Enroll online or download an enrollment form.
Medicare Enrollment Options
If you would like to enroll in a CDPHP Medicare Choices plan outside of the Medicare Advantage Annual Enrollment Period (AEP), you may qualify for a Special Enrollment Period (SEP). Please review and complete this attestation and fax it, along with a completed enrollment form, to (518) 641-4606. Or, mail it to:
CDPHP Medicare Sales
500 Patroon Creek Blvd.
Albany, NY 12206-1057
The quickest and easiest way to enroll in your Medicare plan is to do it all online. Simply click on the link below and follow the step-by-step instructions.
If you prefer to enroll by mail or fax, just download the form that suits you best and follow the instructions included with the form. Then mail or fax it back to us.
CDPHP Medicare Choices HMO Plans - Available to Medicare-eligible beneficiaries residing in Albany, Broome, Chenango, Columbia, Delaware, Dutchess, Essex, Fulton, Greene, Hamilton, Herkimer, Madison, Montgomery, Oneida, Orange, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Tioga, Ulster, Warren, and Washington counties in New York state.
CDPHP Medicare Choices HMO Enrollment Form
Y0019_H3388 13-2001 CMS Accepted
CDPHP Medicare Choices PPO Plans - Available to Medicare-eligible beneficiaries residing in Albany, Broome, Chenango, Columbia, Delaware, Dutchess, Essex, Fulton, Greene, Hamilton, Herkimer, Madison, Montgomery, Oneida, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Tioga, Ulster, Warren, or Washington counties.
CDPHP cannot process Medicare Advantage enrollments before October 15, 2012. The Annual Election Period occurs October 15, 2012 through December 7, 2012. During this time, eligible individuals may enroll in or change Medicare Advantage plans. Coverage will be effective January 1, 2013.
If you decide to mail in your enrollment application prior to October 15, 2012, CDPHP will retain your application and begin processing it on October 15, 2012. You will receive acknowledgement letters from CDPHP when your application is processed, along with a confirmation letter and ID cards from CDPHP when your application is approved by the federal government.
You may enroll in only one Medicare Advantage plan at a time and you may join or leave that plan at certain times of the year or in special circumstances.
Medicare beneficiaries may also enroll in CDPHP Medicare Choices plans through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at www.medicare.gov. For more information contact CDPHP Medicare Choices Customer Care.
Medicare Advantage Disenrollment (Leaving the Plan)
"Disenrollment" means ending your membership in CDPHP Medicare Choices plans. View the Evidence of Coverage for HMO or the Evidence of Coverage for PPO for more information on the rules that apply and your coverage choices after you leave.
Potential for Contract Termination for Medicare Advantage Plans
All CDPHP Medicare Choices plans agree to stay in the Medicare program for a full year at a time. Each year, CDPHP decides whether to continue for another year. If CDPHP decides not to continue, we must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area, and your options will always include Original Medicare. All of the benefits and rules you had under CDPHP will continue until your membership with CDPHP ends.
Additional Help for Low-Income Beneficiaries
You may be one of the millions of beneficiaries who qualify for reduced premiums and decreased cost-sharing for prescription drug expenses. Additional support is available depending on your situation (taking into consideration your assets, savings, and stocks, but not including the value of your home). For more information about this support, call 1-800-MEDICARE (1-800-633-4227) or your local Social Security office. If you think you qualify for extra help with your prescription drug costs but you don’t have or can’t find proof, please read the CMS Best Available Evidence (BAE) policy.
You may wish to view the Low Income Subsidy Website Premium Summary Table for Those Receiving Extra Help(Y0019_13_7011 CMS Accepted). This document informs potential enrollees of what their plan premium will be once they are eligible and receive the low-income subsidy.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for 75 percent of drug costs, including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.
CDPHP refers to both the Capital District Physicians’ Health Plan, Inc., a Medicare-approved HMO plan, and CDPHP Universal Benefits®, Inc., a Medicare-approved PPO plan. CDPHP is a health plan with a Medicare contract. To join, you must have Medicare Parts A and B and live in the service area.
Y0019_13_10034 CMS Approved 10/22/2012
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