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enrollee meets all the other requirements to enroll in that plan (e.g., living within the service area). Individuals may use the 5-star SEP to disenroll from an MA plan by enrolling in a 5-star MA or Part D plan that is open for enrollment.

As overall ratings are assigned for the plan contract year (January through December), possible enrollment effective dates are from January 1 to December 1 during the year for which the plan has been assigned an overall performance rating of five stars. An individual may not use this SEP for more than one enrollment in a contract year. The SEP begins December 8 prior to the contract year and ends November 30 of the contract year.

Examples: • Plan X has an overall rating of 4.5 stars in 2020 and 5 stars for 2021. An individual could use this SEP to request enrollment in Plan X beginning December 8, 2020, for an effective date of January 1, 2021. An individual could not use the SEP to enroll in Plan X for an effective date on or before December 1, 2020, as the enrollment effective dates available during that period are prior to the contract year for which Plan X has been assigned a 5-star overall rating. • Plan Y has an overall rating of 5 stars for 2020 but has lost that 5-star rating for 2021. An individual could use this SEP to request enrollment in Plan Y for the first of the following month until November 30, 2020, with the last possible effective date available being December 1, 2020. The individual could not use the SEP to submit an enrollment request in Plan Y on or after December 1, 2020, as the enrollment effective dates available during that period are after the contract year for which Plan Y is assigned a 5-star overall rating.

An individual using this SEP can enroll in an MA-only or an MA-PD plan, even if coming from Original Medicare (with or without concurrent enrollment in a PDP). Individuals enrolled in a plan with a 5-star overall rating may also switch to a different plan with a 5-star overall rating. An individual in an MA-only or MA-PD coordinated care plan who switches to a PDP with a 5- star overall rating will lose MA coverage and will revert to Original Medicare for basic medical coverage.

Regardless of whether the individual has Part D coverage prior to use of this SEP, any individual who enrolls in a 5-star MA Private Fee-for-Service plan without prescription drug coverage or a 5-star cost plan is eligible for a coordinating Part D SEP to enroll in a PDP.

Use of this SEP does not guarantee Part D coverage. If an individual in either an MA-PD plan or a PDP chooses to enroll in an MA-only coordinated care plan with a 5-star overall rating, that individual would lose Part D coverage and must wait for a subsequent enrollment period to obtain Part D coverage under the normal enrollment rules. Part D late enrollment penalties may also apply.

NOTE: An individual who disenrolls from an MA plan and enrolls only in a standalone PDP with a 5-star rating will automatically be enrolled in Original Medicare.

30.6.23 – SEP for individuals who use the 5-star SEP to enroll in a plan without Part D 42 CFR § 423.38(c)(29)