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coverage (as defined at 42 CFR § 423.56(a)), to enroll in a PDP. The SEP begins when an individual is notified of the loss of (or reduction in) creditable coverage and ends two calendar months after either the loss (or reduction) occurs or the individual's receipt of the notice, whichever is later.

The effective date of coverage is the first of the month after the enrollment election request is made or, at the individual’s request, may be later; however, the effective date may not be more than two months from the end of the SEP.

Coordinating MA SEP:

In addition, this SEP permits enrollment into an MA-PD plan and begins when an individual is notified of the loss of (or reduction in) creditable coverage and ends two calendar months after either the loss (or reduction) occurs or the individual’s receipt of the notice, whichever is later.

The effective date of this SEP is the first of the month after the enrollment election is made or, at the individual's request, may be up to three months prospective.

NOTE: Loss of creditable prescription drug coverage due to failure to pay required premium is not considered involuntary loss of the coverage.

30.6.18 – SEP for individuals who were not adequately informed of a loss of creditable prescription drug coverage 42 CFR §§ 422.62(b)(20) and 423.38(c)(2)

A Medicare-eligible individual who was not adequately informed of the creditable status of drug coverage provided by an entity required to give such notice or was not adequately informed of a loss of creditable prescription drug coverage, (or that they never had creditable coverage) may be eligible to enroll in, or disenroll from, a PDP or an MA-PD plan. This SEP begins the month that CMS determines the individual is eligible for the SEP. The SEP ends two calendar months after the month CMS makes the determination of eligibility.

CMS determines eligibility for this SEP on a case-by-case basis, based on its determination that an entity offering prescription drug coverage to a Medicare-eligible individual, failed to provide accurate and timely disclosure of the loss of creditable prescription drug coverage or whether the prescription drug coverage offered was creditable.

30.6.19 – SEP for individuals who disenroll from Part D to enroll in or maintain other creditable coverage 42 CFR §§ 422.62(b)(14) and 423.38(c)(18)

This SEP allows an individual who is enrolled in a Part D plan to disenroll from that Part D plan to enroll in or maintain other creditable prescription drug coverage (e.g., TRICARE or VA coverage). An individual using this SEP to disenroll from an MA-PD plan may also use the SEP to elect Original Medicare or enroll in an MA-only plan. This SEP begins upon the individual’s