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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.

CMS Notice to Individuals Enrolled in Plans with Fewer Than Three Stars for Three or More Consecutive Years

CMS will further the goals of facilitating beneficiary enrollment into higher quality plans by issuing notices to individuals enrolled in plans with fewer than three stars for three consecutive years.  The notices inform enrollees of an opportunity to contact CMS to request a special enrollment period (SEP) to move into a higher quality plan.  Plans are not able to effectuate enrollments for this one-time SEP; all requests must come into CMS via 1-800-MEDICARE by the beneficiary and will be handled on a case-by-case basis. Spanish and English notices are  mailed to current members in October and notices are sent to new members in February. Copies of the notices are available below.

Revisions to the MA and §1876 Cost Plan Enrollment and Disenrollment Guidance for CY 2014

On August 30, 2013, CMS released a memo in our Health Plan Management System (HPMS) that revised the 2012 MA Enrollment and Disenrollment Guidance (updated for CY 2013 on August 7, 2012) and the 2013 Cost Plan Enrollment and Disenrollment Guidance (updated on November 21, 2012) for CY 2014. The CY 2014 guidance is now available below with the file names: CY 2014 MA Enrollment and Disenrollment Guidance and CY 2014 Cost Plan Enrollment and Disenrollment Guidance. The HPMS memo summarizing all the clarifications is also available below.

All enrollments with an effective date on or after January 1, 2014, must be processed in accordance with the revised guidance requirements, including revised model notices provided.