Model Medicare Advantage and Medicare Prescription Drug Plan Individual Enrollment Request Form (CMS-10718)
Extension without change of a currently approved collection
No
Regular
Approved without change
02/13/2026
12/16/2025
table that charts list comparision
Inventory as of this Action
Requested
Previously Approved
02/28/2029
36 Months From Approved
12/31/2026
49,153,959
0
39,858,503
12,240,174
0
9,916,605
0
0
0
As established by Section 1851 of the Act, and implementing regulations at §§ 422.50 and 422.60, an MA-eligible individual who meets the eligibility requirements for enrollment into an MA plan may enroll during the enrollment periods specified in §422.62, by completing an enrollment form with the MA organization or enrolling through other mechanisms that the Centers for Medicare & Medicaid Services (CMS) determines are appropriate.
In addition, the authority for requiring this data collection for PDP enrollment is section 1860D-1 of the Act, and implementing regulations at §§ 423.30 and 423.32, a Part D-eligible individual who wishes to enroll in a Medicare Prescription Drug Plan (PDP) may enroll during the enrollment periods specified in §423.38, by completing an enrollment form with the PDP, or enrolling through other mechanisms CMS determines are appropriate.
US Code:
42 USC 1395wâ21
Name of Law: Part C- Medicare + Choice Program: Eligibility, Election and Enrollment
PL:
Pub.L. 108 - 173 101
Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act of 2003
PL:
Pub.L. 105 - 33 4001
Name of Law: Balanced Budget Act of 1997
US Code:
42 USC 1395w-101
Name of Law: Part D Eligible Individuals and Prescription Drug Benefit
Burden has increased due to updating this collection of information request to account for changes to administrative and cost estimates resulting from updated enrollment data and wage estimates.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Form CMS-10718 Enrollment Form
CY 2027 CMS-10718_Supporting Statement_A_.docx
National Health Law Program.pdf
Required Notice for Reinstatements Based on Beneficiary Cancellation of New Enrollment ((§§ 422.60 and 423.32))