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• The individual is involuntarily disenrolled from Part D coverage. • In the case of an individual in LI NET due to an immediate need, the individual’s LIS eligibility cannot be confirmed within the period of LI NET coverage.

Summary of Differences between Auto- and Facilitated Enrollment Processes:

Auto-Enrollment of Full Duals Facilitated Enrollment of Other LIS Individuals Steps 1. Identify full-benefit dual eligible individuals in an MA-only plan who need to be enrolled into an MA-PD plan 2. Notice sent to individual within 10 calendar days of identifying need for person to be auto-enrolled 3. If the individual does not opt out within 10 calendar days, submit transaction to move to an MA-PD plan

1. Identify partial-benefit dual eligibles and other LIS eligible individuals in an MA-only plan who need to be enrolled into an MA-PD plan 2. Notice sent to individual within 10 calendar days of identifying need for person to be facilitated enrolled 3. If the individual does not opt out by last day before effective date of facilitated enrollment, will be enrolled in an MA-PD plan Who needs to be moved • Full-benefit dual who newly enrolls in an MA-only plan • Individual in an MA-only plan who recently became eligible for full Medicaid benefits • Partial-benefit dual or other LIS eligible individual who newly enrolls in an MA-only plan • Individual in an MA-only plan who recently became LIS- eligible Plan into Which Beneficiary Should be Enrolled MA-PD plan with the lowest combined Part C and D premium

Notice Includes • Name of receiving Part D plan and enrollment effective date • Costs associated with being an enrollee of the new plan (LIS copay amount) • Individual may choose another Part D plan (either another MA-PD plan or Original Medicare with a PDP) or • Can opt out of auto/facilitated enrollment into the Part D benefit by writing or calling the MA-PD/PDP into which the individual has been • Name of receiving MA-PD plan and enrollment effective date • Costs associated with being an enrollee of the new plan (LIS deductible and copay amount) • Individual may choose another Part D plan (either another MA- PD plan or Original Medicare with a PDP) or • Can opt out of auto/facilitated enrollment into the Part D benefit by writing or calling the MA-PD/PDP into which the individual has been