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This guide is for training purposes only and should be used in conjunction with current CMS guidelines and carrier-specific compliance requirements. All agents must stay up-to-date with the latest Medicare regulations and compliance standards. The examples provided are for illustrative purposes and should be adapted according to specific situations and requirements.

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Eligibility for Enrollment

Category: Compliant Medicare Sales Calls

Last Updated: March 12, 2025

CMS Reference:

• MMCM CH 2: 10 (Definition of Authorized/Legal Representative)
• MMCM CH 2: 20 (Eligibility for Enrollment in MA Plans)
• MMCM CH 2: 30 (Election Periods and Effective Dates)
• MMCM CH 2: 30.6 (Effective Date of Coverage)
• MMCM CH 2: 40.1.3 (Enrollment via Telephone)
• MMCM CH 2: 40.2 (Processing the Enrollment Request)
• MMCM CH 2: 40.2.1 (Who May Complete an Enrollment Request)

Overview

To enroll in a Medicare Advantage (MA) plan, a beneficiary must meet eligibility requirements, enroll during a valid election period, and personally complete the enrollment request unless an authorized representative is acting on their behalf.

Agents must verify all eligibility requirements before proceeding with enrollment to ensure compliance with CMS rules.