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Individuals who use the 5-star SEP (described in § 30.6.22 above) to enroll in a 5-star MA-only Private Fee-for-Service plan without Part D benefits, or enrolls in a Section 1876 cost plan, is eligible to request enrollment in a PDP or the cost plan’s optional supplemental Part D benefit, if offered. The PDP selected using this coordinating SEP does not have to be 5-star rated.

This SEP begins the month the individual uses the 5-star SEP and ends two calendar months after the month in which the 5-star SEP is used.

NOTE: Enrollment in an MA-only coordinated care plan prevents enrollment in a stand-alone PDP under 423.30(b). Individuals who use the 5-star SEP to enroll in an MA-only coordinated care plan are not eligible for this Part D SEP and must wait until their next valid election period in order to enroll in a plan with Part D coverage.

30.6.24 – SEP for individuals who requested materials in an accessible format 42 CFR §§ 422.62(b)(17) and 423.38(c)(22)

In order to comply with the prohibitions on discrimination in federal health care programs on the basis of disability outlined in Section 504 of the Rehabilitation Act of 1973 (Section 504), MAOs and Part D sponsors must provide materials in accessible formats to their enrollees. This generally includes formats such as Braille, data, and audio files, or other formats accepted by the enrollee in place of, or in addition to, the original print material.

This SEP is for individuals who requested but did not receive required notices or information in an accessible format within the same time frame as the MAO, Part D plan sponsor, or CMS provided the same information to individuals who did not request an accessible format. This SEP allows an individual equal time to make an enrollment decision and allows the individual to make the same election(s) that was permitted before the individual received the required notices in an accessible format.

This SEP begins at the end of the election period during which the individual was seeking to make an election and continues for at least as long as the time it takes for the information to be provided to the individual in an accessible format.

NOTE: MAOs and Part D plan sponsors may determine eligibility for this SEP when the criterion is met, ensuring adequate documentation of the situation (such as records indicating the amount of time taken to provide accessible versions of materials) is maintained. Individuals seeking assistance for this SEP may also contact 1-800-MEDICARE.

30.6.25 – SEP for individuals affected by a government-entity declared disaster or other emergency 42 CFR §§ 422.62(b)(18) and 423.38(c)(23)

An individual affected by an emergency or major disaster declared by a federal, state, or local government is eligible to enroll in or disenroll from an MA plan or a Part D plan.