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30.6.3 – SEP for individuals who enroll in Part B during the Part B GEP 42 CFR § 423.38(c)(16)

An SEP will be provided to individuals who are not entitled to premium-free Part A and who enroll in Part B during the GEP for Part B (January–March). The SEP will begin when the individual submits their Part B application and ends after the first two months of Part B enrollment. An election will be effective the first of the month following the month the Part D sponsor receives the enrollment request. This SEP permits an enrollment choice in a PDP or MA-PD plan.

30.6.4 – SEP for individuals who terminated a Medigap policy upon enrolling for the first time in an MA plan and are still in a trial period 42 CFR §§ 422.62(b)(8) and 423.38(c)(24)

An individual who terminated a Medigap policy upon enrolling for the first time in an MA plan is eligible to make a one-time election to disenroll from their first MA plan to join Original Medicare, at any time of the year, if the individual is still in a “trial period” (12 months) and is eligible for “guaranteed issue” of a Medigap policy (as outlined in Section 1882(s)(3)(B)(v) of the Act). The MA SEP begins on the effective date of the individual’s enrollment in the MA plan and ends after 12 months of enrollment.

Coordinating Part D SEP:

An individual using this SEP to disenroll from an MA-PD plan is eligible for a coordinating Part D SEP to make a one-time election to enroll in a PDP. This SEP begins the month they disenroll from the MA-PD plan and continues for two additional months.

30.6.5 – SEP for individuals who are institutionalized 42 CFR §§ 422.2 and 423.38(c)(15)

An individual who moves into, resides in, or moves out of an institution (see definition of “institutionalized” in 42 CFR § 422.2) is eligible to enroll in or disenroll from a Part D plan. The SEP begins when the individual moves into or out of an institution, continues while the individual resides in the institution, and ends two calendar months after the month the individual moves out of the institution.

NOTE: An election made during this SEP may never become effective prior to the first day of the month in which the individual’s residency in an institution begins.

30.6.6 – SEP for individuals who use the OEPI to disenroll from an MA-PD plan 42 CFR § 423.38(c)(25)

An individual using the MA OEPI (see § 30.5) 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.