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OMB No. 09381378 Expires: 7/31/2023Medicare Advantage/Medicare Advantage Prescription Drug Individual Enrollment Request Form Who can use this form? People with Medicare who want to join a Medicare
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How to fill out medicare advantagemedicare advantage

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To fill out Medicare Advantage, follow these points:
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Start by gathering all necessary personal information, such as your name, address, phone number, and Social Security number.
03
Contact a Medicare Advantage plan provider or visit their website to obtain an enrollment form.
04
Fill out the enrollment form accurately and completely, providing all required information.
05
Review the form to ensure everything is filled out correctly.
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Sign and date the form.
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Submit the completed form to the Medicare Advantage plan provider either by mail or online, following their specific instructions.
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Keep a copy of the completed form for your records.

Who needs medicare advantagemedicare advantage?

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Medicare Advantage is for individuals who are eligible for Medicare Part A and Part B, also known as Original Medicare. It is particularly beneficial for those who want more coverage than what Original Medicare provides.
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Specifically, the following individuals may benefit from Medicare Advantage:
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- Individuals who want coverage for prescription drugs (Medicare Part D)
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- Individuals who prefer a single plan that combines Medicare Part A (hospital insurance) and Part B (medical insurance) coverage
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- Individuals who desire additional benefits beyond what Original Medicare offers, such as dental, vision, or hearing coverage
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- Individuals who wish to have a cap on their out-of-pocket expenses for covered services
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- Individuals who want the convenience of having all their healthcare needs managed under a single plan
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Medicare Advantage is a type of Medicare health plan offered by private companies that contracts with Medicare to provide all your Part A and Part B benefits.
Individuals who are eligible for Medicare can choose to enroll in Medicare Advantage.
You can enroll in Medicare Advantage during the initial enrollment period, the annual open enrollment period, or during special enrollment periods.
The purpose of Medicare Advantage is to provide additional coverage options beyond traditional Medicare, such as vision, dental, and prescription drug coverage.
Medicare Advantage plans must report information on the benefits, network, quality of care, and costs associated with the plan.
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