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To be eligible for a Medicare HMO, PPO
or PFFS:
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1. You must have both Part A (hospital) and Part B
(medical) Medicare.
2. You cannot be medically determined to have end-state renal disease
(ESRD).
3. You must live in the area in which the plan has agreed to provide
services
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Medicare Advantage
Plans such as HMOs, PPOs and PFFSs must accept enrollees in the
following situations:
1. Initial Coverage Election Period.
This is a seven-month period beginning three months before the
65th birthday. The effective date for the HMO coverage is
same as the first day of entitlement to both Part A and Part B
Medicare.
2. Annual Election Period takes
place from November 15 to December 31, 2007. During this period Medicare
beneficiaries are able to choose between the Original Medicare program
and a Medicare Advantage plan (HMOs and PPOs are the prime
examples). Those in Original
Medicare fee-for-service who fail to make an election remain in
Original Medicare.
In addition to the above standard enrollment opportunities,
the Medicare Prescription Drug, Improvement, and Modernization Act
(MMA) provided a one time Open Enrollment Period (OEP) between January
1, 2008 and March 31, 2008 with a limited option to change plans. Assuming the Medicare beneficiary had
enrolled in a MA-PD during the Annual Election Period, he/she can only
switch to another MA-PD, if it is open for enrollment, or go back to
Original Medicare and a stand alone PDP
Updated: January 4, 2008
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