Skip to Main Content

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.  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 are  mailed to current members in October and notices are sent to new members in February. Copies of the notices are available below.

Revisions to the PDP Enrollment and Disenrollment Guidance for CY 2014

On August 30, 2013, CMS released a memo in our Health Plan Management System (HPMS) that revised the 2012 PDP Enrollment & Disenrollment Guidance (previously updated for CY 2013 on August 7, 2012) for CY 2014. The CY 2014 guidance is now available below in the file named: CY 2014 PDP Enrollment and Disenrollment Guidance. The HPMS memo summarizing all the clarifications is also available below.

All enrollments with an effective date on or after January 1, 2014 must be processed in accordance with the revised guidance requirements, including revised model notices provided.