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Examples: A. Situation: On August 18, 2020, Mrs. Jones submits an enrollment request to a Part D plan. Her enrollment form shows she became entitled to Medicare Parts A and B March 1, 2012. She has indicated on her enrollment form that she lives in a long-term care facility.

Analysis: Since the date the request was received was August 18, 2020, this is not an AEP request. The entitlement date for Medicare Parts A and B shows that she is not in her IEP for Part D. That leaves only an SEP. Mrs. Jones indicated that she resides in a long-term care facility, so this enrollment request can be processed under the SEP for Institutionalized Individuals (see § 30.6.5). The effective date for this enrollment is September 1, 2020.

B. Situation: Mr. Doe calls a PDP sponsor for plan information on October 2, 2020. The PDP representative discusses the PDP plans available and the enrollment requirements, including when an individual may enroll. Mr. Doe tells the representative that he is retiring and his employer coverage will end on October 31, 2020. He submits an enrollment request on October 6, 2020. His entitlement to Medicare Parts A and B was June 1, 2008. He indicates on the request that he does not reside in a long-term care facility.

Analysis: Since the date the request was received was October 6, 2020, this is not an AEP request. The entitlement date for Medicare Parts A and B shows he is not in his IEP for Part D. No other details on the request itself point to any specific enrollment period, however we know that he has retired and his employer sponsored commercial coverage is ending. The enrollment can be processed using the SEP EGHP (see § 30.6.16). Mr. Doe can choose an effective date of up to three months after the month in which the request is made. The PDP sponsor contacts Mr. Doe, confirms his retirement, explains the SEP EGHP and asks him about the effective date. Since his employer coverage is ending on October 31, 2020, he requests a November 1, 2020, effective date.

An individual may make an enrollment request when they are eligible for more than one election period, resulting in more than one possible effective date. Therefore, if an MAO or Part D plan sponsor receives an enrollment request and determines the applicant is eligible for more than one election period, the plan must allow the individual to choose the enrollment effective date from those available under the applicable election periods (see exceptions in the next paragraph regarding the ICEP and Part D IEP). To accomplish this, the plan must attempt to contact the individual, and must document its attempt(s), to determine the individual’s choice.

NOTE: This requirement does not apply to individual requests for enrollment into an employer or union sponsored plan using the group enrollment mechanism, as these may be submitted to CMS with the EGHP SEP election type code. Individuals who make an election via the employer or union election process will be assigned an effective date according to the SEP EGHP, unless the individual requests a different effective date that is allowed by one of the other elections periods for which they are eligible.