Who Qualifies?

The SEP is for individuals who were unable to enroll, disenroll, or switch a Medicare Advantage or prescription drug plan during a qualifying election period because they were affected by a Federal, State, or Local government declared disaster or emergency. An individual qualifies for an SEP if they:

• Reside in an area that has been declared as an emergency or disaster by Federal, State, or Local governments.  This includes those who resided in the disaster or emergency area at the start of the incident.
• Do not live in the affected area but rely on help making health care decisions by one or more individuals who reside in the area.
• Were eligible for an enrollment period (i.e. initial enrollment period or other) during the time of the disaster or emergency.
• Missed a valid enrollment period due to the disaster or emergency.

What Agents Need to Know

If your client has been affected by a disaster or emergency and missed a valid enrollment period they may qualify for the special enrollment period.  Here’s what you will need to do to verify their eligibility:

• Obtain proof that they lived/live in an impacted area at the start of the SEP eligibility period (If they do not have proof, they may verbally attest.)
• Confirm that they had another election period available during the time of the incident.
• Confirm the beneficiary lived/lives in the county declared as a disaster or emergency.
• Confirm that an individual they rely on for help making health care decisions lived/live in the affected area.

Once you have verified your client’s eligibility you can proceed with the application process using election code SEP DST. Enrollments made during this SEP are effective the first of the month following the enrollment request.

How to Stay Compliant

The emergency and disaster related SEP should never be used as a marketing tool to promote Medicare Advantage or prescription drug plans.  Agents should not actively market this special enrollment period.  Agents should stay informed so they may advise clients who have missed a valid enrollment period due to a declared disaster or emergency.

Contact our compliance department at compliance@appliedga.com for any questions or concerns regarding this SEP.

Where to Find More Information

For any updates to eligible counties for FEMA declarations please refer to the FEMA website at: https://www.fema.gov/disasters

 

For compliance related inquiries please contact us at, compliance@appliedga.com or 800-498-6880 ext. 2914.