Medicare Prescription Drug Eligibility and Enrollment

What’s New?

New! Updated MA and Part D Enrollment and Disenrollment Guidance for CY 2025

On August 8, 2024, 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 2025. 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, 2025. Plans may, optionally, use the updated guidance for AEP enrollments effective January 1, 2025.

Guidance improvements include:

• Reduction of duplicative language between existing chapters, reducing overall page count by ~130 pages.
• Use of plain and consistent language across the MA and Part D programs.
• Use of graphics, tables, and text boxes to improve clarity.
• Content updates to reflect recent rulemaking effective in 2025.

New! Addition of New Data Fields on the CY 2025 PDP Model Enrollment Request Form

On July 2, 2024, CMS released the “Advance Announcement of January 2025 Software Release - Additions to the Model Individual Enrollment Request Form to Enroll in a Medicare Advantage Plan (MA) or Medicare Prescription Drug Plan (Part D)” memorandum via HPMS to announce the addition of new sexual orientation and gender identity fields, enrollee assistance fields, and a data compact disc (CD) format option on the model PDP enrollment form, OMB No. 0938-1378.  

Part D plans are expected to use the new form for all enrollment requests received on or after January 1, 2025. Changes noted in this memo and the attachments apply to all model enrollment forms in the enrollment guidance.

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)