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Enroll
Usually you may enroll in a Medicare Advantage Plan only during the annual enrollment period, the open enrollment period, or during a special enrollment period.
If you have both Medicare and full Medicaid benefits, you are entitled to a continuous special election period. This means that you can enroll at any time during the year.
Annual Election Period
November 15, 2008, through December 31, 2008, is the Annual Election Period for 2009. During this time you can switch from one way of getting Medicare to another. You have the opportunity to choose the plan that’s best for you. The change will take effect on January 1, 2009.
Open Enrollment Period
January 1, 2009, through March 31, 2009, is the Open Enrollment Period. During this time you have the opportunity to change to another Medicare Advantage plan with drug coverage or to Original Medicare with a stand-alone prescription drug plan. You may also change from a medical-only Medicare Advantage plan to another medical-only plan. You may not drop or add drug coverage during this time.
Special Election Period
The Special Election Period is a special period of time during which you may enroll. For instance if you:
- are turning 65 and are newly eligible for Medicare in 2009
- have just moved into the plan’s service area
- are enrolled in another prescription drug plan or a Medicare Advantage plan whose 2009 contract is terminated
- have full Medicaid benefits or prescription drug assistance through PACE
This is not a complete list. To obtain more information about these election periods, please call 1-877-393-6733 (TTY/TDD: 1-877-219-5457), 8 a.m. to 8 p.m., seven days a week.
You may enroll online, by phone or by mail:
Completing your application
If you prefer to enroll by phone, need help completing the form, or if you have any questions concerning our plans, just call our toll-free number at 1-877-393-6733 (TTY/TDD: 1-877-219-5457), 8 a.m. to 8 p.m., seven days a week.
If anyone helps you fill out your application, that individual must sign the form and indicate his or her relationship to you.
No premium payment is required at time of enrollment.
Once your application has been processed, we will notify you of your effective date and we’ll send you a member packet that includes your identification card, your Evidence of Coverage, and other important information.
Enroll online
Click on the plan you would like to join, and complete the online enrollment form.
Enroll by phone
Call toll-free 1-877-393-6733 (TTY/TDD: 1-877-219-5457), 8 a.m. to 8 p.m., seven days a week.
Enroll by mail
Click on your selected plan to download the application form.
| Enroll me in | Mail completed applications to |
|---|---|
 Keystone 65 Value/Advantage/Preferred |
Keystone 65 Medicare Department PO Box 13713 Philadelphia, PA 19101-3717 |
| Keystone 65 Complete |
Keystone 65 Complete Medicare Department PO Box 13713 Philadelphia, PA 19101-3717 |
| Select Advantage Silver |
Select Advantage Medicare Department PO Box 37679 Philadelphia, PA 19101-0679 |
| Personal Choice 65 Standard |
Personal Choice 65 Medicare Department PO Box 13713 Philadelphia, PA 19101-3717 |
Disenrollment
Please note this important information about disenrollment:
- If you move out of the area that your plan serves, you must notify the plan so you can disenroll and find a new plan in your new area.
- If you intentionally provide false information on your enrollment form, you will be disenrolled from the plan.
- You may disenroll from our plan only at certain times of the year, or under certain special circumstances, by sending a written request.
Send a written request for disenrollment to:
Independence Blue Cross
Medicare Department
PO Box 13713
Philadelphia, PA 19101-9606
Or you can call 1-800-MEDICARE (1-800-633-4227) (TTY/TDD: 1-877-486-2048), 24 hours a day/7 days a week.