US · guidance
CMS Pub. 100-18, ch. 12, § 20.2.2
Direct Contract EGWP Service Areas
In general, PDP sponsors can only cover beneficiaries in the service areas in which they
operate. However under CMS waiver authority, for employers/unions which directly contract
with CMS to sponsor their own PDP, coverage can extend to all of their Part D eligibles,
regardless of whether they reside in one or more other PDP regions in the nation. However, in
order to meet the enrollment eligibility requirements described in Pub. 100-18, chapter 3,
section 10, which includes the requirement that the beneficiary must permanently reside in the
EGWP-specific service area, all Direct Contract PDPs should ensure their defined service area
includes all geographic areas in which their plan Part D eligibles may reside (e.g., national
service area).
History
(Rev.6, Issued: 11-07-08, Effective/Implementation: 11-07-08)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-09-17
- Edition
- iom-2026-09-17
- Content hash
8f58b0176b4d3d791587bceb2ceae99e18a428f4314b99d39d0d3da3b97dfd14
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