42 CFR 423.38 - Enrollment periods.
(a)Initial enrollment period for Part D - Basic rule. The initial enrollment period is the period during which an individual is first eligible to enroll in a Part D plan.
(1)In 2005. An individual who is first eligible to enroll in a Part D plan on or prior to January 31, 2006, has an initial enrollment period from November 15, 2005 through May 15, 2006.
(2)February 2006. An individual who is first eligible to enroll in a Part D plan in February 2006 has an initial enrollment period from November 15, 2005 through May 31, 2006.
(3)March 2006 and subsequent months.
(i) Except as provided in paragraph (a)(3)(ii) and (a)(3)(iii) of this section, the initial enrollment period for an individual who is first eligible to enroll in a Part D plan on or after March 2006 is the same as the initial enrollment period for
(iii) An individual who becomes entitled to
(b)Annual coordinated election period -
(1)For 2006. This period begins on November 15, 2005 and ends on May 15, 2006.
(2)For 2007 through 2010. The annual coordinated election period for the following calendar year is November 15 through December 31.
(3)For 2011 and subsequent years. Beginning with 2011, the annual coordinated election period for the following calendar year is October 15 through December 7.
(c)Special enrollment periods. A Part D eligible individual may enroll in a PDP or disenroll from a PDP and enroll in another PDP or MA-PD plan (as provided at § 422.62(b) of this chapter), as applicable, under any of the following circumstances:
(1) The individual involuntarily loses creditable prescription drug coverage or such coverage is involuntarily reduced so that it is no longer creditable coverage as defined under § 423.56(a). Loss of credible prescription drug coverage due to failure to pay any required premium is not considered involuntary loss of the coverage.
(2) The individual was not adequately informed, as required by standards established by CMS under § 423.56, that he or she has lost his or her creditable prescription drug coverage, that he or she never had credible prescription drug coverage, or the coverage is involuntarily reduced so that it is no longer creditable prescription drug coverage.
(3) The individual's enrollment or non-enrollment in a Part D plan is unintentional, inadvertent, or erroneous because of the error, misrepresentation, or inaction of a Federal employee, or any person authorized by the Federal government to act on its behalf.
(i) Except as provided in paragraph (ii), the individual is a full-subsidy eligible individual or other subsidy-eligible individual as defined in § 423.772, who is making an allowable onetime-per-calendar-quarter election between January through September.
(ii) An individual described in paragraph (i) is not eligible for this special enrollment period if he or she has been notified that he or she has been identified as a “potential at-risk beneficiary” or “at-risk beneficiary” as defined in § 423.100 and such identification has not been terminated in accordance with § 423.153(f)).
(5) The individual elects to disenroll from a MA-PD plan and elects coverage under
(7) The individual is no longer eligible for the PDP because of a change in his or her place of residence to a location outside of the PDP region(s) in which the PDP is offered.
(i) The PDP sponsor offering the PDP substantially violated a material provision of its contract under this part in relation to the individual, including, but not limited to the following -
(A) Failure to provide the individual on a timely basis benefits available under the plan;
(B) Failure to provide benefits in accordance with applicable quality standards; or
(ii) The individual meets other exceptional circumstances as CMS may provide.
(d)Enrollment period to coordinate with MA annual 45-day disenrollment period. Through 2018, an individual enrolled in an MA plan who elects Original
(e)Enrollment period to coordinate with MA open enrollment period. For 2019 and subsequent years, an individual who makes an election as described in § 422.62(a)(3) of this chapter, may make an election to enroll in or disenroll from Part D coverage. An individual who elects Original
Title 42 published on 16-Nov-2018 03:48
The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 42 CFR Part 423 after this date.
- 42 CFR 422.62 — Election of Coverage Under an MA Plan.
- 42 CFR 422.60 — Election Process.
- 42 CFR 423.120 — Access to Covered Part D Drugs.
- 42 CFR 423.32 — Enrollment Process.
- 42 CFR 423.34 — Enrollment of Low-Income Subsidy Eligible Individuals.
- 42 CFR 423.40 — Effective Dates.
- 42 CFR 423.56 — Procedures to Determine and Document Creditable Status of Prescription Drug Coverage.
- 42 CFR 423.36 — Disenrollment Process.