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OMB No. 09381378 Expires: 7/31/2024EXHIBIT 1: MODEL INDIVIDUAL ENROLLMENT REQUEST FORM TO ENROLL IN A MEDICARE ADVANTAGE PLAN (PART C) OR MEDICARE PRESCRIPTION DRUG PLAN (PART D) Who can use this
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How to fill out a medicare advantage plan

How to fill out a medicare advantage plan
01
Gather all necessary information such as personal details, Medicare ID, and current healthcare coverage.
02
Research and compare different Medicare Advantage plans offered in your area.
03
Contact the insurance provider offering the plan you choose and request an application form.
04
Fill out the application form accurately and completely, providing all required information.
05
Review the filled-out application form to ensure accuracy before submitting it to the insurance provider.
Who needs a medicare advantage plan?
01
Individuals who are already enrolled in Medicare Parts A and B.
02
Those looking for additional benefits beyond what original Medicare covers.
03
People who prefer a single plan that combines hospital, medical, and prescription drug coverage.
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What is a medicare advantage plan?
A Medicare Advantage plan is a type of health insurance plan offered by private companies that provides Medicare benefits, including coverage for hospital stays, outpatient care, preventive services, and often additional benefits like prescription drug coverage.
Who is required to file a medicare advantage plan?
Individuals who are enrolled in Medicare and choose to receive their Medicare benefits through a Medicare Advantage plan instead of Original Medicare are required to file for enrollment in a Medicare Advantage plan.
How to fill out a medicare advantage plan?
To fill out a Medicare Advantage plan application, individuals typically need to visit the Medicare website or the website of the private insurer, provide personal information, including Medicare number, contact information, and choose a plan that fits their needs.
What is the purpose of a medicare advantage plan?
The purpose of a Medicare Advantage plan is to provide an alternative way to receive Medicare benefits, often with additional coverage options and potentially lower out-of-pocket costs compared to Original Medicare.
What information must be reported on a medicare advantage plan?
When enrolling in a Medicare Advantage plan, individuals must report personal information such as name, address, Medicare number, date of birth, and any other relevant health information required by the insurer.
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