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Enrollment Application 2020

Click here for 2019 Enrollment Application


Instructions and Disclaimers

Here is how you can enroll in a Preferred Care Partners plan NOW:

1. Download, print and complete form with signature:

Application Instructions for plans above

Plan Recap

Application Instructions

Plan Recap

If you are enrolling in Preferred Special Care Miami-Dade (HMO C-SNP), you must fill out the Chronic Condition Pre-Assessment Form.

Click here to download.

Application Instructions

Plan Recap

Please mail or fax to:

United Healthcare Medicare Enrollment
UnitedHealthcare
P.O. Box 30770
Salt Lake City, UT 84130-0770

Fax: 1-888-950-1170

2. OR- Complete and submit your Enrollment Form via the Medicare website

By completing and sending the enrollment election form to be enrolled, you are sending an actual enrollment election to Preferred Care Partners.

You must complete and sign an enrollment election form. Except for forms that are faxed to our plan, you should submit original, not photocopied forms.

Once we receive your enrollment election form, and prior to submitting the enrollment transaction to CMS, we will contact you (via phone or mail) to confirm that you still intend to enroll in the plan.

If your enrollment election form is incomplete, we may need to contact you to acquire additional information to complete your election.

After submitting the enrollment transaction to CMS, we may send you an acknowledgement letter notifying you that we have submitted the transaction to CMS for processing.

After we receive confirmation from CMS' systems of the enrollment transaction, we will send you one of the following letters:

  • Confirmation letter notifying that you are enrolled in the plan.
  • Denial of enrollment letter.
  • Rejection of enrollment letter.

Election Periods and Conditions for Enrollment

Below are the periods and conditions when a Medicare eligible individual may apply for enrollment in one of our plans.

  • Annual Election Period (AEP)- from October 15 through December 7
  • Initial Coverage Election Period (ICEP) is for all newly-eligible Medicare beneficiaries. You can enroll any time within the three months before your 65th birthday month, the month of your birthday and three months after. 

Medicare Website

Medicare beneficiaries may enroll in Preferred Care Partners through the CMS Medicare Online Enrollment Center, located at www.medicare.gov.

NOTE: Medicare beneficiaries with special exceptions, such as those who have Medicaid coverage or chronic conditions, can enroll at any time during the year. Contact us for additional information.


Need Assistance Completing This Form?

Phone

Preferred Choice Dade (HMO)
Preferred Choice Broward (HMO)
Preferred Choice Palm Beach (HMO)
Preferred Complete Care (HMO)


1-844-723-6470 (TTY 711)
toll free

Preferred Medicare Assist (HMO D-SNP)
Preferred Medicare Assist Palm Beach (HMO D-SNP)

1-855-874-6282 (TTY 711)
toll free

Preferred Special Care Miami-Dade (HMO C-SNP)

1-855-548-1564 (TTY 711)
toll free

Hours of Operations

Open  8 a.m. to 8 p.m.    7 days a week, including holidays

Fax

1-888-950-1170

Disclaimer information

Preferred Care Partners is insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan's contract renewal with Medicare. Limitations, co-payments, and restrictions may apply. Benefits, premium and/or co-payments/co-insurance may change on January 1 of each year. Every year, Medicare evaluates plans based on a 5‐star rating system. Star rating is for 2020