How To Become A Member?

To become an American Health Medicare member, you have three options:

Option 1: If you’d prefer a Service Representative to visit your residence, call 1-866- 620-2420 or 1-866-620-2520 from Monday – Sunday 8:00am to 8:00pm to set up an appointment or to request information. TTY/TDD users should call 1-866-620-2520 to receive more information or set up a visit.

Option 2: You may request an orientation about our plans by visiting one of our Regional Offices throughout the Island. Click here to find the nearest Regional Office.

Option 3: You may download and complete the form at the end of this page and send it to one of our Regional Offices.

Do you want a representative to contact you? Fill out this Scope of Appointment Form.

Important Information About the Enrollment Periods:

Initial Enrollment Period

During the Initial Enrollment Period, you must enroll in Medicare Parts A and B as well as in Medicare prescription drug plan. This period lasts seven (7) months: three (3) months prior to the beneficiary’s birthday, the beneficiary’s birthday month, and three (3) months after.

Annual Enrollment Period

Starting this year, 2011, the Annual Enrollment Period will begin on October 15 and end on December 7.

Medicare Advantage Disenrollment Period

Starting this year, the period beginning January 1st to February 14, will be a Medicare Advantage Disaffiliation Period. During this period you can only change to Medicare Original and enroll in a Medicare Prescription Drug Plan. You can’t change from one Medicare Advantage Plan to another.

Special Enrollment Period (SEP)

The Special Enrollment Period can be at anytime of the year. There are several reasons why a member could be eligible for a Special Enrollment Period. Some of them are:

• The member moves outside the coverage are for a period longer than 6 consecutive months.
• Breach of contract – the member demonstrates that the plan did not comply with the stipulated contract or the sales agent did not correctly represent the plan.
• Termination of contract
• The contract was not renewed
• The beneficiary is eligible for Medicare and Medicaid (for example, Medicare Platino)
• Special conditions such as diabetes

Questions and Answers

1) Could I be dropped or discharged from a Plan as a result of too many claims or visits to the doctor?

No. You may only be dropped or discharged for one of the reasons explained below. If American Health Medicare should discharge you for any of these reasons, we will provide a written notification that includes information on how to appeal our decision.

• You permanently move outside of the area of coverage for 6 or more consecutive months.
• You lose your rights to Medicare Part A or B.
• The contract between American Health Medicare and CMS (Centers for Medicare & Medicaid Services) is cancelled or American Health Medicare’s service area is reduced.
• You make a fraudulent declaration on your enrollment form or you improperly use your member id card number.
• You exhibit altered, inappropriate or abusive behavior to the point that you limit our capacity to offer services. CMS has to approve the discharge and notify through written form.

2) Can I disenroll from American Health Medicare?

Yes. Medicare allows enrollment during specific periods throughout the year (Annual Enrollment Period) and allows you to choose the manner in which you wish to receive healthcare services and the Medicare Prescription Drug Plan. During the Annual Enrollment Period you can choose from:

• Switching from a Private Fee-for-Service Plan to a Medicare Advantage Plan
• Switching from a Medicare Advantage Plan to another Medicare Advantage Plan
• Switching from a Medicare Advantage Plan to a Private Fee-for-Service Plan
• Switching from Medicare Original to a Medicare Advantage Plan

Beneficiaries may make as many changes as desired during the Annual Enrollment Period, from October 15 to December 7. Your new Healthcare Plan and/or the Prescription Drug Plan will start the following 1st of January with your last chosen option.

If you should decide not to choose any option during the Annual Affiliation Period, you will automatically continue receiving your Medicare services as you have been doing regularly. From January 1 to February 14, any person that has a Medicare Advantage Plan has an opportunity to change the way in which he or she receives their Medicare benefits. However, during this period he/she will only be able to change to Medicare Original and add one Medicare Prescription Drug Plan.

Generally, you may not make any other change throughout the year except in specials cases such as if you move outside of the service area or if you have Medicare and Medicaid coverage. For those with dual eligibility (those who are in the ASES Platino Program, Medicaid), you may enroll, change, or disenroll from the plan at any given moment of the year.

2012 Enrollment Request Forms

• Enrollment Form MA H5774_2001_12_02_E CMS Approved 09262011
• Enrollment Form MAPD H5774_2001_12_01_E CMS Approved 09212011
• Enrollment Form AHM_Platino Plus H5774_2001_12_03_E CMS Approved 09212011

Last Updated 01/01/2012