Page 42

41 | P a g e

disenrollment from the Part D plan and ends the first day of the month following the month in which a disenrollment request is received by the plan.

30.6.20 – SEP for individuals who change permanent residence 42 CFR §§ 422.62(b)(2) and 423.38(c)(7)

This SEP allows individuals to enroll in a new MA or Part D plan because they have changed their permanent residence. If an individual is enrolled in a plan at the time of the permanent change in residence, an SEP is not needed to effectuate an involuntary disenrollment from the plan, as they would no longer be eligible to be enrolled in the plan.

Common scenarios in which an individual is eligible for this SEP include when the individual: • Changes their permanent residence to outside of the plan’s service area (for MA plans, this includes a move out of an MA plan continuation area); • Has been living outside of the U.S. and has now moved back to the U.S.; • Was incarcerated and has now been released; or • Has new MA or Part D plans available to them as a result of a permanent move.

The SEP begins: • The date of the change in permanent residence; • The month before the change in permanent residence, for an individual who notifies the MAO or Part D sponsor in advance of the change; or • When the individual is being disenrolled because they have been out of the service area for over six months (Part C) or over 12 months (Part D) and the MAO or Part D plan has not been able to confirm the residency status of the individual. See below for more information.

The SEP ends: • Two months following the month it begins; or • Two months following the month of the move, whichever is later.

NOTE: An individual using this SEP may choose an effective date of up to three months after the month in which the plan receives the individual’s enrollment request; however, the effective date may not be earlier than the date the individual moves to the new service area and the plan receives the enrollment request.

Part C Policy: When the MAO learns from CMS or the U.S. Post Office (as described in § 60.2.1) that the individual has been out of the service area for over six months and the individual is disenrolled because the MAO has not been able to confirm the residency status of the individual, the SEP for that individual begins the first day of the sixth month and ends the last day of the eighth month of the individual’s absence from the service area.