If a Medicare beneficiary misses a valid enrollment period due to a FEMA emergency, beneficiaries may qualify for a DST SEP. As of April 1, 2025, important Medicare DST SEP changes go into effect. Agents must be aware of this to ensure their clients are able to take advantage of this opportunity too get needed coverage.
What is a Medicare DST SEP
The Medicare DST SEP is an enrollment election period. CMS provides for Medicare beneficiaries who miss a valid election period due to either weather-related emergencies or major FEMA declared disasters.
This SEP is only available in areas where state or local government officials declare an emergency or disaster. DST SEPs begins the date the incident occurs and extends for two months up to a year after it starts or the extension period begins.
The DST SEP election period allows Medicare beneficiaries to either enroll in or disenroll from a Medicare plan. Enrollment in the new coverage goes into effect the first day of the month following the submission of the application.
DST SEP Changes
CMS released a memo on December 3, 2024 announcing the changes to the DST SEP election. The change begins on April 1, 2025.
Please note; as of April1, 2025, beneficiaries using the DST SEP 2025 must submit applications directly through CMS. Beneficiaries call 1-800-MEDICARE or TTY 1-877-486-2048 to submit applications. In other words, brokers cannot submit DST applications. CMS will not accept them.
Applications submitted using any other means will be labeled as using an invalid election period. The plan provider will attempt to contact the enrollee to obtain a valid election period. If a valid election period cannot be verified, the application will be denied and the beneficiary will not receive coverage.
Important: this SEP does not allow (RFIs) Request for Information process for invalid or missing election information. In other words, beneficiaries are not given extra time to respond to correct their election. Additionally, carriers will update applications and disenrollment to remove the DST election.
When to use the DST SEP
Use the DST SEP when a beneficiary resides in an area where a natural disaster (earthquake, flood, hurricane, wildfire or other incident) occurs, resulting in missing a valid election period. Some FEMA emergencies require beneficiaries to leave their homes for safety. This sometimes results in a missed enrollment period.
Some individuals may use the SEP if they rely on a family member or other caregiver who is impacted by a disaster. This can make it impossible for them to receive the assistance they need during an enrollment period.
A few more reasons to use the DST SEP; inability to access Medicare plan information or submit an enrollment due to a FEMA declared disaster. In some instances, beneficiaries may use the SEP if their healthcare provider of facilities are impacted by the disaster. When this happens, the beneficiary may be unable to receive necessary information and make an informed decision.
Eligibility for the Medicare DST SEP
Those who wish to use this SEP, must live in the direct area the disaster occurred in. This must have caused them to miss a valid enrollment period such as; AEP, IEP or OEP.
Click here to learn more about Medicare election periods
Agents who want to join the team at Crowe; click her for online contract.
Important: Beneficiaries cannot use this SEP if; they already made a change during the specified enrollment period.
Beneficiaries must call 1-800-MEDICARE or TTY 1-877-486-2048 to submit an application to avoid missing their window to enroll.
Leave a Comment