Medicare Managed Care Eligibility and Enrollment

What’s New?

New! Revisions to the CY 2026 MA Model Enrollment Request Form

On May 6, 2025, CMS released the “Advance Announcement of January 2026 Software Release - Revisions to the Model Individual Enrollment Request Form to Enroll in a Medicare Advantage Plan (MA) or a Medicare Prescription Drug Plan (Part D)” memorandum via HPMS. This memorandum announces the removal of voluntary race, ethnicity, sexual orientation, and gender identity data fields from the model MA and Part D Individual Enrollment Request Form (OMB No. 0938-1378) with an application date of January 1, 2026, or later.

MA plans are expected to use the new form for all enrollment requests received on or after January 1, 2026. Changes noted in this memo apply to all model enrollment forms in the enrollment guidance.

Revisions to the Medicare Cost Plan Enrollment and Disenrollment Instructions

On January 8, 2025, CMS released the “Updated Medicare Cost Plan Enrollment and Disenrollment Instructions” memorandum via HPMS to provide guidance updates. These changes are related to the revised Special Election Period for dually eligible individuals and other low-income subsidy (LIS) eligible individuals and its effect on cost plans offering a Part D Optional Supplemental Benefit. Other general changes include: 

• Updating references to the Medicare Advantage (MA) and Part D Enrollment and Disenrollment Guidance. 

• Using language referring to individuals/enrollees and expressing numeric values as words, consistent with the MA and Part D Enrollment and Disenrollment Guidance. 

• Revising model enrollment forms to more closely align language with MA and Part D model forms. 

• Removing language from exhibits about the coverage gap phase of the Part D benefit, which ended on December 31, 2024. 

• Removing outdated times for contacting the Social Security Administration from exhibits. 

Updated MA and Part D Enrollment and Disenrollment Guidance for CY 2025

On August 8, 2024, CMS released the “Medicare Advantage and Part D Enrollment and Disenrollment Guidance” memorandum via HPMS to announce the updates to the enrollment and disenrollment guidance for MA and Part D plans for 2025. The updated appendices, model notices, and exhibits for MA and Part D plans are provided in separate documents.

Plans are expected to use the new guidance for all requests received on or after January 1, 2025. Plans may, optionally, use the updated guidance for AEP enrollments effective January 1, 2025.

Guidance improvements include:

• Reduction of duplicative language between existing chapters, reducing overall page count by ~130 pages.
• Use of plain and consistent language across the MA and Part D programs.
• Use of graphics, tables, and text boxes to improve clarity.
• Content updates to reflect recent rulemaking effective in 2025.

Overview

This page contains information for Medicare Advantage (MA) organizations, other health plans, and other parties interested in the policy and operational aspects of Medicare health plan enrollment and disenrollment.

The guidance on this page covers the enrollment and eligibility provisions set forth at 42 CFR § 417, Subpart K, 42 CFR § 422, Subpart B and 42 CFR § 423, Subpart B. It addresses eligibility requirements for enrollment and disenrollment, the election process, election periods, and effective dates of coverage for both Medicare Advantage (MA) organizations, other Medicare health plans, and Part D plan sponsors.

To join a Medicare health plan, an individual must:

• Have Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
• Live in the service area of the plan you want to join.
• Be a U.S. citizen or lawfully present in the U.S.
• Complete an enrollment request during a valid election period.

There are six types of election periods:

1. Initial Enrollment Period for Part D (Part D IEP)
2. Initial Coverage Election Period (ICEP)
3. Annual Coordinated Election Period (AEP)
4. Medicare Advantage Open Enrollment Period (MA OEP)
5. Open Enrollment Period for Institutionalized Individuals (OEPI)
6. Special Election Periods (SEPs)