Eligibility, Enrollment, Disenrollment, & Payment Options
I am:

Here’s what you need to know to get started.

Eligibility

  • You must be enrolled in Medicare Part A (Hospital) and Part B (Medical)
  • You must continue to pay your Part B premium
  • You must live within our service area.  Our service area includes the following counties:
    • Iowa: Dubuque, Clayton, Delaware, Jackson and Jones
    • Illinois: Jo Daviess
    • Wisconsin: Grant, Crawford, Lafayette, and Iowa
  • Medicare beneficiaries diagnosed with End Stage Renal Disease may not be eligible to enroll

Enrollment

  • Your application needs to be completed and received by our office by the last working day of the month to be eligible for coverage to begin the first of the following month, (i.e. sign up by January 31st to be eligible for February 1st)
  • Enrollment Instructions

2019 Enrollment Applications:

  • Iowa  (Tri-States)
  • Iowa (North Iowa Health, Cedar Valley Health, Mercy Iowa City, Clinton Community Health, Genesis Health, Central Iowa Health, Mercy Cedar Rapids)
  • Illinois
  • Wisconsin

Scope of Appointment form                      

Disenrollment

  • You may disenroll from MAHP at any time for any reason.
  • MAHP needs to receive your disenrollment request in writing and coverage will end the last day of the month.  Your request needs to be our office by the last day of the month to disenroll for that month.
  • You will receive written confirmation from MAHP of your disenrollment effective date.  Any paid, unused premium will be returned to you.

Payment Options

  1. Automatic withdrawal directly from your checking or savings account on a monthly basis; deduction taken on the 5th of each month.
    Automatic Transfer of Funds Form.  Please fill out this form and mail to: 

    Medical Associates Health Plans
    Attn: Finance Dept
    1605 Associates Drive
    Dubuque, IA 52002
     
  2. Coupon Payment Book