Joining, Switching and Dropping Medicare PPO Plan

Joining a Medicare PPO Plan

There are certain eligibility requirements for joining a Medicare PPO Plan

  • The member must have or be eligible for both Original Medicare Part A and Part B.
  • The member needs to reside in the plan's local service area.
  • The member cannot have ESRD.

NEW 2012 Add, Drop Join Rules for Medicare PPO Plans

In 2012 there is a new Medicare incentive program that is designed to get as many Medicare recipients onto good plans as is possible. Starting December 8, 2011 and going into 2012 you will no longer need to wait until Open Enrollment to join a 5-star PPO Plan in your area. Under this new provision if you are eligible for the plan and live in the plan's service area you can join the plan and drop your old plan at any time during the year. You can only do this one time per year and the prevision is reserved only for 5-star plans. Medicare Cost Plans are excluded from the program. These 5-star PPO plans have been voted by other Medicare recipients as excellent plans. The usual 12-month trial period still applies to these plans.

Normal Medicare Enrollment Periods for PPO Plans

Every eligible Medicare recipient has an Initial Open Enrollment Period that includes the 7 months surrounding his or her 65th birthday. During this time they can sign up for a PPO plan. Disabled individuals also have a 7th month Initial Enrollment Period which surrounds their 25th month of disability. For both groups of people the best benefits are available during this 7-month window. Take advantage of the first three months in order to have your plan start on your 65th birthday.

Every year after Initial Enrollment in Medicare a member has the chance to change plans. This is known as the Open Enrollment Period. This year for PPO Plan's Open Enrollment in between October 15- December 7, 2011 with coverage commencing in January 2012.

Switching and Dropping PPO Plans

To switch to a new PPO Plan from another plan you only have to sign up and your old plan will be contacted and they will disenroll you. You can do this anytime for a 5-star plan or during Open Enrollment form October 15- December 7, 2011.

Returning to Original Medicare happens at a different time. Between January 1-14th you can leave your PPO plan and return to Original Medicare. You will have an additional month until February 14th, to sign up for a Medicare Prescription Drug Plan if you need one.