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Medicare Advantage and Part D Enrollment and Disenrollment Guidance Updated: August 8, 2024 and August 1, 2025

Table of Contents 10 – Definitions and Acronyms .......................................................................................................5 10.1 – Definitions.......................................................................................................................5 10.2 – Acronyms ......................................................................................................................11 20 – Eligibility for Enrollment in MA and Part D Plans ................................................................13 20.1 – Simultaneous Enrollment in MA and Part D ................................................................13 20.2 – Entitlement to Medicare Parts A and B ........................................................................14 20.2.1 – Grandfathering of Members on January 1, 1999 .................................................14 20.3 – Place of Permanent Residence ......................................................................................15 20.3.1 – Continuation Areas ..............................................................................................17 20.4 – U.S. Citizenship or Lawful Presence ............................................................................17 20.5 – Completion of Enrollment Request ..............................................................................18 This guidance update is effective beginning with contract year 2026. All enrollments with an effective date on or after January 1, 2026, must be processed in accordance with the revised requirements. Plans are expected to use the updated model enrollment form for enrollment requests received on or after January 1, 2026. Organizations may, at their option, implement any new requirement consistent with this guidance prior to the required implementation date. This guidance covers the enrollment and eligibility provisions set forth at 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 and Part D plan sponsors. The contents of this document do not have the force and effect of law and are not meant to bind the public in any way, unless specifically incorporated into a contract. This document is intended only to provide clarity to the public regarding existing requirements under the law. Organizations are required to provide information to individuals in accessible/alternate formats (for example, Large Print, Braille), upon request and thereafter, as outlined in Section 504 of the Rehabilitation Act of 1973 (and subsequent revisions). Such individuals must have an equal opportunity to participate in enrollment, paying premium bills, and communicating with the plan, as enrollees who do not request accessible/alternate formats. The MA and Part D appendices and model exhibits for plan issued notices referenced in this guidance are posted at the following links: MA: https://www.cms.gov/medicare/enrollment-renewal/managed-care-eligibility-enrollment Part D: https://www.cms.gov/medicare/enrollment-renewal/part-d-plans