TN 6 (10-07)

HI 00208.072 Handling Medicare Advantage (MA) Inquiries and Problem Cases

CAUTION: Do not attempt to provide detailed responses to questions about the MA program or counsel individuals in their choice of MA plan.

A. Procedure — MA inquiries

1. Beneficiaries requesting printed material

Refer beneficiaries who request the following printed material to CMS at 1-800-MEDICARE; TTY users call 1-877-486-2048:

  • Medicare and You in Spanish

  • Information on MA MSA plans

  • List of MA plans available in beneficiary’s area

2. Selecting an MA plan

Refer beneficiaries who require assistance in selecting an MA plan to:

  • CMS at 1-800-MEDICARE; TTY users call 1-877-486-2048 or,

  • The State Health Insurance Assistance Program (SHIP). Each State has a SHIP which can answer questions concerning health care options and the MA program. Refer to HI 00208.073B for State SHIP telephone numbers.

3. Beneficiaries requesting enrollment

Beneficiaries who wish to enroll in a MA plan should contact the plan directly to request enrollment with the plan.

B. Procedure — MA enrollment/disenrollment cases

1. Enrollment in Premium - HI

Follow the procedures in HI 00801.142 through HI 00801.144 if the beneficiary requests enrollment in Premium - HI.

2. All enrollment/disenrollment cases

In all enrollment/disenrollment cases, take the following actions:

  • Advise the beneficiary to contact the MA plan for resolution.

  • Beneficiaries may also contact 1-800-MEDICARE (TTY 1-877-486-2048)

  • If the beneficiary is unsuccessful and has come into the SSA FO, take a statement from the beneficiary on Form SSA-795 explaining the problem. Forward the SSA-795 along with an MEQY to the servicing CMS RO.

  • If the beneficiary is unsuccessful and has contacted the TSC, take a statement from the beneficiary on Form SSA-5002 explaining the problem. Forward the SSA-5002 along with an MEQY to the servicing CMS RO.

C. Process — CMS RO-Handling problem cases

Any follow-up action needed between CMS and the beneficiary relative to this case is conducted by the CMS RO.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600208072
HI 00208.072 - Handling Medicare Advantage (MA) Inquiries and Problem Cases - 04/08/2015
Batch run: 04/08/2015
Rev:04/08/2015