Enrollment Information
Enrollment Eligibility
Creditable Coverage
Initial Enrollment Period (IEP)
Important
Annual Enrollment Period (AEP)
Special Enrollment Period (SEP)
Enrollment Eligibility
Medicare Part D is available to everyone that meets the following requirements: entitled to Medicare Part A and/or enrolled in Medicare Part B; living within a Plan’s service area; and not enrolled in more than one Medicare Part D plan at the same time. Because it is a voluntary program, eligible individuals must choose to enroll.
Creditable Coverage
Creditable Coverage is any source of drug coverage, other than the Medicare Prescription Drug Program, that is equal to or better than the Medicare drug benefit.
Initial Enrollment Period (IEP)
IEP is when people are first eligible to enroll in a plan and is similar to the enrollment period for Medicare Part B. The IEP begins three months before a person becomes eligible for Medicare, continues through the month of eligibility and extends three months after the month of eligibility. A person’s coverage obtained during the IEP becomes effective the 1st of the month following the enrollment month.
Important
You may NOT have the beneficiary complete the enrollment form any earlier than three months prior to the month in which they are turning 65 or becoming eligible for Medicare, then hold the enrollment form and submit it during the IEP.
For example, if a beneficiary is turning 65 in July, the enrollment form can be completed and signed ONLY from April 1st through October 31st. If you receive the enrollment form in this example on March 1st, it will not comply with CMS guidelines.
Annual Enrollment Period (AEP)
AEP is a set period that falls between Nov. 15th and Dec. 31st every year. People who enroll during this period are mainly those who already have coverage but would like to change or discontinue their plan. Members generally have to remain enrolled in their current drug plan until the next AEP. A person who enrolls during the AEP is covered as of January 1st.
A member is under no obligation to change plans and is not required to re-enroll annually.
Special Enrollment Period (SEP)
If a person must enroll in a plan due to extenuating circumstances, he or she may enroll during an SEP. Those circumstances include, but are not limited to, the following:
- a recent move into the service area.
- an involuntary loss of creditable coverage.
- new eligibility for, or loss of, dual eligibility status.
- eligible for Low Income Subsidy.
- a move into or a move out of one of the following:
- a skilled nursing facility
- an intermediate care facility for the mentally retarded
- a psychiatric hospital or unit
- a rehabilitation hospital
- a long-term care hospital
- a swing bed hospital
Enrolling in another Part D plan during the SEP will automatically disenroll the member from their current plan. Each SEP circumstance has a specific enrollment time frame and requires documentation. Since the time frames and documentation vary, review the PDP Online Toolkit for specific information.
