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SEP for Individuals Who: MA MA-PD PDP Reference Are in PACE

30.6.12 Lose special needs status

30.6.13 Are eligible or are found ineligible to enroll in a C-SNP

✔ 30.6.14 Disenroll from a cost plan with optional Part D supplemental benefits

30.6.15 Election into or out of employer sponsored coverage

30.6.16 Involuntarily lose creditable prescription drug coverage

30.6.17 Were not adequately informed of a loss of creditable coverage*

30.6.18 Disenroll from Part D to enroll in/maintain other creditable coverage

30.6.19 Permanently change residence

30.6.20 Are enrolled or not enrolled in Part D due to federal employee error*

30.6.21 Want to enroll in a 5-star plan

30.6.22 Use the 5-star SEP to enroll in a plan without Part D

30.6.23 Requested materials in an accessible format

30.6.24 Are affected by a government entity-declared disaster or emergency

30.6.25 Are enrolled in a plan placed in receivership

30.6.26 Are enrolled in a plan identified as a consistent poor performer

30.6.27 Are enrolled in a plan that violates its contract*

30.6.28 Disenroll in connection with a CMS sanction

30.6.29 Receive notification of a CMS or state-initiated enrollment action

30.6.30 Are involuntarily disenrolled from an MA-PD plan due to loss of Part B

30.6.31 Are non-U.S. citizens who become lawfully present

30.6.32 Are impacted by a CMS established significant change in provider network*

30.6.33 Enroll in Medicare premium-Part A or Part B using an A/B Exceptional Condition SEP

30.6.34 Are enrolling in a FIDE SNP, HIDE SNP, or AIP

30.6.35 Have an exceptional circumstance*

30.6.36 *Requires CMS approval.

Please refer to the PCUG, Table 3-8 (https://www.cms.gov/data-research/cms-information- technology/access-cms-data-application/mapd-plan-communication-user-guide) for more information on the election submission process using these SEPs, including: SEP reason code, plan type applicability (MA, MA-PD, PDP, Cost Drug, PACE, and MSA), and use for enrollment and/or disenrollment transactions.

Subject to the limits on the types of MA and Part D plans in which individuals may be enrolled simultaneously (see § 20.1), and unless otherwise specified below, an individual who uses an MA SEP to disenroll from an MA-PD plan may also use the SEP to enroll in a PDP. Unless