Does a beneficiary who no longer needs hospice care receive a Special Enrollment Period (SEP) to enroll in a Part D plan?

Prescription drug coverage provided under hospice care is creditable drug coverage. If the beneficiary was not adequately informed by hospice that his/her drug coverage is creditable, he/she may be entitled to a SEP. According to the "PDP Eligibility, Enrollment, and Disenrollment Guidance," a SEP is provided to "beneficiaries who were not adequately informed of the creditable status of drug coverage provided by an entity required to give such notice, or a loss of creditable coverage. This SEP permits one enrollment in or disenrollment from a PDP on a case-by-case-basis. This SEP begins the month the individual receives CMS approval of the SEP and continues for two additional months following this approval" (p. 20).

A SHIP counselor can help a beneficiary in this circumstance who would like to ask CMS for a discretionary SEP. The beneficiary will need to explain his/her individual circumstance to CMS, and ask for a one-time SEP to enroll in a Part D plan.

HAP Tool for More Information: http://www.hapnetwork.org/medicare-drug-coverage/aep-toolkit.html#Enrollment_and_Disenrollment

Source: Centers for Medicare & Medicaid Services, "PDP Guidance: Eligibility, Enrollment and Disenrollment," §20.3.6. Update: June 20, 2007 http://www.cms.hhs.gov/MedicarePresDrugEligEnrol/Downloads/PDPEnrollmentGuidanceUpdate.pdf

(Back to Medicare Drug Coverage: Enrollment)