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NOTE: The definition of “institutionalized” for the purpose of the OEPI (as provided in 42 CFR § 422.2) differs from that used in determining when an institutionalized full-benefit dual eligible qualifies for the low-income subsidy copayment level of zero.

Coordinating Part D SEP:

An individual using the MA OEPI to disenroll from an MA plan that includes Part D benefits is eligible for a coordinating Part D SEP to enroll in a Part D plan.

This SEP begins the first day of the month in which the individual requests disenrollment from the MA plan and ends on the last day of the second month following the month the MA enrollment ended.

NOTE: The effective date of an election made during this SEP is the first day of the month following the month in which the enrollment/disenrollment request is received, but not prior to the month residency begins.

30.6 – Special Election Periods (SEPs) 42 CFR §§ 422.62(b), 422.68(d), 423.38(c), and 423.40(c)

Special election periods (SEPs) are election periods outside of the Part D IEP, ICEP, AEP, OEPI, or MA OEP, when an individual may elect a plan or change their current election. The effective date of an election made during an SEP is the first day of the month following the month in which the election is made, unless otherwise noted that the effective date may be retroactive or prospective past the following month. Coverage effective dates are always in whole calendar month increments; both retroactive and prospective effective dates are always the first of the calendar month. The SEPs discussed in this section include the following:

SEP for Individuals Who: MA MA-PD PDP Reference Turn age 65 (SEP65)

30.6.1 Are entitled to Medicare retroactively

30.6.2 Enroll in Part D during the Part B GEP

30.6.3 Terminated a Medigap policy when they enrolled for the first time in an MA plan and are still in a trial period

30.6.4 Are institutionalized

30.6.5 Use the OEPI to disenroll from an MA-PD plan

30.6.6 Are eligible for Medicaid or the low-income subsidy (LIS)

30.6.7 Gain, lose, or have a change in their dual-eligible or LIS status

30.6.8 Belong to a qualified SPAP or who lose SPAP eligibility

30.6.9 Have a plan or contract terminated or non-renewed, including: ▪ Have a plan or contract non-renewed ▪ Have a contract modified or terminated by mutual consent ▪ Have a contract terminated by CMS

30.6.10 A B C Are enrolled in a cost contract that is non-renewing for the area in which the enrollee resides

30.6.11