§ 1395w-101. Eligibility, enrollment, and information
(a)
Provision of qualified prescription drug coverage through enrollment in plans
(1)
In general
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 section
1395w–102
(a) of this title) as follows:
(B)
Medicare Advantage enrollees
(i)
Enrollees in a plan providing qualified prescription drug coverage receive coverage through the plan
A part D eligible individual who is enrolled in an MA–PD plan obtains such coverage through such plan.
(ii)
Limitation on enrollment of MA plan enrollees in prescription drug plans
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.
(iii)
Private fee-for-service enrollees in MA plans not providing qualified prescription drug coverage permitted to enroll in a prescription drug plan
A part D eligible individual who is enrolled in an MA private fee-for-service plan (as defined in section
1395w–28
(b)(2) of this title) that does not provide qualified prescription drug coverage may obtain qualified prescription drug coverage through enrollment in a prescription drug plan.
(2)
Coverage first effective January 1, 2006
Coverage under prescription drug plans and MA–PD plans shall first be effective on January 1, 2006.
(b)
Enrollment process for prescription drug plans
(1)
Establishment of process
(A)
In general
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.
(B)
Application of MA rules
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–PD plan under the following provisions of section
1395w–21 of this title:
(i)
Residence requirements
Section
1395w–21
(b)(1)(A) of this title, relating to residence requirements.
(ii)
Exercise of choice
Section
1395w–21
(c) of this title (other than paragraph (3)(A) of such section), relating to exercise of choice.
(iii)
Coverage election periods
Subject to paragraphs (2) and (3) of this subsection, section
1395w–21
(e) of this title (other than subparagraphs (B), (C), and (E) 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.
(iv)
Coverage periods
Section
1395w–21
(f) of this title, relating to effectiveness of elections and changes of elections.
(v)
Guaranteed issue and renewal
Section
1395w–21
(g) of this title (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.
(C)
Special rule
The process established under subparagraph (A) shall include, in the case of a part D eligible individual who is a full-benefit dual eligible individual (as defined in section
1396u–5
(c)(6) of this title) who has failed to enroll in a prescription drug plan or an MA–PD plan, for the enrollment in a prescription drug plan that has a monthly beneficiary premium that does not exceed the premium assistance available under section
1395w–114
(a)(1)(A) of this title).[1] 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.
(2)
Initial enrollment period
(A)
Program initiation
In the case of an individual who is a part D eligible individual as of November 15, 2005, there shall be an initial enrollment period that shall be the same as the annual, coordinated open election period described in section
1395w–21
(e)(3)(B)(iii) of this title, as applied under paragraph (1)(B)(iii).
(B)
Continuing periods
In the case of an individual who becomes a part D eligible individual after November 15, 2005, there shall be an initial enrollment period which is the period under section
1395w–21
(e)(1) of this title, as applied under paragraph (1)(B)(iii) of this section, as if “entitled to benefits under part A of this subchapter or enrolled under part B of this subchapter” were substituted for “entitled to benefits under part A of this subchapter and enrolled under part B of this subchapter”, but in no case shall such period end before the period described in subparagraph (A).
(3)
Additional special enrollment periods
The Secretary shall establish special enrollment periods, including the following:
(A)
Involuntary loss of creditable prescription drug coverage
(i)
In general
In the case of a part D eligible individual who involuntarily loses creditable prescription drug coverage (as defined in section
1395w–113
(b)(4) of this title).
(ii)
Notice
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.
(C)
Exceptional circumstances
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.
(4)
Information to facilitate enrollment
(A)
In general
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–PD plans to such individuals and enrollment of such individuals in such plans.
(5)
Reference to enrollment procedures for MA–PD plans
For rules applicable to enrollment, disenrollment, termination, and change of enrollment of part D eligible individuals in MA–PD plans, see section
1395w–21 of this title.
(c)
Providing information to beneficiaries
(1)
Activities
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) of this section.
(2)
Requirements
The activities described in paragraph (1) shall—
(A)
be similar to the activities performed by the Secretary under section
1395w–21
(d) of this title, including dissemination (including through the toll-free telephone number 1–800–MEDICARE) of comparative information for prescription drug plans and MA–PD plans; and
(B)
be coordinated with the activities performed by the Secretary under such section and under section
1395b–2 of this title.
(3)
Comparative information
(A)
In general
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:
[1] So in original. The closing parenthesis probably should not appear.