Medicare Requirements for Providers and Online Enrollment

by Mary Jane Stern

The great part about today’s technology is you can enroll in different Medicare plans over the Internet.  This is a great tool offered by most major providers for Part C and Part D plans.  It can save you a lot of time and you can find answers quickly and not be forced into making a decision immediately.

Medicare does, however, have requirements for providers offering enrollments over their internet website.  All websites must be approved by CMS for review and receive approval.

Providers must have the following information on their site via links and the links must be active. If a link is inactive (or doesn’t work) there needs to be a notification (e.g., under construction, coming soon).

• Summary of Benefits;
• Enrollment Instructions and Forms;
• Evidence of Coverage ;
• LIS Premium Summary Chart;
• Privacy Notice (privacy notices are subject to enforcement by the Office of Civil Rights);
• Plan Transition process information via a link from the Medicare Prescription Drug Plan Finder (http://www.medicare.gov/MPDPF/home.asp.) to the organization’s website;
• Information related to the plan’s exception and appeals process, including instructions and forms required to file and complete a coverage determination (including an exception) or appeal request; and
• Provide a link on their website to the section of CMS’ website regarding Best Available Evidence (BAE) policy and make information about BAE policy readily available for those who contact the plan sponsor’s call center.

If you decide to enroll online here are other requirements:

• All plans must follow the marketing regulations as outlined in 42 CFR 422.
• Plan providers cannot offer you other lines of their business during the enrollment process.
• All plans must have contact information on their website and toll free telephone and TTY number.
• The plan must have some type of tracking mechanism as evidence of Internet enrollment.
• Must send you a confirmation email showing receipt of the online enrollment.
• Must provide you with a summary plan.
• Provide a statement that the enrollee will receive a notice in the mail acknowledging receipt of the completed enrollment request or requesting additional information.

These items are mandatory and if you don’t see them the on the website, STOP your enrollment immediately and call their customer service department to have them point you in the right direction.  Most of the customer service departments are generally very helpful and can walk you through the whole process.

Sometimes things are just hard to find on websites and you have to search for the links.