Medicare Prescription Drug Eligibility and Enrollment

This page contains enrollment and disenrollment guidance for current and future contracting Part D plan sponsors and other parties interested in the operational and regulatory aspects of Part D plan enrollment and disenrollment.

CMS Notice to Individuals Enrolled in Plans with Fewer Than Three Stars for Three or More Consecutive Years

CMS will further the goals of facilitating beneficiary enrollment into higher quality plans by issuing notices to individuals enrolled in plans with fewer than three stars for three consecutive years.  The notices inform enrollees of an opportunity to contact CMS to request a special enrollment period (SEP) to move into a higher quality plan in 2013.  Plans are not able to effectuate enrollments for this one-time SEP; all requests must come into CMS via 1-800-MEDICARE by the beneficiary and will be handled on a case-by-case basis. Spanish and English notices were  mailed in October and notices were sent to new members in February. Copies of the notices are available below.

Revisions to the CY 2012 PDP Enrollment and Disenrollment Guidance for CY 2013

CMS has released a memo in our Health Plan Management System (HPMS) that revises the 2012 PDP Enrollment & Disenrollment Guidance (previously revised on November 16, 2011) for CY 2013. The CY 2012 guidance has been updated and is now available below in the file named: Final PDP Enrollment and Disenrollment Guidance Update for CY2012-Rev 8.7.2012 for CY2013. The HPMS memo summarizing all the clarifications is also available below.

Notes Regarding Revised PDP Enrollment and Disenrollment Guidance  for CY 2013 (NOTE: Updated on September 4, 2012):
CMS has corrected some unintentional inconsistencies between the August 7, 2012 HPMS memorandum and  the CY 2013 guidance revisions. The final guidance revisions have been replaced below and include all items outlined within the HPMS memorandum. Some areas of the guidance did not show the text being removed or changed from the last update; this has been corrected. In addition, the following sections were corrected to match the guidance outlined in the HPMS memorandum:  Introduction language at the beginning of the chapter, §40.1.5, §40.4, §60.2.4, §60.7, and Exhibit 20.  Please use the corrected version as of
September 4, 2012. We apologize for any inconvenience.

All enrollments with an effective date on or after January 1, 2013 must be processed in accordance with the revised guidance requirements, including new model enrollment forms and notices provided.