Medicare Managed Care Eligibility and Enrollment

This page contains information for current and future contracting Medicare Advantage (MA) Organizations, other health plans and other parties interested in the operational and regulatory aspects of Medicare health plan enrollment and disenrollment.

NEW! – Revisions to the 2012 MA Enrollment and Disenrollment Guidance for CY 2013

CMS has released a memo in our Health Plan Management System (HPMS) that revises the 2012 MA Enrollment and Disenrollment Guidance (previously revised on November 16, 2011) for CY 2013. The CY 2012 guidance has been updated and is now available below with the file name: Final MA Enrollment and Disenrollment Guidance Update for CY2012-Revised 8.7.2012 for CY 2013. The HPMS memo summarizing all the clarifications is also available below.

Notes Regarding the Revised MA Enrollment and Disenrollment Guidance for CY 2013 (Note: Updated on September 4, 2012):
CMS has corrected some unintentional inconsistencies between the August 7, 2012 HPMS memorandum and  the CY 2013 guidance revisions. The final guidance revisions have been replaced below and include all items outlined within the HPMS memorandum. Some areas of the guidance did not show the text being removed or changed from the last update; this has been corrected. In addition, the following sections were corrected to match the guidance outlined in the HPMS memorandum:  Introduction language at the beginning of the chapter, §10 – definition for “completed election”, §40.4, and Exhibit 20.  Please use the corrected version as of September 4, 2012. We apologize for any inconvenience.

All enrollments with an effective date on or after January 1, 2013, must be processed in accordance with the revised guidance requirements, including new model enrollment forms and notices provided.

NEW! – Draft Update of the Cost Plan Enrollment and Disenrollment Guidance for CY 2013
Thank you for your comments to the draft cost plan Enrollment and Disenrollment Manual (Chapter 17d).  CMS is working to finalize the sub-chapter and release it as soon as possible.  The draft guidance remains available for plans to review areas of potential change for CY 2013.

We recognize the need for plans to have adequate time to prepare enrollment materials to coincide with the Medicare Annual Election Period. Thus, cost plans who have already submitted their enrollment materials for marketing review or who plan to use the CY 2012 models may continue to do so for this Annual Election Period only.  We encourage cost plans to correct the eligibility statement on Exh. 1 (model cost plan enrollment form) if possible.  The language next to the picture of the Medicare card should read “You must have Medicare Part B to join a Medicare cost plan.”

Note that the this allowance for use of 2012 models and submitted non-model materials to CMS only applies to the enrollment notices (Exhibits 1 – 5a). Any changes in guidance to other exhibits must be made for use with enrollments or disenrollments with effective dates of January 1, 2013 or later.