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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.

NEW! Revisions to the Prescription Drug Plan Enrollment and Disenrollment Guidance for CY 2019

On July 31, 2018, CMS released the “Enrollment Guidance Policy Changes and Updates for Contract Year 2019” in our Health Plan Management System (HPMS) to provide guidance and model enrollment form updates. It includes policy and technical changes as a result of recently published regulation changes from CMS-4182-F:

  • Special Election Period (SEP) to accompany the new Medicare Advantage Open Enrollment Period (MA OEP);
  • Special election period (SEP) changes for duals/LIS individuals, including limitations for this population identified as potential at-risk or at-risk for misuse or abuse of a frequently abused drug; and
  • Changes to passive enrollment.

Other updates include provisions for enrollment communications in accessible formats, Medicare number enrollment processing, and clarification of the disaster SEP. Finally, enrollment forms and model notices were updated to incorporate these changes.

The update to the CY 2019 guidance is now available below with the file names: CY 2019 PDP Enrollment and Disenrollment Guidance. Also included is a summary of changes chart, outlining the changed sections.

All enrollments with an effective date on or after January 1, 2019, must be processed in accordance with the revised guidance requirements.

Good Cause Flow Process and Frequently Asked Questions

Below are resources to help plans process good cause reinstatement requests: 

  • Frequently Asked Questions
  • Good Cause Triage Process Flow Chart

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