Medicare Choices Enrollment

Enrollment

Complete Your Enrollment Online

Online enrollment is easy. Simply click the link below and you will be prompted to enter your information safely and securely.

Download an Enrollment Form

Download an enrollment application for your chosen CDPHP Medicare Choices plan. Follow the instructions included with the form. Complete the form and mail or fax to CDPHP.

• CDPHP Medicare Choices HMO Plans
• Available to Medicare-eligible beneficiaries residing in Albany, Dutchess, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, or Ulster counties.
• CDPHP Medicare Choices HMO Enrollment Form

• CDPHP Medicare Choices PPO Plans
• Available to Medicare-eligible beneficiaries residing in Albany, Broome, Chenango, Columbia, Delaware, Dutchess, Essex, Fulton, Greene, Hamilton, Herkimer, Madison, Montgonery, Oneida, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Tioga, Ulster, Warren, or Washington counties.
• CDPHP Medicare Choices PPO Enrollment Form

Enrollment Dates

CDPHP cannot process enrollments before November 15, 2009. The Annual Election Period occurs November 15, 2009 through December 31, 2009. During this time, eligible individuals may enroll in or change Medicare Advantage Plans. Coverage will be effective January 1, 2010.

If you decide to mail in your enrollment application prior to November 15, 2009, CDPHP will retain your application and begin processing it on November 15, 2009. You will receive acknowledgement letters from CDPHP when your application is processed, along with a confirmation letter and ID cards from CDPHP when your application is approved by the federal government.

You may only enroll in one Medicare Advantage Plan at a time and you may join or leave a Medicare Advantage Plan at certain times of the year.

Medicare beneficiaries may enroll in CDPHP Medicare Choices plans through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at www.medicare.gov . For more information contact the CDPHP Medicare Choices Customer Care.

Disenrollment - Leaving The Plan

"Disenrollment" means ending your membership in CDPHP Medicare Choices Plans. View your plan's Evidence of Coverage for the rules that apply and information on your Medicare coverage choices after you leave.

Potential for Contract Termination
All CDPHP Medicare Choices Plans agree to stay in the Medicare program for a full year at a time. Each year, CDPHP decides whether to continue for another year. If CDPHP decides not to continue, we must send you a letter at least 90 days before your coverage will end, and you will have to change to another way of getting your Medicare benefits. The letter will explain your options for Medicare coverage in your area, and your options will always include Original Medicare. All of the benefits and rules you had under CDPHP will continue until your membership with CDPHP ends.

Additional Help for Low-Income Beneficiaries

You may be one of the millions of beneficiaries who will qualify for reduced premiums and increased cost sharing. Additional support may be available depending on your situation (taking into consideration your assets, savings and stocks, but not including the value of your home). For more information about this support, call 1-800-MEDICARE (1-800-633-4227) or your local Social Security office. If you think you qualify for extra help with your prescription drug costs but you don’t have or can’t find proof, please read the CMS Best Available Evidence (BAE) policy.

You may wish to view the "Low Income Subsidy Website Premium Summary Table for Those Receiving Extra Help." This document informs potential enrollees of what their plan premium will be once they are eligible and receive the low-income subsidy.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7days a week;
• The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
• Your State Medicaid Office.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for seventy-five percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.