processing Center
P.O. Box 659403
San Antonio, TX 78265-9403
Fax #: 1-800-833-8554
12900 Park Plaza Dr Suite #150
Cerritos, CA 90703
Fax #: 1-855-295-7816All Medicare Advantage Part D plans in CO, IN, KY, OH, ME, MO, NH, NV, VA and WI:
Attn: Enrollment Processing Center
P.O. Box 659403
San Antonio, TX 78265-9403
Fax #: 1-800-833-8554
Beneficiaries interested in available Medicare Part D subsidies may contact Blue MedicareRx (PDP) Customer Service, or call toll free at 1-866-755-2776 and TTY at 711. Customer Service representatives are available to answer your call directly from 8 a.m. to 8 p.m., 7 days a week (except Thanksgiving and Christmas) from October 1 through February 14, and Monday through Friday (except holidays) from February 15 through September 30. Our automated system is available anytime for self-service options, including after hours, weekends, and holidays. Beneficiaries may also call 1-800-MEDICARE (TTY users call 1-877-486-2048), the State Medicaid Office, or the local Social Security Administration Office. If you have a Medicare Supplement (Medigap) policy that includes prescription drug coverage, you must contact your Medigap Issuer to let them know that you have joined a Medicare Prescription Drug plan.
After you've enrolled, what happens next?
- If you called and one of our licensed sales representatives assisted you with completing the enrollment application, or if your agent or broker assisted you with completing the enrollment application, you’ll get a call from us to make sure you understand what a Medicare Advantage or Medicare prescription drug plan offers. The call is required by Medicare and will not affect your ability to enroll in the plan. Your sales representative will not be on the call.
We will make a minimum of three attempts to contact you by telephone within fifteen (15) calendar days of receipt of the application. In addition to confirming that your application correctly reflects your wishes, we will also discuss:
a. Which ID card to use for your health care services, if you selected a Medicare Advantage or Medicare Advantage with prescription drug plan.
b. Your share of the cost for services.
c. Which providers to use to get your health care services (if you selected a Medicare Advantage or a Medicare Advantage with prescription drug plan).
d. Which pharmacies to use to get your prescription drugs (if you selected a Medicare Advantage with prescription drug plan, or a Medicare Prescription drug plan).
e. How to cancel your enrollment in our plan if you want to.
- You'll get a letter with your proposed effective date. This letter is your proof of membership until you get your member ID card.
- Your application will be sent to the Centers for Medicare & Medicaid Services (CMS) for approval.
- Once it is approved by CMS, you will get a welcome letter that confirms your effective start date with us. You will also get your member ID card and other new member materials, including your Evidence of Coverage and Welcome Kit.
- Within 90 days after your health plan starts, you will get a call to fill out a health survey. This survey lets us know your health status so we can help you with your care needs as soon as possible.
Please note: You must continue to pay your Medicare Part B premium. Also, you must continue to pay any Part D IRMAA (Income-Related Medicare Adjustment Amount) premium if CMS has notified you that you owe a Part D IRMAA premium.
Materials may be available in alternative formats. Please call your sales agent (if applicable) or Customer Service if you need information in another format.
- For details on your plan’s benefits, check the Summary of Benefits and Evidence of Coverage on the plan’s Documents tab. The benefit information provided is a brief summary, not a complete description, of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Reference the Evidence of Coverage for information on premiums, cost-sharing, out-of-network coverage, rights and responsibilities upon disenrollment and any applicable conditions and limitations associated with using the plan benefits.
- Network of pharmacies
Our plans feature more than 69,000 pharmacies in our network. Generally, you must use network pharmacies to receive plan coverage. Our network includes both preferred retail and network retail pharmacies. You are never far from one of our network pharmacies; but to pay a lower amount, you should go to one of the preferred pharmacies. Network retail pharmacies are still in our network but do not offer the discounted prices available at preferred pharmacies. You can search for a network pharmacy, or contact your sales representative or independent agent. For information on provisions for nonroutine access to covered Part D drugs at out-of-network pharmacies, including limits and financial responsibility for access to these drugs, please reference your Evidence of Coverage or call Customer Service.
- PDP and MAPD contract renewal
Our Prescription Drug (PDP) plans and Medicare Advantage prescription drug (MAPD) plans have a Medicare contract. Since contracts with Medicare are renewed annually, both the Prescription Drug plans and the Medicare Advantage prescription drug (MAPD) plans cannot guarantee availability of coverage beyond the end of their current contract year. If our Medicare contract is terminated or if we stop offering PDP or MAPD benefits, we will give you written notice of when that change will be effective. We will also provide you with information about alternative Prescription Drug plans or Medicare Advantage prescription drug (MAPD) plans in your area, and the steps you need to take to continue your prescription drug coverage with Medicare. At that time, you would be eligible for a Special Enrollment Period, and could choose a new PDP or MAPD sponsor without being subject to a late enrollment penalty. Again, you cannot have a stand-alone Medicare Advantage plan and a stand-alone Medicare Prescription Drug plan at the same time unless as specified above.
- PDP and MAPD contract termination procedures
All Medicare stand-alone Prescription Drug plans and Medicare Advantage Prescription Drug plans agree to stay in the program for a full year at a time. Each year, the plans decide whether to continue for another year. Even if a Medicare Prescription Drug plan or Medicare Advantage Prescription Drug plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue, it must send you a letter at least 60 days before your coverage will end. The letter will explain your options for Medicare prescription drug coverage in your area.