This section of the Medicare Part D enrollment form usually is the very first section and is sometimes started with the title: "Please Provide the Following Information"
Clearly mark which plan you would like to enroll in, by filling in the entire square next to the plan name. A few enrollment forms also require that you enter the price of the plan and/or the plan id.
Both can be found through our PDP-Finder
. Just select your state and enter the partial plan name such as Cigna
in PDP-Finder and you will be shown the Plan ID and Premium along with other plan details.
This section of the enrollment form is sometimes started with the title:
"Please Provide the Following Information"
It is very important that you enter the information in this section clearly and accurately. The phone number is critical because if there is a problem with your application, the insurance company will need a fast way to get in touch with you. The date of birth must match what is on file with Medicare and Social Security.
Common Mistake: If the date of birth does not match what is on file with Medicare, you application will be denied for incorrect information!
Be sure to enter both your email address (becoming just as important as your phone number) and the information for an Emergency Contact.
Medicare Insurance Information
Many common mistakes occur in this section of the application!
It is critical that you copy the information from your Red, White, and Blue Medicare Card accurately and clearly. Please double - and triple check the accuracy.
Common Mistake: If any of the information in this section does not match what is on file with Medicare, you application will be denied for incorrect information!
Paying Your Plan Premium
In this section, you select how you would like to pay your Medicare Part D plan premium.
Remember: The U.S. Department of Health & Human Services says, "It generally takes about two months from the time your Medicare drug plan submits the request for the premium deduction to start [before the payments are withdrawn]. This means that most of the time, the first time premiums are withheld from your Social Security benefit, two monthly premium payments will be withheld at the same time. Social Security will deduct only the cost of one monthly premium payment from your monthly Social Security benefit after that."
Note: we have had clients say that it has taken sometimes up to six months for the payments to be deducted.
Coordination of Benefits - "Please Answer the Following Questions"
This very important sections is sometimes entitled: "Please Answer the Following Questions"
This section tries to determine if you have other coverage which must be coordinated with your prescription drug coverage.
Please read and answer the questions very carefully.
Common Problem: If you currently have an employer plan that will end soon and you are attempting to enroll in a plan that will start as soon as your employer plan ends, the questions in this section can be a bit tricky. You must keep in mind that Medicare is trying to make sure that you do not loose your employer coverage by enrolling in a Prescription Drug Plan. So if the question is stated as: " At the time of enrollment will you or your spouse (if married) have group health coverage? YES / NO The answer would be NO. the "time of enrollment" is not right now as you are filling out the enrollment form. The "time of enrollment" is the date on which the new plan will take effect. This is generally the first day of the month after you enroll (unless you are just turning 65 and enroll during the three months prior to your eligibility month -- then your plan will start the first day of the month of your eligibility).
STOP - Please Read This Important Information
This section makes you aware of the fact that if you already have coverage through an employer plan or Medicare Advantage plans such as an HMO or PPO, you may loose your current coverage if you enroll in a Medicare Part D Plan.
Please Read and Sign Below
Most of the enrollment forms simply have you read the disclaimer and sign at the bottom. The WellCare enrollment form wants you to initial next to each point and sign at the bottom.
Please read carefully. Do not forget to sign and date the disclaimer.
If a representative is completing the enrollment form for the beneficiary, be sure to complete the section for the representative. You must have a Medical Power of Attorney to sign for the beneficiary. Some, but not all, enrollment form require that you send the Medical Power of Attorney along with the enrollment form.
Information to Determine Enrollment Periods
This section only appears in a few of the enrollment forms. Please read the options and select the box that be meets your situation.
Common Mistake: Medicare will deny your application if you select the wrong enrollment period. This section is VERY important. On the applications that do not have this section, your insurance agent or the insurance carrier determine which enrollment period is appropriate by the information and answers you have entered on the enrollment form.
Medicare Prescription Drug Plan Use Only / Producer Use Only
You do not need to enter any information in this section. However it contains valuable information!
In this section, you will find the name, phone number and sometimes email address for the insurance agent responsible for your application. You can contact this person should you need to.