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Medicare Advantage Enrollment – What’s In The Enrollment Kit?

 

Checklist with Red PencilA look inside the Medicare Advantage Enrollment kit

Joining the right Medicare Advantage plan is one of the most important decisions you can make. And because a plan is only good for one calendar year, it’s one you will make time and time again.

Why is it then that so many people enroll in a Medicare Advantage plan with incomplete information? There’s more to an Advantage plan than whether or not the monthly premium is affordable and if your doctor is in the network.

Understanding all the components of the enrollment kit can help you compare plans and choose the best Medicare Advantage plan for your circumstances.. It’s important to look beyond the Plan Benefits Guide to ensure that you are choosing a plan that you can live with all year.

Medicare Advantage plan enrollment kit contents

Plan Benefits Guide: This is the high-level overview of the plan. This guide will detail the type of plan, any network restrictions and general information about co-pays and other cost sharing that will be required. Additional benefits beyond original Medicare and any optional riders are also highlighted. Think of this as the plan’s sales brochure.

Summary of Benefits: This booklet is an in-depth look at plan benefits and limitations. Also included in the Summary of Benefits is information about the member appeals and grievances process. To truly understand how your plan will benefit you and what your financial responsibilities will be look beyond the Plan Benefits Guide to the Summary of Benefits.

Medicare Advantage Explained: This informational piece is a good place to start if you are new to Medicare Advantage plans or have questions about how Advantage plans deliver benefits to their members. Types of plans are discussed as well as information about plans having the option to include Part D drug coverage. If you are considering Medicare Advantage enrollment this is good information.

Provider Directory: The Medicare Advantage provider directory can be one of the most important parts of your enrollment kit. This will include all types of medical providers for you plan. Provider directories are printed prior to October 1st, so it’s always a good idea to check with you provider to make sure that nothing has changed. Also consider that a provider may accept the plan and did not opt-in soon enough to be included in the directory.

Plan Formulary: The formulary is the list of medications that are included in an Advantage plan offering Part D coverage. Not all Advantage plans include Part D. If you don’t see a fornulary in your  Medicare Advantage enrollment kit, there’s a good chance it is not included. If Part D is included it will also be referenced in the Summary of Benefits and in the Plan Benefits Guide.

Plan Contact Information: A separate sheet is included detailing the different methods of contact. It is important to keep this information handy in the event that you have a need to call customer service or if the company offers telephonic enrollment.

Considering Medicare Advantage Insurance? – Read This Before You Enroll


Compare Medicare Advantage plans by reviewing the enrollment kit

Understanding the enrollment kit is essential to choose the best Advantage plan for your needs. You may find yourself with enrollment kits from several different companies. All components listed above should be included.

Once you have several Medicare Advantage enrollment kits you may want to create a spread sheet and compare the different aspects of each plan in order to choose the best Advantage plan for you circumstances.

You can also go online to the Medicare website and get a high level view of plans that are available in your area. If you want to get more detail and compare all types of Medicare plans as well as process an enrollment you may find the eHealthInsurance website helpful.

17 comments

  1. I will be moving to Oviedo, Florida in September 2011. I am presently residing in Puerto Rico, where I have Medicare y Mucho Mas Medical Plan, which is an HMO provider here in Puerto Rico. I am diabetic and have high blood pressure and my concern is that once I make the move I do need coverage from a Medicare Advantage Plan. How should I go about this. I cannot wait till January before I receive services for my medical needs. Thank you. I await your reply……..

  2. Jose, You will not need to wait until January to get coverage. Your move will afford you a Special Enrollment Period. Start comparing 2011 Medicare Advantage plans in Florida by visiting Medicare.gov. Read this article… Medicare Advantage Programs – Navigating Medicare.gov. If you enroll in September (this can be done online) your new 2011 plan will be effective October 1.

  3. I am 65 yrs. old and still working full time (Medical Ins. provided by employer), I plan on working full time until 7/1/2012 at which time I will be 66 yrs. old. I am currently signed up on Medicare B but am totally confused on when I have to get all the other plans put in place. Can you tell me do I need to during the Oct – Dec 2011 enrollment period or can I do it later?
    PS: I may decide to continue to work full time until 1/1/2013.

  4. Janet, As long s as you are covered under your employer group plan you don’t need to take action. When you retire and lose your current coverage you will be afforded a Special Enrollment Period. Your human resources department should also be able to confirm this.

  5. Sheila Tomassetti

    I am currently enrolled in Anthem Blue Medicare Access Value since July 2011 – is there anything I need to do???

    Thanks, Sheila

  6. Sheila, Medicare Advantage plans and part D plans are annual plans. Each year a plan provider can change the premium, benefits and out-of-pocket costs. They can also choose not to renew a plan for the following year. You should have received a Annual Notice of Change in the mail. This will detail any changes to your plan.

    If a plan is renewing for the following year and you do nothing you will automatically be enrolled. But for all intents and purposes you will have chosen a plan blindly. If a plan non-renews you will be given a Special Enrollment Period that lasts until January 31. But choose before December 31 if you want coverage in January.

    If you don’t have a copy of your annual Notice of Change go to your plan’s website and search for the 2012 Summary of Benefits. You should at least know what the 2012 plan benefits will be before you accept any changes.

  7. RE: your reply to Sheila Tomassetti, next to last paragraph: The proper phrase is “for all intents and purposes” not “for all intensive purposes.”

  8. SJFT, Thank you.

  9. Are HMO’s all you have?

  10. Elaine, to find all available plans in your area you can visit the official Medicare website and search by zip code. Here is a brief tutorial on finding plans.

  11. I visit Chatham County, Ga for about two weeks each year. I understand that Passport benefits are no longer available there. What exactly does this mean? Do I have health care coverage when I visit this location?

  12. Barbara, If the Passport benefits are not available, your only coverage when in Chatham County will be for emergency or urgent care. With only two weeks per year, it sounds like you will be fine.

  13. I am interested in doing housesitting. Is there a site I can visit to determine those areas I can use my Passport services with AARP United Healthcare?

  14. Linda, Call member services and ask for a Summary of benefits. That will include the information you are looking for.

  15. Is NJ and Florida part of the United Healthcare passport areas?

  16. Judy, If you are enrolled in a United Healthcare plan it may be easier to call member services. Apparently a full list of which areas are included in the Passport program are a secret. After searching the web the information is not readily available. The most recent comprehensive information I could find was for 2012. At that time it was not available in all New Jersey Counties but was available Statewide for Florida. It is also not included in all plans.

  17. Thank you. I was beginning to think it was some big secret because I’m pretty good at the internet and it was nowhere to be found.

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