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MAOs may offer simplified enrollment via paper, telephone or electronically, as outlined in § 40.1. For telephonic or electronic requests, the plan may limit the data to be collected from the applicant to those items it does not already have.

The MAO must ensure the data elements outlined in § 40.1 is collected for the simplified enrollment process.

Organizations are encouraged, but not required, to request premium payment option information in the simplified enrollment request. In the absence of a stated preference by the applicant, individuals are to be placed in direct billing status, as outlined in § 60.3.1. Additionally, the parameters outlined in §§ 40.1 must be met based on the method of the simplified enrollment request (telephonic, electronic, or paper).

Enrollments requested using this mechanism are the same as any other new ICEP enrollment the plan receives and should be processed similarly.

Example: Mr. Smith is turning 65 in June and is enrolled in commercial coverage with an organization named Good Insurance. Good Insurance identifies in its records that Mr. Smith’s Medicare Part A and B Initial Enrollment Period begins in March. Based on its data from Mr. Smith’s commercial enrollment, Good Insurance knows that Mr. Smith lives in the service area of MA plans that Good Insurance offers.

A representative of Good Insurance calls Mr. Smith in May and identifies herself as his commercial health insurance plan. Using the plan’s internal protocols, she confirms his identity on the call. In this call, she informs Mr. Smith that because he is soon to be eligible for Medicare, he can enroll in a plan that Good Insurance offers, just for people with Medicare. She provides information on Good Insurance MA plans available in Mr. Smith’s area and asks if he is interested in enrolling in one of these plans or learning more. Mr. Smith expresses his interest in enrolling in Good Insurance’s MA plan with prescription drugs. Good Insurance already has Mr. Smith’s personal information via its internal systems and, while on the call, the representative obtains what is needed for the MA enrollment that Good Insurance does not already have. The representative uses this information to complete the telephonic enrollment request in Good Insurance’s internal MA enrollment system. Good Insurance confirms the MA plan Mr. Smith wants to enroll in and asks for his Medicare number. Good Insurance explains the legal requirements for enrollment, release of information, and confirms Mr. Smith’s understanding and acknowledgement/approval to process the request. Good Insurance also provides information to Mr. Smith to process his disenrollment from the commercial coverage to be effective as of May 31. Good Insurance processes the telephonic enrollment the same as other received requests and submits the enrollment transaction to CMS. Mr. Smith’s MA plan coverage will begin on June 1, when his Medicare coverage begins.

40.1.8 – Auto- and Facilitated Enrollment 42 CFR § 423.34