You have three options to become an American Health Medicare affiliate:

STEP 1: If you prefer for a Service Representative to visit you at your place of residence, call 1-866-620-2420 or 1-866-620-2520 to set up an appointment or to receive information.

STEP 2: You may visit one of our Regional Offices throughout the Island to receive information.

STEP 3: You may download or complete the form at the end of this page.

¿Could I be dropped or discharged from the Plan for too many claims or visits to the doctor?

No. You may only be dropped or discharged if: you move permanently outside the area of coverage for 6 consecutive months; you lose your right to Medicare Part A or B; the contract between American Health Medicare and the Medicare/Medicaid Service Centers is cancelled or the service area of American Health Medicare is reduced ; you make a fraudulent declaration in your form or use your member card number in an inappropriate manner; you exhibit altered, inappropriate or abusive conduct to the point that you limit our capacity to offer services (in this case CMS has to approve the discharge). A discharge or drop from the plan for this reason can only be carried out once we have informed you in writing the reason for the discharge and informed you of the complaint process of American Health Medicare. If American Health Medicare should discharge you or drop you for any of these reasons, we will notify you in writing beforehand.
The notification will inform you of any rights to appeal you
may have.

Can I leave American Health Medicare?

Yes. The Medicare Modernization Act of 2003, which applies to any company with a Medicare contract, introduced the so-called “Enrollment Lock-In”. This allows affiliation during a specific period throughout the year (Open Affiliation Period), and allows you to choose the manner in which you wish to receive healthcare services for the 2009 calendar year.

During the Open Affiliation Period you can choose from:

• Switching from a Charge-per-Service to a Medicare Advantage Plan
• From a Medicare Advantage Plan to another Medicare Advantage Plan
• From a Medicare Advantage Plan to a Charge-per-Service Plan
• From a Medicare Original to a Medicare Advantage Plan.  

Beneficiaries may carry out as many changes as desired during the Annual Affiliation Period, from November 15, 2009 to December 31, 2009 (45 days). They will begin in January 2010 with the last option chosen in 2009 (year). 
If you should decide not to choose any option during the Open Affiliation Period, you will automatically remain receiving your Medicare services as you have been doing regularly.
 
From January 1, 2009 to March 31, 2009 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 the period from January 1 and March 31 you will have limits in the type of plan that you may affiliate yourself to. You will not be able to add or eliminate the Medicare prescription medications during this period. For example, if you have Medicare prescription medications coverage you will only be able to join a plan that has Medicare prescription medications coverage or return to the Original Medicare Plan and affiliate yourself to a Medicare Prescription Medications Plan. If you do not have any Medicare Prescription Medications coverage, you may not use this option to obtain such coverage.
 
Generally you may not make any other changes throughout the year except in the case of special exceptions, such as if you move outside the service area of the plan or if you have Medicare and Medicaid coverage.

Do these customer periods and the “enrollment Lock-in” apply to Platinum Plan beneficiaries?

For dual eligible (for those who are in the Reform) you can affiliate yourself or exit the plan at any given moment and will not have a closing period after December 31, 2009.
 
Always count on our Affiliate Service Department. Should you have any questions or inquiries regarding your benefits with American Health Medicare, just call, toll-free, our Affiliate Service Department at 1-888-620-1919 or at 1-866-620-2520 for the hearing impaired (from 8:00 a.m. to 8:00 p.m., Mondays through Sunday). Our dedicated Service Representatives will gladly provide you with the information that you need to receive the quality service and support you deserve. 

You must receive all routine care from Plan providers.  If you obtain routine care from out of Plan providers neither Medicare nor American Health Medicare will be responsible for the costs.