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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, 2010. 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, 2010 and March 31, 2010 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: March 22, 2010
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