Usually you may enroll in a Medicare Advantage Plan only during the annual enrollment period, the open enrollment period, or during a special enrollment period.

If you have both Medicare and full Medicaid benefits, you are entitled to a continuous special election period. This means that you can enroll at any time during the year.

Annual Election Period

November 15, 2008, through December 31, 2008, is the Annual Election Period for 2009. During this time you can switch from one way of getting Medicare to another. You have the opportunity to choose the plan that’s best for you. The change will take effect on January 1, 2009.

Open Enrollment Period

January 1, 2009, through March 31, 2009, is the Open Enrollment Period. During this time you have the opportunity to change to another Medicare Advantage plan with drug coverage or to Original Medicare with a stand-alone drug plan. You may also change from a medical-only Medicare Advantage plan to another medical-only plan. You may not drop or add drug coverage during this time.

Special Election Period

The Special Election Period is a special period of time during which you may enroll. For instance if you:

• are turning 65 and are newly eligible for Medicare in 2009;
• have just moved into the plan’s service area;
• are enrolled in another prescription drug plan or a Medicare Advantage plan whose 2009 contract is terminated;
• have full Medicaid benefits or prescription drug assistance through PACE.

This is not a complete list. To obtain more information about these election periods, please call 1-800-898-4892 (TTY/TDD: 1-877-219-5457), 8 a.m. to 8 p.m., seven days a week.

Eligibility

Review the basic eligibility requirements and other important information that follows.

Enroll online

Complete the online enrollment form.

Enroll by phone

Call toll-free 1-800-898-4892 (TTY/TDD: 1-877-219-5457), 8 a.m. to 8 p.m., seven days a week.

Enroll by mail

Download the application form.

An application (in PDF format) will open in a new window for you to download.

In order to view the application, you will need to have the Acrobat Reader software. For more information about PDFs and to download the free software, visit the Adobe Acrobat Reader website.

When you have completed the form, print it, sign it, and mail it to:

AmeriHealth 65
Medicare Department
P O Box 7576
Philadelphia, PA 19101-8951

Completing your application

If you prefer to enroll by phone, need help completing the form, or if you have any questions concerning our plans, just call our toll-free number at 1-800-898-4892 (TTY/TDD: 1-877-219-5457), 8 a.m. to 8 p.m., seven days a week.

If anyone helps you fill out your application, that individual must sign the form and indicate his or her relationship to you.

No premium payment is required at time of enrollment.

Once your application has been processed, we will notify you of your effective date and we’ll send you a member packet that includes your identification card, your Evidence of Coverage, and other important information.