{"identifier":"/us/usc/t42/s1395w\u2013101","title":42,"num":"\u00a7\u202f1395w\u2013101.","heading":"Eligibility, enrollment, and information","text":"\u00a7\u202f1395w\u2013101.\nEligibility, enrollment, and information\n(a)\nProvision of qualified prescription drug coverage through enrollment in plans\n(1)\nIn general\nSubject to the succeeding provisions of this part, each part D eligible individual (as defined in paragraph (3)(A)) is entitled to obtain qualified prescription drug coverage (described in\n(A)\nFee-for-service enrollees may receive coverage through a prescription drug plan\nA part D eligible individual who is not enrolled in an MA plan may obtain qualified prescription drug coverage through enrollment in a prescription drug plan (as defined in\nsection 1395w\u2013151(a)(14) of this title\n(B)\nMedicare Advantage enrollees\n(i)\nEnrollees in a plan providing qualified prescription drug coverage receive coverage through the plan\nA part D eligible individual who is enrolled in an MA\u2013PD plan obtains such coverage through such plan.\n(ii)\nLimitation on enrollment of MA plan enrollees in prescription drug plans\nExcept as provided in clauses (iii) and (iv), a part D eligible individual who is enrolled in an MA plan may not enroll in a prescription drug plan under this part.\n(iii)\nPrivate fee-for-service enrollees in MA plans not providing qualified prescription drug coverage permitted to enroll in a prescription drug plan\nA part D eligible individual who is enrolled in an MA private fee-for-service plan (as defined in\nsection 1395w\u201328(b)(2) of this title\n(iv)\nEnrollees in MSA plans permitted to enroll in a prescription drug plan\nA part D eligible individual who is enrolled in an MSA plan (as defined in\nsection 1395w\u201328(b)(3) of this title\n(2)\nCoverage first effective January 1, 2006\nCoverage under prescription drug plans and MA\u2013PD plans shall first be effective on\nJanuary 1, 2006\n(3)\nDefinitions\nFor purposes of this part:\n(A)\nPart D eligible individual\nThe term \u201cpart D eligible individual\u201d means an individual who is entitled to benefits under part A or enrolled under part B (but not including an individual enrolled solely for coverage of immunosuppressive drugs under section 1395\no\n(B)\nMA plan\nThe term \u201cMA plan\u201d has the meaning given such term in\nsection 1395w\u201328(b)(1) of this title\n(C)\nMA\u2013PD plan\nThe term \u201cMA\u2013PD plan\u201d means an MA plan that provides qualified prescription drug coverage.\n(b)\nEnrollment process for prescription drug plans\n(1)\nEstablishment of process\n(A)\nIn general\nThe Secretary shall establish a process for the enrollment, disenrollment, termination, and change of enrollment of part D eligible individuals in prescription drug plans consistent with this subsection.\n(B)\nApplication of MA rules\nIn establishing such process, the Secretary shall use rules similar to (and coordinated with) the rules for enrollment, disenrollment, termination, and change of enrollment with an MA\u2013PD plan under the following provisions of\n(i)\nResidence requirements\nSection 1395w\u201321(b)(1)(A) of this title\n(ii)\nExercise of choice\nSection 1395w\u201321(c) of this title\n(iii)\nCoverage election periods\nSubject to paragraphs (2) and (3) of this subsection,\nsection 1395w\u201321(e) of this title\n(iv)\nCoverage periods\nSection 1395w\u201321(f) of this title\n(v)\nGuaranteed issue and renewal\nSection 1395w\u201321(g) of this title\n(vi)\nMarketing material and application forms\nSection 1395w\u201321(h) of this title\nIn applying clauses (ii), (iv), and (v) of this subparagraph, any reference to\nsection 1395w\u201321(e) of this title\n(C)\nSpecial rule\nThe process established under subparagraph (A) shall include, except as provided in subparagraph (D), in the case of a part D eligible individual who is a full-benefit dual eligible individual (as defined in\nsection 1396u\u20135(c)(6) of this title\nsection 1395w\u2013114(a)(1)(A) of this title\n1\n1 So in original. The closing parenthesis probably should not appear.\n(D)\nSpecial rule for plans that waive de minimis premiums\nThe process established under subparagraph (A) may include, in the case of a part D eligible individual who is a subsidy eligible individual (as defined in\nsection 1395w\u2013114(a)(3) of this title\nsection 1395w\u2013114(a)(5) of this title\n(2)\nInitial enrollment period\n(A)\nProgram initiation\nIn the case of an individual who is a part D eligible individual as of\nNovember 15, 2005\nsection 1395w\u201321(e)(3)(B)(iii) of this title\n(B)\nContinuing periods\nIn the case of an individual who becomes a part D eligible individual after\nNovember 15, 2005\nsection 1395w\u201321(e)(1) of this title\n2\n2 So in original. Probably should be \u201cof this subsection,\u201d.\n(3)\nAdditional special enrollment periods\nThe Secretary shall establish special enrollment periods, including the following:\n(A)\nInvoluntary loss of creditable prescription drug coverage\n(i)\nIn general\nIn the case of a part D eligible individual who involuntarily loses creditable prescription drug coverage (as defined in\nsection 1395w\u2013113(b)(4) of this title\n(ii)\nNotice\nIn establishing special enrollment periods under clause (i), the Secretary shall take into account when the part D eligible individuals are provided notice of the loss of creditable prescription drug coverage.\n(iii)\nFailure to pay premium\nFor purposes of clause (i), a loss of coverage shall be treated as voluntary if the coverage is terminated because of failure to pay a required beneficiary premium.\n(iv)\nReduction in coverage\nFor purposes of clause (i), a reduction in coverage so that the coverage no longer meets the requirements under\nsection 1395w\u2013113(b)(5) of this title\n(B)\nErrors in enrollment\nIn the case described in\nsection 1395p(h) of this title\n(C)\nExceptional circumstances\nIn the case of part D eligible individuals who meet such exceptional conditions (in addition to those conditions applied under paragraph (1)(B)(iii)) as the Secretary may provide.\n(D)\nMedicaid coverage\nIn the case of an individual (as determined by the Secretary, subject to such limits as the Secretary may establish for individuals identified pursuant to\nsection 1395w\u2013104(c)(5) of this title\nsection 1396u\u20135(c)(6) of this title\n(E)\nDiscontinuance of MA\u2013PD election during first year of eligibility\nIn the case of a part D eligible individual who discontinues enrollment in an MA\u2013PD plan under the second sentence of\nsection 1395w\u201321(e)(4) of this title\n(4)\nInformation to facilitate enrollment\n(A)\nIn general\nNotwithstanding any other provision of law but subject to subparagraph (B), the Secretary may provide to each PDP sponsor and MA organization such identifying information about part D eligible individuals as the Secretary determines to be necessary to facilitate efficient marketing of prescription drug plans and MA\u2013PD plans to such individuals and enrollment of such individuals in such plans.\n(B)\nLimitation\n(i)\nProvision of information\nThe Secretary may provide the information under subparagraph (A) only to the extent necessary to carry out such subparagraph.\n(ii)\nUse of information\nSuch information provided by the Secretary to a PDP sponsor or an MA organization may be used by such sponsor or organization only to facilitate marketing of, and enrollment of part D eligible individuals in, prescription drug plans and MA\u2013PD plans.\n(5)\nReference to enrollment procedures for MA\u2013PD plans\nFor rules applicable to enrollment, disenrollment, termination, and change of enrollment of part D eligible individuals in MA\u2013PD plans, see\nsection 1395w\u201321 of this title\n(6)\nReference to penalties for late enrollment\n(A) enroll in a prescription drug plan or an MA\u2013PD plan after the initial enrollment period described in paragraph (2); and\n(B) fail to maintain continuous creditable prescription drug coverage during the period of non-enrollment.\n(c)\nProviding information to beneficiaries\n(1)\nActivities\nThe Secretary shall conduct activities that are designed to broadly disseminate information to part D eligible individuals (and prospective part D eligible individuals) regarding the coverage provided under this part. Such activities shall ensure that such information is first made available at least 30 days prior to the initial enrollment period described in subsection (b)(2)(A).\n(2)\nRequirements\nThe activities described in paragraph (1) shall\u2014\n(A) be similar to the activities performed by the Secretary under\nsection 1395w\u201321(d) of this title\n(B) be coordinated with the activities performed by the Secretary under such section and under\nsection 1395b\u20132 of this title\n(3)\nComparative information\n(A)\nIn general\nSubject to subparagraph (B), the comparative information referred to in paragraph (2)(A) shall include a comparison of the following with respect to qualified prescription drug coverage:\n(i)\nBenefits\nThe benefits provided under the plan.\n(ii)\nMonthly beneficiary premium\nThe monthly beneficiary premium under the plan.\n(iii)\nQuality and performance\nThe quality and performance under the plan.\n(iv)\nBeneficiary cost-sharing\nThe cost-sharing required of part D eligible individuals under the plan.\n(v)\nConsumer satisfaction surveys\nThe results of consumer satisfaction surveys regarding the plan conducted pursuant to\nsection 1395w\u2013104(d) of this title\n(B)\nException for unavailability of information\nThe Secretary is not required to provide comparative information under clauses (iii) and (v) of subparagraph (A) with respect to a plan\u2014\n(i) for the first plan year in which it is offered; and\n(ii) for the next plan year if it is impracticable or the information is otherwise unavailable.\n(4)\nInformation on late enrollment penalty\nThe information disseminated under paragraph (1) shall include information concerning the methodology for determining the late enrollment penalty under\nsection 1395w\u2013113(b) of this title","url":"https://projectusc.org/usc/t42/s1395w\u2013101.html","content":[{"t":"sec","id":"/us/usc/t42/s1395w\u2013101","children":[{"t":"num","text":"\u00a7\u202f1395w\u2013101."},{"t":"heading","text":"Eligibility, enrollment, and information"},{"t":"subsec","id":"/us/usc/t42/s1395w\u2013101/a","children":[{"t":"num","text":"(a)"},{"t":"heading","text":"Provision of qualified prescription drug coverage through enrollment in plans"},{"t":"para","id":"/us/usc/t42/s1395w\u2013101/a/1","children":[{"t":"num","text":"(1)"},{"t":"heading","text":"In general"},{"t":"chapeau","text":"Subject to the succeeding provisions of this part, each part D eligible individual (as defined in paragraph (3)(A)) is entitled to obtain qualified prescription drug coverage (described in ","children":[{"t":"ref","text":"section 1395w\u2013102(a) of this title","href":"/us/usc/t42/s1395w\u2013102/a","tail":") as follows:"}]},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/a/1/A","children":[{"t":"num","text":"(A)"},{"t":"heading","text":"Fee-for-service enrollees may receive coverage through a prescription drug plan"},{"t":"content","children":[{"t":"p","text":"A part D eligible individual who is not enrolled in an MA plan may obtain qualified prescription drug coverage through enrollment in a prescription drug plan (as defined in ","children":[{"t":"ref","text":"section 1395w\u2013151(a)(14) of this title","href":"/us/usc/t42/s1395w\u2013151/a/14","tail":")."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/a/1/B","children":[{"t":"num","text":"(B)"},{"t":"heading","text":"Medicare Advantage enrollees"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/a/1/B/i","children":[{"t":"num","text":"(i)"},{"t":"heading","text":"Enrollees in a plan providing qualified prescription drug coverage receive coverage through the plan"},{"t":"content","children":[{"t":"p","text":"A part D eligible individual who is enrolled in an MA\u2013PD plan obtains such coverage through such plan.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/a/1/B/ii","children":[{"t":"num","text":"(ii)"},{"t":"heading","text":"Limitation on enrollment of MA plan enrollees in prescription drug plans"},{"t":"content","children":[{"t":"p","text":"Except as provided in clauses (iii) and (iv), a part D eligible individual who is enrolled in an MA plan may not enroll in a prescription drug plan under this part.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/a/1/B/iii","children":[{"t":"num","text":"(iii)"},{"t":"heading","text":"Private fee-for-service enrollees in MA plans not providing qualified prescription drug coverage permitted to enroll in a prescription drug plan"},{"t":"content","children":[{"t":"p","text":"A part D eligible individual who is enrolled in an MA private fee-for-service plan (as defined in ","children":[{"t":"ref","text":"section 1395w\u201328(b)(2) of this title","href":"/us/usc/t42/s1395w\u201328/b/2","tail":") that does not provide qualified prescription drug coverage may obtain qualified prescription drug coverage through enrollment in a prescription drug plan."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/a/1/B/iv","children":[{"t":"num","text":"(iv)"},{"t":"heading","text":"Enrollees in MSA plans permitted to enroll in a prescription drug plan"},{"t":"content","children":[{"t":"p","text":"A part D eligible individual who is enrolled in an MSA plan (as defined in ","children":[{"t":"ref","text":"section 1395w\u201328(b)(3) of this title","href":"/us/usc/t42/s1395w\u201328/b/3","tail":") may obtain qualified prescription drug coverage through enrollment in a prescription drug plan."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013101/a/2","children":[{"t":"num","text":"(2)"},{"t":"heading","text":"Coverage first effective January 1, 2006"},{"t":"content","children":[{"t":"p","text":"Coverage under prescription drug plans and MA\u2013PD plans shall first be effective on ","children":[{"t":"text","text":"January 1, 2006","tail":"."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013101/a/3","children":[{"t":"num","text":"(3)"},{"t":"heading","text":"Definitions"},{"t":"chapeau","text":"For purposes of this part:"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/a/3/A","children":[{"t":"num","text":"(A)"},{"t":"heading","text":"Part D eligible individual"},{"t":"content","children":[{"t":"p","text":"The term \u201cpart D eligible individual\u201d means an individual who is entitled to benefits under part A or enrolled under part B (but not including an individual enrolled solely for coverage of immunosuppressive drugs under section 1395","children":[{"t":"text","text":"o","tail":"(b) of this title)."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/a/3/B","children":[{"t":"num","text":"(B)"},{"t":"heading","text":"MA plan"},{"t":"content","children":[{"t":"p","text":"The term \u201cMA plan\u201d has the meaning given such term in ","children":[{"t":"ref","text":"section 1395w\u201328(b)(1) of this title","href":"/us/usc/t42/s1395w\u201328/b/1","tail":"."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/a/3/C","children":[{"t":"num","text":"(C)"},{"t":"heading","text":"MA\u2013PD plan"},{"t":"content","children":[{"t":"p","text":"The term \u201cMA\u2013PD plan\u201d means an MA plan that provides qualified prescription drug coverage.","tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1395w\u2013101/b","children":[{"t":"num","text":"(b)"},{"t":"heading","text":"Enrollment process for prescription drug plans"},{"t":"para","id":"/us/usc/t42/s1395w\u2013101/b/1","children":[{"t":"num","text":"(1)"},{"t":"heading","text":"Establishment of process"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/b/1/A","children":[{"t":"num","text":"(A)"},{"t":"heading","text":"In general"},{"t":"content","children":[{"t":"p","text":"The Secretary shall establish a process for the enrollment, disenrollment, termination, and change of enrollment of part D eligible individuals in prescription drug plans consistent with this subsection.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/b/1/B","children":[{"t":"num","text":"(B)"},{"t":"heading","text":"Application of MA rules"},{"t":"chapeau","text":"In establishing such process, the Secretary shall use rules similar to (and coordinated with) the rules for enrollment, disenrollment, termination, and change of enrollment with an MA\u2013PD plan under the following provisions of ","children":[{"t":"ref","text":"section 1395w\u201321 of this title","href":"/us/usc/t42/s1395w\u201321","tail":":"}]},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/b/1/B/i","children":[{"t":"num","text":"(i)"},{"t":"heading","text":"Residence requirements"},{"t":"content","children":[{"t":"p","children":[{"t":"ref","text":"Section 1395w\u201321(b)(1)(A) of this title","href":"/us/usc/t42/s1395w\u201321/b/1/A","tail":", relating to residence requirements."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/b/1/B/ii","children":[{"t":"num","text":"(ii)"},{"t":"heading","text":"Exercise of choice"},{"t":"content","children":[{"t":"p","children":[{"t":"ref","text":"Section 1395w\u201321(c) of this title","href":"/us/usc/t42/s1395w\u201321/c","tail":" (other than paragraph (3)(A) and paragraph (4) of such section), relating to exercise of choice."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/b/1/B/iii","children":[{"t":"num","text":"(iii)"},{"t":"heading","text":"Coverage election periods"},{"t":"content","children":[{"t":"p","text":"Subject to paragraphs (2) and (3) of this subsection, ","children":[{"t":"ref","text":"section 1395w\u201321(e) of this title","href":"/us/usc/t42/s1395w\u201321/e","tail":" (other than subparagraphs (B), (C), (E), and (F) of paragraph (2) and the second sentence of paragraph (4) of such section), relating to coverage election periods, including initial periods, annual coordinated election periods, special election periods, and election periods for exceptional circumstances."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/b/1/B/iv","children":[{"t":"num","text":"(iv)"},{"t":"heading","text":"Coverage periods"},{"t":"content","children":[{"t":"p","children":[{"t":"ref","text":"Section 1395w\u201321(f) of this title","href":"/us/usc/t42/s1395w\u201321/f","tail":", relating to effectiveness of elections and changes of elections."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/b/1/B/v","children":[{"t":"num","text":"(v)"},{"t":"heading","text":"Guaranteed issue and renewal"},{"t":"content","children":[{"t":"p","children":[{"t":"ref","text":"Section 1395w\u201321(g) of this title","href":"/us/usc/t42/s1395w\u201321/g","tail":" (other than paragraph (2) of such section and clause (i) and the second sentence of clause (ii) of paragraph (3)(C) of such section), relating to guaranteed issue and renewal."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/b/1/B/vi","children":[{"t":"num","text":"(vi)"},{"t":"heading","text":"Marketing material and application forms"},{"t":"content","children":[{"t":"p","children":[{"t":"ref","text":"Section 1395w\u201321(h) of this title","href":"/us/usc/t42/s1395w\u201321/h","tail":", relating to approval of marketing material and application forms."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n\n"},{"t":"continuation","text":"In applying clauses (ii), (iv), and (v) of this subparagraph, any reference to ","children":[{"t":"ref","text":"section 1395w\u201321(e) of this title","href":"/us/usc/t42/s1395w\u201321/e","tail":" shall be treated as a reference to such section as applied pursuant to clause (iii) of this subparagraph."}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/b/1/C","children":[{"t":"num","text":"(C)"},{"t":"heading","text":"Special rule"},{"t":"content","children":[{"t":"p","text":"The process established under subparagraph (A) shall include, except as provided in subparagraph (D), in the case of a part D eligible individual who is a full-benefit dual eligible individual (as defined in ","children":[{"t":"ref","text":"section 1396u\u20135(c)(6) of this title","href":"/us/usc/t42/s1396u\u20135/c/6","tail":") who has failed to enroll in a prescription drug plan or an MA\u2013PD plan, for the enrollment in a prescription drug plan that has a monthly beneficiary premium that does not exceed the premium assistance available under "},{"t":"ref","text":"section 1395w\u2013114(a)(1)(A) of this title","href":"/us/usc/t42/s1395w\u2013114/a/1/A","tail":")."},{"t":"ref","text":"1"},{"t":"num","text":"1","tail":"\u202fSo in original. The closing parenthesis probably should not appear."},{"t":"text","text":"\u202fSo in original. The closing parenthesis probably should not appear.","tail":" If there is more than one such plan available, the Secretary shall enroll such an individual on a random basis among all such plans in the PDP region. Nothing in the previous sentence shall prevent such an individual from declining or changing such enrollment."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/b/1/D","children":[{"t":"num","text":"(D)"},{"t":"heading","text":"Special rule for plans that waive de minimis premiums"},{"t":"content","children":[{"t":"p","text":"The process established under subparagraph (A) may include, in the case of a part D eligible individual who is a subsidy eligible individual (as defined in ","children":[{"t":"ref","text":"section 1395w\u2013114(a)(3) of this title","href":"/us/usc/t42/s1395w\u2013114/a/3","tail":") who has failed to enroll in a prescription drug plan or an MA\u2013PD plan, for the enrollment in a prescription drug plan or MA\u2013PD plan that has waived the monthly beneficiary premium for such subsidy eligible individual under "},{"t":"ref","text":"section 1395w\u2013114(a)(5) of this title","href":"/us/usc/t42/s1395w\u2013114/a/5","tail":". If there is more than one such plan available, the Secretary shall enroll such an individual under the preceding sentence on a random basis among all such plans in the PDP region. Nothing in the previous sentence shall prevent such an individual from declining or changing such enrollment."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013101/b/2","children":[{"t":"num","text":"(2)"},{"t":"heading","text":"Initial enrollment period"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/b/2/A","children":[{"t":"num","text":"(A)"},{"t":"heading","text":"Program initiation"},{"t":"content","children":[{"t":"p","text":"In the case of an individual who is a part D eligible individual as of ","children":[{"t":"text","text":"November 15, 2005","tail":", there shall be an initial enrollment period that shall be the same as the annual, coordinated open election period described in "},{"t":"ref","text":"section 1395w\u201321(e)(3)(B)(iii) of this title","href":"/us/usc/t42/s1395w\u201321/e/3/B/iii","tail":", as applied under paragraph (1)(B)(iii)."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/b/2/B","children":[{"t":"num","text":"(B)"},{"t":"heading","text":"Continuing periods"},{"t":"content","children":[{"t":"p","text":"In the case of an individual who becomes a part D eligible individual after ","children":[{"t":"text","text":"November 15, 2005","tail":", there shall be an initial enrollment period which is the period under "},{"t":"ref","text":"section 1395w\u201321(e)(1) of this title","href":"/us/usc/t42/s1395w\u201321/e/1","tail":", as applied under paragraph (1)(B)(iii) of this section,"},{"t":"ref","text":"2"},{"t":"num","text":"2","tail":"\u202fSo in original. Probably should be \u201cof this subsection,\u201d."},{"t":"text","text":"\u202fSo in original. Probably should be \u201cof this subsection,\u201d.","tail":" as if \u201centitled to benefits under part A or enrolled under part B\u201d were substituted for \u201centitled to benefits under part A and enrolled under part B\u201d, but in no case shall such period end before the period described in subparagraph (A)."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013101/b/3","children":[{"t":"num","text":"(3)"},{"t":"heading","text":"Additional special enrollment periods"},{"t":"chapeau","text":"The Secretary shall establish special enrollment periods, including the following:"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/b/3/A","children":[{"t":"num","text":"(A)"},{"t":"heading","text":"Involuntary loss of creditable prescription drug coverage"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/b/3/A/i","children":[{"t":"num","text":"(i)"},{"t":"heading","text":"In general"},{"t":"content","children":[{"t":"p","text":"In the case of a part D eligible individual who involuntarily loses creditable prescription drug coverage (as defined in ","children":[{"t":"ref","text":"section 1395w\u2013113(b)(4) of this title","href":"/us/usc/t42/s1395w\u2013113/b/4","tail":")."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/b/3/A/ii","children":[{"t":"num","text":"(ii)"},{"t":"heading","text":"Notice"},{"t":"content","children":[{"t":"p","text":"In establishing special enrollment periods under clause (i), the Secretary shall take into account when the part D eligible individuals are provided notice of the loss of creditable prescription drug coverage.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/b/3/A/iii","children":[{"t":"num","text":"(iii)"},{"t":"heading","text":"Failure to pay premium"},{"t":"content","children":[{"t":"p","text":"For purposes of clause (i), a loss of coverage shall be treated as voluntary if the coverage is terminated because of failure to pay a required beneficiary premium.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/b/3/A/iv","children":[{"t":"num","text":"(iv)"},{"t":"heading","text":"Reduction in coverage"},{"t":"content","children":[{"t":"p","text":"For purposes of clause (i), a reduction in coverage so that the coverage no longer meets the requirements under ","children":[{"t":"ref","text":"section 1395w\u2013113(b)(5) of this title","href":"/us/usc/t42/s1395w\u2013113/b/5","tail":" (relating to actuarial equivalence) shall be treated as an involuntary loss of coverage."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/b/3/B","children":[{"t":"num","text":"(B)"},{"t":"heading","text":"Errors in enrollment"},{"t":"content","children":[{"t":"p","text":"In the case described in ","children":[{"t":"ref","text":"section 1395p(h) of this title","href":"/us/usc/t42/s1395p/h","tail":" (relating to errors in enrollment), in the same manner as such section applies to part B."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/b/3/C","children":[{"t":"num","text":"(C)"},{"t":"heading","text":"Exceptional circumstances"},{"t":"content","children":[{"t":"p","text":"In the case of part D eligible individuals who meet such exceptional conditions (in addition to those conditions applied under paragraph (1)(B)(iii)) as the Secretary may provide.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/b/3/D","children":[{"t":"num","text":"(D)"},{"t":"heading","text":"Medicaid coverage"},{"t":"content","children":[{"t":"p","text":"In the case of an individual (as determined by the Secretary, subject to such limits as the Secretary may establish for individuals identified pursuant to ","children":[{"t":"ref","text":"section 1395w\u2013104(c)(5) of this title","href":"/us/usc/t42/s1395w\u2013104/c/5","tail":") who is a full-benefit dual eligible individual (as defined in "},{"t":"ref","text":"section 1396u\u20135(c)(6) of this title","href":"/us/usc/t42/s1396u\u20135/c/6","tail":")."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/b/3/E","children":[{"t":"num","text":"(E)"},{"t":"heading","text":"Discontinuance of MA\u2013PD election during first year of eligibility"},{"t":"content","children":[{"t":"p","text":"In the case of a part D eligible individual who discontinues enrollment in an MA\u2013PD plan under the second sentence of ","children":[{"t":"ref","text":"section 1395w\u201321(e)(4) of this title","href":"/us/usc/t42/s1395w\u201321/e/4","tail":" at the time of the election of coverage under such sentence under the original medicare fee-for-service program."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013101/b/4","children":[{"t":"num","text":"(4)"},{"t":"heading","text":"Information to facilitate enrollment"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/b/4/A","children":[{"t":"num","text":"(A)"},{"t":"heading","text":"In general"},{"t":"content","children":[{"t":"p","text":"Notwithstanding any other provision of law but subject to subparagraph (B), the Secretary may provide to each PDP sponsor and MA organization such identifying information about part D eligible individuals as the Secretary determines to be necessary to facilitate efficient marketing of prescription drug plans and MA\u2013PD plans to such individuals and enrollment of such individuals in such plans.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/b/4/B","children":[{"t":"num","text":"(B)"},{"t":"heading","text":"Limitation"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/b/4/B/i","children":[{"t":"num","text":"(i)"},{"t":"heading","text":"Provision of information"},{"t":"content","children":[{"t":"p","text":"The Secretary may provide the information under subparagraph (A) only to the extent necessary to carry out such subparagraph.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/b/4/B/ii","children":[{"t":"num","text":"(ii)"},{"t":"heading","text":"Use of information"},{"t":"content","children":[{"t":"p","text":"Such information provided by the Secretary to a PDP sponsor or an MA organization may be used by such sponsor or organization only to facilitate marketing of, and enrollment of part D eligible individuals in, prescription drug plans and MA\u2013PD plans.","tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013101/b/5","children":[{"t":"num","text":"(5)"},{"t":"heading","text":"Reference to enrollment procedures for MA\u2013PD plans"},{"t":"content","children":[{"t":"p","text":"For rules applicable to enrollment, disenrollment, termination, and change of enrollment of part D eligible individuals in MA\u2013PD plans, see ","children":[{"t":"ref","text":"section 1395w\u201321 of this title","href":"/us/usc/t42/s1395w\u201321","tail":"."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013101/b/6","children":[{"t":"num","text":"(6)"},{"t":"heading","text":"Reference to penalties for late enrollment"},{"t":"chapeau","children":[{"t":"ref","text":"Section 1395w\u2013113(b) of this title","href":"/us/usc/t42/s1395w\u2013113/b","tail":" imposes a late enrollment penalty for part D eligible individuals who\u2014"}]},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/b/6/A","children":[{"t":"num","text":"(A)"},{"t":"content","text":" enroll in a prescription drug plan or an MA\u2013PD plan after the initial enrollment period described in paragraph (2); and","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/b/6/B","children":[{"t":"num","text":"(B)"},{"t":"content","text":" fail to maintain continuous creditable prescription drug coverage during the period of non-enrollment.","tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1395w\u2013101/c","children":[{"t":"num","text":"(c)"},{"t":"heading","text":"Providing information to beneficiaries"},{"t":"para","id":"/us/usc/t42/s1395w\u2013101/c/1","children":[{"t":"num","text":"(1)"},{"t":"heading","text":"Activities"},{"t":"content","children":[{"t":"p","text":"The Secretary shall conduct activities that are designed to broadly disseminate information to part D eligible individuals (and prospective part D eligible individuals) regarding the coverage provided under this part. Such activities shall ensure that such information is first made available at least 30 days prior to the initial enrollment period described in subsection (b)(2)(A).","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013101/c/2","children":[{"t":"num","text":"(2)"},{"t":"heading","text":"Requirements"},{"t":"chapeau","text":"The activities described in paragraph (1) shall\u2014"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/c/2/A","children":[{"t":"num","text":"(A)"},{"t":"content","text":" be similar to the activities performed by the Secretary under ","children":[{"t":"ref","text":"section 1395w\u201321(d) of this title","href":"/us/usc/t42/s1395w\u201321/d","tail":", including dissemination (including through the toll-free telephone number 1\u2013800\u2013MEDICARE) of comparative information for prescription drug plans and MA\u2013PD plans; and"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/c/2/B","children":[{"t":"num","text":"(B)"},{"t":"content","text":" be coordinated with the activities performed by the Secretary under such section and under ","children":[{"t":"ref","text":"section 1395b\u20132 of this title","href":"/us/usc/t42/s1395b\u20132","tail":"."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013101/c/3","children":[{"t":"num","text":"(3)"},{"t":"heading","text":"Comparative information"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/c/3/A","children":[{"t":"num","text":"(A)"},{"t":"heading","text":"In general"},{"t":"chapeau","text":"Subject to subparagraph (B), the comparative information referred to in paragraph (2)(A) shall include a comparison of the following with respect to qualified prescription drug coverage:"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/c/3/A/i","children":[{"t":"num","text":"(i)"},{"t":"heading","text":"Benefits"},{"t":"content","children":[{"t":"p","text":"The benefits provided under the plan.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/c/3/A/ii","children":[{"t":"num","text":"(ii)"},{"t":"heading","text":"Monthly beneficiary premium"},{"t":"content","children":[{"t":"p","text":"The monthly beneficiary premium under the plan.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/c/3/A/iii","children":[{"t":"num","text":"(iii)"},{"t":"heading","text":"Quality and performance"},{"t":"content","children":[{"t":"p","text":"The quality and performance under the plan.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/c/3/A/iv","children":[{"t":"num","text":"(iv)"},{"t":"heading","text":"Beneficiary cost-sharing"},{"t":"content","children":[{"t":"p","text":"The cost-sharing required of part D eligible individuals under the plan.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/c/3/A/v","children":[{"t":"num","text":"(v)"},{"t":"heading","text":"Consumer satisfaction surveys"},{"t":"content","children":[{"t":"p","text":"The results of consumer satisfaction surveys regarding the plan conducted pursuant to ","children":[{"t":"ref","text":"section 1395w\u2013104(d) of this title","href":"/us/usc/t42/s1395w\u2013104/d","tail":"."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395w\u2013101/c/3/B","children":[{"t":"num","text":"(B)"},{"t":"heading","text":"Exception for unavailability of information"},{"t":"chapeau","text":"The Secretary is not required to provide comparative information under clauses (iii) and (v) of subparagraph (A) with respect to a plan\u2014"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/c/3/B/i","children":[{"t":"num","text":"(i)"},{"t":"content","text":" for the first plan year in which it is offered; and","tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395w\u2013101/c/3/B/ii","children":[{"t":"num","text":"(ii)"},{"t":"content","text":" for the next plan year if it is impracticable or the information is otherwise unavailable.","tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395w\u2013101/c/4","children":[{"t":"num","text":"(4)"},{"t":"heading","text":"Information on late enrollment penalty"},{"t":"content","children":[{"t":"p","text":"The information disseminated under paragraph (1) shall include information concerning the methodology for determining the late enrollment penalty under ","children":[{"t":"ref","text":"section 1395w\u2013113(b) of this title","href":"/us/usc/t42/s1395w\u2013113/b","tail":"."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"text","text":"\n"},{"t":"text","text":"\n"}]}]}