Because some agents are unsure of the PAP ACC and MCD SEPs, we will go over them and try and clear up any confusion. It is important to know; both CMS and the carriers monitor the use of these SEPs. They are reporting any inappropriate use of these SEPs. We hope this post provides information that makes is easier to use these SEPs properly. This will help prevent delays with your client’s application processing.
What is a PAP SEP
A PAP (Pharmaceutical Assistance Program) SEP is an enrollment period for individuals who qualify to enroll in the state’s pharmaceutical assistance program (SPAP). To qualify for the SPAP program, beneficiaries must meet specific income and asset requirements.
Click here to see a list of states where the SPAP is available
Who can use a PAP SEP
The PAP SEP begins when the individual enrolls in the SPAP. If an individual enrolls in the SPAP program, they receive one oppportunity annually to use this SEP. They can use it to enroll in or change their Medicare Advantage or PDP plan. Anyone automatically enrolled in a PDP plan by their SPAP cannot use this SEP.
If an individual receives notice that they no longer qualify for SPAP benefits, they can use the PAP SEP. The SEP begins the month they lose the SPAP and continues for two months after they are notified of the loss (whichever comes later).
What is an ACC SEP
The ACC SEP is a Medicare Advantage Special Enrollment Period for those who request plan information in an accessible format. Beneficiaries cannot use the ACC SEP as an election period on it’s own. The beneficiary must have been eligible for another valid election period before they can use this SEP. The ACC SEP ensures beneficiaries who requested information in an accessible format receive additional time to submit an application for a vailid election period. This helps them get enrollment requests processed by extending the deadlines for application submissions.
Accessible format is a way of receiving health coverage information in a way that can be understood by individuals with disabilities. This format includes large print, Braille, audio recordings, or digital text that can be read by screen readers. This allows beneficiaries to access and understand important medical inforamtion and make appropriate plan choices.
Find out about the CT MSP income limits 2025
Who can use an ACC SEP
The ACC SEP is available to any Medicare beneficiary who did not recieve the materials they needed to make an informed enrollment decision in an accessible format at the same time standard material is provided.
Important: This is not a “stand-alone” election period. Indviduals must have been eligible of another valid election period but didn’t have the information they needed in an accessible format to make an informed decision in time. This SEP starts at the end of an election period in which the beneficiary submits a request for accessible formatted materials. The SEP is ineffect for at least as long it takes for the beneficiary to recieve the materials.
Watch a YouTube video on new rules for Dual and Drug help in 2025
What is an MCD SEP
The code MCD is for Medicaid and can only be used by individuals who have a change in Medicaid status of some type. Individuals who are newly eligible for Medicaid, lose eligibility Medicaid, or who’s Medicaid status changes can use the MCD SEP. Qualified individuals can use this SEP once within 3 months of the qualifying event or notification of change (whichever is later).
Who can use the MCD SEP
The MCD SEP applies to Medicare beneficiaires who:
Become eligible for any type of assistance through the Title XIX program. This includes partial duals who receive cost sharing assistance under Medicaid.
Those who lose eligibility for assistance or have a change in the level of assistance they qualify for. This applies even if they stop receiving Medicaid benefits or still qualify for LIS (Low Income Subsidy).
This SEP gives individuals one chance to make a change within 3 months of a qualifying event or when they receive a notice of the changes, whichever is later. The effective date for enrollments is the first day of the month after the carrier recieves the enrollment request.
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Please remember: Agents must use the correct SEP code to ensure carriers can process enrollments in a timely manner. Using an incorrect code could cause a delay or denial by the carrier. In some instances, it can result in the agent receiving corrective action from carriers and/or CMS.
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