Medicare SEPs for emergencies or disasters

By Ed Crowe | General Articles | 0 comment | 23 November, 2023 | 0

Click here to view SEP_Report as of 4-28-25

Medicare SEPs for emergencies or disasters

There are a lot of moving parts to selling Medicare plans including several choices for Enrollment opportunities. We will explain a little about the Medicare SEPs for emergencies or disasters. This SEP may be available to some of your clients.

It can be very helpful to know that in some instances, CMS allows a SEP (special enrollment period) for beneficiaries to enroll in or change either a Medicare Advantage or prescription drug plan. This SEP is available to individuals affected by either a disaster or a federal, state or local government declared emergency. The SEP can only be used if you missed a valid election period during the time of the disaster or emergency. It is important to check with each carrier to see if they are accepting the SEP for enrollments or plan changes.

Who can use this SEP

Beneficiaries must live in the area where the emergency or disaster took place.
They need to have been unable to enroll during a valid election period because of the disaster or emergency.
Were eligible for a valid election period some time when the incident occurred.
If the beneficiary does not live in the affected area, they are still eligible to use it if they require help with health care decisions from someone who does live in the affected area.

How to use the SEP for emergency or disasters

If you have a beneficiary who may qualify for this SEP, be sure you check to see if the carrier of the desired pan is accepting this SEP. The beneficiary may need to verify they live in the area that was declared an emergency or disaster. You also need to be able to verify that they have missed a valid election period during the emergency/disaster. After you verify that they qualify, you can move forward with the application.

When you are filling out the application, you will look for the SEP choice that pertains to an Emergency or disaster declared by FEMA or other government agency. The application may ask for the dates of the valid enrollment period that was missed.

CMS will need to decide if the SEP election period is valid. If there are any questions, the carrier will contact the agent or the client or both with any questions.