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Some individuals who moved from employer-sponsored health insurance and are eligible for Medicare may wonder how COBRA works with Medicare. Understanding the rules and coordination between these two programs is essential to avoid gaps in coverage and potential penalties.

What is COBRA

COBRA (Consolidated Omnibus Budget Reconciliation Act) allows eligible employees and their dependents to continue their employer-sponsored health coverage for a limited time when they experience a qualifying event, such as job loss, reduction in work hours, or retirement. In most cases, COBRA coverage is available for up to 18 months. In some circumstances, beneficiaries may be eligible to extend this coverage.

How COBRA Works with Medicare

The way COBRA and Medicare work together depends on which coverage individuals have first and their specific situation.

1. If you have COBRA and become eligible for Medicare

If the beneficiary is enrolled in COBRA and then becomes eligible for Medicare (usually at age 65), COBRA coverage may end. Employers are not required to continue COBRA once an individual enrolls in Medicare. However, dependents covered under COBRA may still maintain their coverage. It is important to enroll in Medicare on time to avoid late enrollment penalties.

Click here to learn more about how Medicare works with other insurance

2. If you have Medicare and then become eligible for COBRA

Beneficiaries already enrolled in Medicare and then become eligible for COBRA due to job loss or another qualifying event can enroll in COBRA. However, COBRA acts as secondary insurance to Medicare, meaning Medicare will pay first for covered services, and COBRA will cover remaining costs according to the plan.

3. Can you delay Medicare and keep COBRA

Relying solely on COBRA instead of enrolling in Medicare when first eligible can lead to serious consequences. Medicare considers COBRA secondary to Medicare-eligible individuals, so delaying Medicare enrollment may result in penalties and a coverage gap when COBRA ends.

It is important to note; Medicare does not consider COBRA creditable coverage even if it provides the same coveage the employer provided. In othe rwords, beneficiaries could end up with a coverage gap leading to lifetime penalties for Part B. This depends on the amount of time beneficiaries go without creditable coverage.

Things to consider

• Medicare Enrollment Deadlines: Individuals who are eligible for Medicare should enroll during their IEP (Initial Enrollment Period) to avoid penalties. COBRA does not count as creditable coverage to delay Medicare Part B enrollment. However, it is usually considered creditable Part D coverage.
• COBRA Costs: In most cases, COBRA coverage is expensive because beneficiaries must pay the full premium, including the employer’s share.
• Medigap and Medicare Advantage Options: Once COBRA ends, beneficiaries may want to enroll in a Medicare Supplement (Medigap) and PDP plan or a Medicare Advantage plan to fill the coverage gaps left by Original Medicare.

Learn about Medicare OEP, SEPs and Late Enrollment Penalties watch a quick YouTube video

COBRA and Medicare can work together, but understanding how they coordinate is crucial for making informed healthcare decisions. For individuals on COBRA who are approaching Medicare eligibility, it’s advisable to consult with a licensed Medicare agent to ensure you avoid LEPs and coverage gaps.

Agents do you need a scope of appointment – click here

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.

Do you need a scope of appointment – click here

Ready to join the team at Crowe – click here for online contract

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. 

If you are a Medicare agent, you know that 2025 has been a challenge finding plans that offer the benefits our clients are looking for. That is why we want you to take a look at the Connecticare Medicare Advantage Plans 2025. The plans offer some great coerage with many great supplemental benefits.

Connecticare Medicare Advantage Plans 2025

Connecticare is offering 5 Advantage plans in 2025 this includes 1 D-SNP. Each plan is available statewide in all counties of CT.

It is important to note: these plans also provide coverage in NY with Emblem providers.

Here are some of the plan highlights:

All the plans include SilverSneakers to help members stay active. Plans also include a $0 Teledoc copay amount and over $150 in member rewards ad a comprehensive formulary.

If you are an agent who is ready to join our team; click here for contract

Choice Plan 3 (HMO-POS)

This plans has a $0 monthly premium. It also has a $0 co-pay for PCP visits and a $35 specialist co-pay. The cost for anual physicals, screenings and immunizations is $0.

Although hearing services are not covered on this plan, it provides a $0 preventative dental benefit that covers cleanings, exams, flouride treatments and standard x-rays every 6 months. It also proides up to $2,000 of comprehensive dental coverage. A free eye exam is included each year and up to $400 for eyewear and $50 per month for mail order OTC items.

Passage Plan 1 (HMO-POS)

The Passage Plan 1 also offers members a $0 premium plan with several great benefits. PCP visits are $0 and the specialist co-pay is only $35.

This plan offers some very generous benefits that include; a hearing benefit for hearing servies and hearing aids of $3,000 annually. The dental benefit covers 1 exam, cleaning, flouride & standard x-rays at no cost every 6 months. The dental coverage includes a comprehensive dental benefit of $2,000. Additioanlly, they also provide a $0 eye exam each year and $550 of eye wear coverage. There is a $75 monthly OTC allowance for plan members. As you can see, this plan includes a fantastic benefit package.

Click here to download a copy of the full 2025 Connecticare First Look

Flex Plan 3 (HMO-POS)

The Flex Plan 3 has a low monthly premium. In the counties of Hartford, Litchfield ,& Tolland, the premium is $29 per month. In the counties of Fairfield, New Haven, New London & Windham; the preium is $36 per month.

This plan has a low PCP co-pay of $5 per visit and a $50 specilaist co-pay amount. Although this plan doe snot include a hearing benefit, it does provide1 dental exam with cleaning, flouride and standard x-rays every 6 months. The plan also offers dental riders for $27 a month for $2,000 or $35 a month for $3,000 of comprehensive coverage. Vision coverage includes a $0 eye exam and a $300 eye wear allowance annually. The OTC benefit for this plan is $50 per quarter.

Watch a YouTube video of the plan benefits

Choice Plan 2 (HMO-POS)

The Choice Plan 2 is another great plan option offering members a $0premium, a $0 co-pay for PCPs and a very low $10 specialist co-pay.

Addtional plan benefits include a $3,000 annual hearing benefit that covers hearign exams and hearing aids. A dental beenfit that covers 1 exam, cleaning, flouride & standard x-rays every 6 monthsas well as $3,000 in coverage for comprehensive services. Additioanlly, the plan provides a $50 monthly OTC benefit.

Important: prescrption drugs are not covered on this plan.

Choice Dual (HMO-POS D-SNP)

In order to enroll in this plan, members must be QMB+, SLMB+, and FBDE eligible. The premium for this plan is $0; as are all doctors visits including; specialists, lab services, in-patient hospital and more.

Learn about the CT MSP income limits 2025

Hearing benefits for each year are $2,500. The plan provides a $0 eye exam as well as a $500 annual eye wear allowance. The dental benefit is $0 for preventative services (cleanings, exam, fouride & stnadard x-rays) every 6 months and includes $3,000 for comprehensive benfits.

Are you a Crowe agent who wants to add Connecticare products; click here for contract

As you can see while other plans have scaled back their benefits, Connecticare has increased benefits. This carrier provides some great plan options and is worth taking a look at for your clients coverage.

Make sure you are aware of the Medicare SEP changes for 2025

There have been some important Medicare SEP changes in 2025 that both agents and enrollees need to be aware of. These regulations were put into effect by the CMS. We will explain those changes and how to navigate them. We’ve summarized the changes and how they could impact your clients.

SEPs for D-SNPs & LIS enrollees

As of January 1, 2025 CMS eliminated the quarterly SEP that let dual eligible individuals or those with LIS make MA/MAPD Medicare Advantage plan changes once each quarter during the first 3 quarters.

What replaced the quarterly SEP for D-SNP & LIS enrollees

Instead of a quarterly SEP, CMS has provided a monthly SEP (Code DEP). This allows DSNP and LIS beneficiaries to disenroll from their MAPD plan and enroll in Original Medicare and a standalone PDP. The SEP also allows LIS members to switch their current PDP coverage to another PDP plan.

There is also a monthly integrated SEP (INT-SEP). This SEP allows only full dual eligible beneficiaries to switch to or from one integrated D-SNP with aligned Medicaid plan to another.

Monthly INT SEP details

Full Dual Beneficiaries can use the INT-SEP once per month. The effective date of the new plan will be the first day of the following month.

Plans that are eligible for the INT-SEP include:

• FIDE SNP: Fully Integrated Dual Eligible Special Needs Plan
• HIDE SNP: Highly Integrated Dual Eligible Special Needs Plan
• AIP: D-SNP is an Applicable Integrated Plan 

Although dual eligible plan enrollees can change plans monthly, staying in their current plan allows them to avoid disruptions to their coordinated care plan.

Disaster (DST) SEPs

CMS has also changed the SEP (DST-SEP). The DST SEP is for those affected by an event that results in a government declared disaster or other emergency. The election process will change as of April 1, 2025.

Medicare beneficiaries who miss a valid election period due to a government declared disaster or emergency must follow these guide lines:

Beneficiaries who qualify for the DST SEP must submit applications directly through CMS by calling 1-800-MEDICARE or TTY 1-877-486-2048 to submit an application.

In other words, CMS will not accept broker assisted DST applications.

Despite the changes to these SEPs, full and partial dual eligible beneficiaries can continue to use other SEPs, if they are eligible (AEP, OEP, move, loss/gain of eligibility, etc.).

How Medicare Works with Employer Health Coverage

Navigating health insurance options can be overwhelming, especially when it comes to understanding how Medicare interacts with employer-sponsored health plans. Those who are either still working or have coverage through a spouse’s employer need to understand how Medicare and employer coverage coordinate. Having knowledge of how these plans work together can ensure benefits are maximized and unnecessary charges are avoided.

Watch a video on how Medicare works with employer coverage

Primary vs. Secondary Payer

One of the most critical aspects of coordinating Medicare with employer health coverage is determining which insurance is the primary payer (pays first) and which is the secondary payer (covers remaining costs). This depends on several factors, including the size of the employer and whether the individual has Medicare due to age, disability, or End-Stage Renal Disease (ESRD).

• If the employer has 20 or more employees: The employer-sponsored plan is typically the primary payer, and Medicare acts as the secondary payer. This means your work plan pays first, and Medicare may cover some remaining costs.
• If the employer has less than 20 employees: Medicare is usually the primary payer, and the employer plan serves as secondary coverage.
• Those who qualify for Medicare due to disability and the employer has less than 100 employees: Medicare generally becomes the primary payer.
• Anyone who has Medicare due to ESRD: The employer plan pays first for the first 30 months, after that, Medicare becomes the primary payer.

Should you enroll in Medicare

Whether or not an individual should enroll in Medicare Part A and/or Part B while working depends on the number of emloyees. It also depends on whether the employer’s plan provides creditable coverage (coverage that is as good as or better than Medicare).

• Medicare Part A (Hospital Insurance): Most people qualify for premium-free Part A, so enrolling is often a good idea, even if you have employer coverage. Although, if you contribute to a Health Savings Account (HSA), enrolling in Medicare will impact your ability to make tax-free contributions.
• Medicare Part B (Medical Insurance): If the employer coverage is primary, individuals may be able to delay Part B enrollment without penalty. However, if Medicare would be the primary payer, the indivdual should enroll in Part B to avoid gaps in coverage to avoid LEPs ( late enrollment penalties).

Medicare and COBRA Coverage

If you leave your job and have access to COBRA coverage, it’s essential to understand how it works with Medicare:

• If you already have Medicare it is very unlikely that you will elect COBRA coverage. when you elect COBRA, Medicare remains your primary payer, and COBRA serves as secondary coverage. Although the cost for COBRA is usually high becuase once you are eligible for Medicare, your employer will not pay any portion of the COBRA premium.
• If you become eligible for Medicare while on COBRA, your COBRA coverage may end. If you do not enroll in Medicare, COBRA may only pay a small portion of your medical expenses leaving beneficiaries with a large bill.

Avoiding Late Enrollment Penalties

Those who delay enrolling in Medicare because they have employer coverage qualify for a Special Enrollment Period (SEP) when employment or coverage ends. This allows them to sign up for Medicare without penalties. However, if they miss this window, they may face lifetime late enrollment penalties,for Part B and Part D (prescription drug coverage).

Watch a quick YouTube video on OEP, SEPs and LEPs

Understanding how Medicare interacts with employer health coverage is key to making informed healthcare decisions. Whether Medicare is the primary or secondary payer, knowing when and how to enroll can save money and ensure seamless coverage. If you’re unsure about your situation, consulting with a Medicare agent or your companies benefits administrator can help ensure you choose the best plan for your health coverage.

We will go over how to become a Medicare GA and what you need to set up a Medicare General Agency. A Medicare GA (General Agency) is an agency that has a contract with one or more Medicare carriers above street level. The GA has a Medicare contract and two or more licensed, producing sub agents.

Each year, CMS releases the maximum, street level commission that agents can receive for either a Medicare Advantage or Prescription Drug Plan  sale.  If an agency has a GA contract or higher, they are elgibile to receive compensation above the street level.  The additional compensation you receive is an override. GAs receive an override payment on every sale made by it’s sub agents.

How to become a Medicare GA

For an agency to receive a GA contract, they must work with an up line agency that is willing to provide a GA level contract.

 Agencies must also meet the qualifications for each carrier.  Each insurance carrier requires a specific number of sub agents in order to qualify as a GA.  For example; Aetna requires 3 total contracted producers (this can include the principal).  In other words, you need the agency and producer connected to it and 2 licensed, certified, producing sub agents. Please note; each company has it’s own requirements. In general, insurance carriers require anywhere from 2 to 5  licensed, certified and producing sub agents in order to get a GA contract.

Agency principals

In order to receive overrides, Medicare requires GAs to complete licensing and certifications.  This applies to their own production as well as production from sub agents. This is sometimes an issue if, the agency owner no longer writes business and has no desire to complete the certifications required to sell Medicare plans.

If the GA is an entity, the entity must be licensed.  Each agency must have a licensed, certified affiliated person.  (Even if they are not going to sell anything).  

Who can recieve GA compensation

An individual agent can receive an GA level agent contract as long as they meet the requirements. This means the compensation is paid to the individuals bank account. In some cases, an entity hold the GA contract (LLC, S-Corp, Corporation, etc..) with the compensation paying to the entity. Again, for an entity to receive payment, they must be connected to a licensed, certified agent.

Downline commission payments

Street level direct payments – Under this set up, the agent recieves street compensation directly from the insurance company.  This includes both initial commission and renewal comp. The GA receives overrides directly from the carrier.

LOA or Assigned Commission– In this scenario, all compensation (street commission and override) is paid to the agency regardless of who places the cases.

See what Crowe has to offer it’s agents

GA Contracting

Crowe and Associates can set up GA levels for just about any company and product type.  We use one contracting kit to appoint with almost all carriers.  The GA should notify our office if adding subagents. The sub agents fill out the online contracting link, check off the companies they want and add the name of their immediate upline so we can properly align them. Please have them note if they are an LOA agent. It is easy to put additional carrier requests in by either completeing a link, emailing or calling our office. There is no need to fill out additional paperwork.

Please note; many carriers take about a week to process contracts.  They process the GA contract first and then they process the sub agents.  As a result, this may cause a delay in the processing of the sub agent’s contracts.

Click here for online contract or to add a carrier to an existing Crowe contract

Adding Medicare to existing agencies

Agencies that already have a successful business may want to add Medicare as an additional revenue stream. In many cases, a good relationship with these clients gives them an opportunity to turn their existing book into a great source for leads. If they have clients nearing age 65 or over, they can easily transition into offering Medicare planning for those clients.

Medicare offers several options for health coverage, including Original Medicare and Medicare Advantage (Part C). Choosing the right plan can be challenging, especially if you’re trying a Medicare Advantage plan for the first time. Fortunately, Medicare provides trial rights that allow beneficiaries to switch back to Original Medicare under specific conditions. Understanding Medicare trial rights helps beneficiaries make informed decisions and avoid being locked into a plan that may not meet your needs.

What are Trial Rights

Medicare trial rights are special protections. They allow beneficiaries to return to Original Medicare if they are dissatisfied with their Medicare Advantage plan. These rights apply in two primary situations:

Those who enroll in a Medicare Advantage plan when first eligible for Medicare and decide within the first 12 months that it’s not the right fit, can return to Original Medicare. You can also enroll in a Medicare Supplement (Medigap) plan without facing medical underwriting restrictions.

Beneficiaries who had a Medigap plan and dropped it to join a Medicare Advantage plan for the first time, can switch back to Original Medicare anytime within the first 12 months. Additionally, they have the right to re-enroll in the same plan they had previously if it is still available. If it is not, they can purchase a different Medigap plan.

Why are Trial Rights important

Medicare Advantage plans may not always work out as expected. They typically have provider networks, may require referrals for specialists, and can come with different costs than Original Medicare. If the beneficiary’s preferred healthcare providers are not in-network, or the coverage does not suit their healthcare needs, trial rights provide a way to switch back without penalty.

Click here to watch a video on what you need to know before a Medicare sale

Understanding how to use a Medicare Trial Right

Those who decide to use the trial right should:

• Contact a Medicare agent, if possible to get the best plan options to fit coverage needs. Those who don’t have an agent; call Medicare at 1-800-MEDICARE or visit Medicare.gov to change their plan back.
• Be sure to apply for a Medigap policy within the 12-month window, if they want supplemental coverage. This helps ensure coverage without going through underwriting.
• Because Original Medicare does not include prescrption drug coverage, it is also important to enroll in a standalone PDP plan.

Things to remember

• Medicare trial rights allow beneficiaries to return to Original Medicare within 12 months of enrolling in a Medicare Advantage plan for the first time.
• Those who switched from a Medigap policy to a Medicare Advantage plan for the first time may be able to reinstate their Medigap policy. If it is not available anymore, they can or get a new one.
• These rights help protect beneficiaries from being stuck in a plan that does not meet their healthcare needs.

Agents who want to see what Crowe has to offer; click here.

Ready to join the team at Crowe; click here for online contracting

It is important to understand the rights of your clients to ensure they have the flexibility to choose the best coverage for their healthcare needs. If a client enrolls in a Medicare Advantage plan for the first time, explain the time available should they want to go back to Original Medicare. To take advantage of these protections, act within the trial period.

For veterans who qualify for both Medicare and VA (Veterans Affairs) benefits, understanding how these two healthcare systems work together is crucial. Although both programs provide coverage, they serve different purposes and operate independently. Coordinating Medicare and VA benefits can help maximize healthcare options and avoid unexpected costs.

Do Veterans need Medicare if they have VA benefits

VA benefits provide healthcare services through VA facilities, but do not cover care veterans receive outside the VA system. This is where a Medicare plan helps. While enrolling in Medicare is not mandatory for veterans, having both Medicare and VA benefits can expand healthcare choices. This helps ensure access to a variety of providers outside the VA network if needed.

Click here to find local VA facilities

How Medicare and VA benefits work together

It is important to note; Medicare and VA benefits do not coordinate directly. This means, one does not cover what the other does not. Instead, each program pays for services independently, depending on where veterans receive care:

VA Facilities

If you receive care at a VA hospital or clinic, only VA benefits cover the cost. Medicare does not pay for services at VA facilities.

Non-VA Providers

If you seek care outside the VA system, Medicare will provide coverage for approved services, but VA benefits will not. Without Medicare, veterans are responsible for the entire cost of care from non-VA providers unless you have other insurance.

How each part of Medicare interacts with VA benefits

Medicare Part A (Hospital Insurance): Covers inpatient hospital care. Many veterans qualify for premium-free Part A, making enrollment a good option even if they normally use VA facilities.

Medicare Part B (Medical Insurance): Covers outpatient care, doctor visits, and preventive services. Those who want access to non-VA doctors or specialists, enrollment in Part B is recommended.

Medicare Part C (Medicare Advantage): Private insurance plans that bundle Parts A and B, often including prescription drug coverage. Some plans offer additional benefits, although some may not work well with VA benefits since VA care providers are separate from Medicare Advantage networks.

Medicare Part D (Prescription Drug Coverage): VA benefits include prescription drug coverage, often with lower costs than Medicare Part D. However, enrolling in Part D can be beneficial for veterans who want access to non-VA pharmacies.

Tricare for Life and VA benefits

Some veterans also qualify for Tricare for Life (TFL), which serves as supplemental coverage for Medicare. In this case:

• Medicare pays first, then TFL covers remaining costs.
• VA benefits still work separately, covering care at VA facilities.

Should veterans enroll in Medicare

• Those who rely solely on VA benefits are limited to VA facilities, which could be problematic if they move or need non-VA care.
• Enrolling in Medicare Part B ensures access to non-VA providers and prevents late enrollment penalties.
• Individuals who plan to use VA prescription drug benefits exclusively can skip Part D enrollment without penalty, as VA drug coverage is considered creditable.

Although VA benefits provide excellent healthcare for eligible veterans, they have limitations, particularly when it comes to non-VA care. Medicare expands healthcare options and ensures comprehensive coverage in case of emergencies or provider preferences.

Veterans should carefully evaluate their healthcare needs and consider Medicare enrollment to maintain flexibility and avoid coverage gaps. A licensed Medicare agent can help go over all the options available and help find the best coverage for each individual.

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. 

Because Medicare agents have a large number of products to choose from when deciding what to sell, we explain why offer Physicians Mutual dental plans in the post below.

Dental products provide necessary coverage not offered by original Medicare. Because poor dental health can lead to serious health issues, regular dental checkups can help avoid health problems down the road.

There are 4 different dental plan options

Each plan provides coverage for over 400 procedures. The difference between the plans is the premium and the amount the plan pays for each covered service. There are plan choices to fit any budget.

All plans provide 100% coverage for preventive treatment at an in-network dentist. This includes; an exam, x-rays and a cleaning.

Take a look at the CT dental Brochure

Please note; There is a 12 month waiting period on major benefits.

All plans use the Ameritas network of providers. There are more than 5000,000 provider locations for member to access. All these plans are PPOs so members can receive out of network coverage for services, but it is always better to use in network providers for the best value.

Economy

As you have probably guessed; these plans are the lowest cost plans.

The Economy plans pay 25% of the maximum allowable charge for Basic treatments (fillings) and Major benefits, such as root canals or crowns.

Standard

Standard plans are another affordable option for dental coverage. They provide a payment of 40% of the maximum allowable charge for basic and major treatments.

Preferred

Preferred plans are similar to the other plans. The plan cost is a little more and so is the coverage percentage members receive. These plans provide 55% payment of the maximum allowable charges for basic and major benefits.

Premier

The Premier plans are the highest coverage level available at Physicans Mutual. This plan pays 70% of the maximum allowable charge for covered services..

Click here for product availability Map

A few more reasons to offer Physicians Mutual Dental Plans

These plans do not require members to pay a deductible. All preventative benefits are covered at 100% from day 1. One important aspect of this plan is; there is no maximum on cash benefits like other plans. That makes these plans a fantastic value no matter which plan beneficiaries choose.

Watch a video on the Physicians Mutual Dental plans

It is easy for members to add a vision and hearing rider to any plan. Once added members can use any participating provider.

See why you should offer ancillary products to your clients

Eye exams are covered up to $100 per year per member. The vision correction benefit of $150 includes prescription eyeglasses, sunglasses, sports glasses and contact lenses. There is a 3 month waiting period for this benefit. Members use the VSP network of providers to receive a discounted price for eye exams and lenses.

The hearing benefit provides up to $75 per member for covered hearing exams and as much as $500 per hearing aid per ear after a 12 month waiting period.

Click here for online contracting with Crowe