Medicare Prescription Drug Eligibility and Enrollment

What’s New?

New! Updated MA and Part D Enrollment and Disenrollment Guidance for CY 2027

On August 25, 2026, CMS released the “Medicare Advantage and Part D Enrollment and Disenrollment Guidance” memorandum via HPMS to announce the updates to the enrollment and disenrollment guidance for MA and Part D plans for 2027. A brief summary of the guidance updates, and the updated appendices, model notices, and exhibits for MA and Part D plans are provided in separate documents.
 

Plans are expected to use the new guidance for all requests received on or after January 1, 2027. Plans may, optionally, use the updated guidance for AEP enrollments effective January 1, 2027.
 

Overview

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

The guidance on this page covers the enrollment and eligibility provisions set forth at 42 CFR § 417, Subpart K, 42 CFR § 422, Subpart B and 42 CFR § 423, Subpart B. It addresses eligibility requirements for enrollment and disenrollment, the election process, election periods, and effective dates of coverage for both Medicare Advantage (MA) organizations, other Medicare health plans, and Part D plan sponsors.

To join Part D plan, an individual must:

• Have Medicare Part A (Hospital Insurance) or Part B (Medical Insurance).
• Live in the service area of the plan you want to join.
• Be a U.S. citizen or lawfully present in the U.S.
• Complete an enrollment request during a valid election period.

There are six types of election periods:

1. Initial Enrollment Period for Part D (Part D IEP)
2. Initial Coverage Election Period (ICEP)
3. Annual Coordinated Election Period (AEP)
4. Medicare Advantage Open Enrollment Period (MA OEP)
5. Open Enrollment Period for Institutionalized Individuals (OEPI)
6. Special Election Periods (SEPs)