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CMS announces Medicare Special Enrollment Period (SEP) for people whose Medicare Part D or Medicare Advantage plan enrollment was affected by the COVID-19 pandemic

Category: Special Enrollment Periods SEP
Published: May, 05 2020 02:05:57

The Centers for Medicare and Medicaid Services (CMS) announced that people who were unable to enroll into a Medicare Part D drug plan or Medicare Advantage plan due to the COVID-19 pandemic, can now use the Major Disaster Special Enrollment Period (SEP) to join a 2020 Medicare plan.  The COVID-19 SEP will continue for four months after the declaration of the Major Disaster through June 30, 2020.

In a May 5, 2020 letter to Medicare Part D and Medicare Advantage plans, CMS noted: "we would like to clarify for Medicare Advantage (MA) and Part D plan sponsors that the exceptional conditions Special Enrollment Period (SEP) adopted under 42 CFR 422.62(b)(4) and 423.38(c)(8)(ii) for Individuals Affected by a FEMA-Declared Weather Related Emergency or Major Disaster is applicable and is available for beneficiaries who were eligible for -- but unable to make -- an election because they were affected by the COVID-19 pandemic and meet the terms of the SEP . . . ."

How does a person qualify for the Natural Disaster Special Enrollment Period?

CMS provides the following guidance: "The special opportunity to enroll in, disenroll from or switch Medicare health or prescription drug plans applies to all individuals who:
  • Reside, or resided at the start of the incident period, in an area for which the Federal Emergency Management Agency (FEMA) has declared an emergency or a major disaster;

  • Had another enrollment period at the time of the incident period (such as the Fall Open Enrollment Period or other special opportunity); and

  • Did not enroll or make a change during that other enrollment period. In addition, the SEP is available to those individuals who don’t live in the affected areas but rely on help making healthcare decisions from friends or family members who live in the affected areas."

Will I need to prove that my Medicare plan enrollment was actually affected by COVID-19?

No.  As noted by CMS: "Beneficiaries will not be expected to provide proof that they were affected by the pandemic-related emergency."

Important:  This Major Disaster Special Enrollment Period is only for a limited time.

Originally, the Special Enrollment Period began on March 1, 2020 when President Trump declared the COVID-19 National Emergency and provides Medicare beneficiaries who was unable to make an enrollment decision due to the COVID-19 pandemic one opportunity to join a Medicare plan for 4 full calendar months or until June 30, 2020.

However, CMS updated the "FEMA-Declared Weather Related Emergency or Major Disaster" SEP and as of January 1, 2021, this SEP is known as the "SEP for Government Entity-Declared Disaster or Other Emergency" and "starts as of the date the declaration is made, the incident start date or, if different, the start date identified in the declaration, whichever is earlier. The SEP ends 2 full calendar months following the end date identified in the declaration or, if different, the date the end of the incident is announced, whichever is later."

The Medicare plan enrollment becomes effective the first of the month after the plan receives the enrollment request.

How can I use this Special Enrollment Period to change Medicare plans?

You can join a Medicare plan using the National Disaster SEP by calling a Medicare representative at 1-800-Medicare (1-800-633-4227) -- or by working with a local insurance agent -- or by calling the Medicare plan's enrollment number directly.

If you cannot find the Medicare plan's telephone number, we have Member Service telephone numbers for most Medicare Part D plans in our Medicare Part D plan finder - https://PDP-Finder.com – just choose your state and click on the plan name.  We have the same Member Services contact information on our Medicare Advantage plan coverage pages (start with https://MA-Finder.com and enter your Zip and then click on the plan name you wish to reach) – the Member Service’s telephone number is listed at the top of the plan detail page.

If you are enrolling into a Medicare plan by submitting a printed application, you may see an Enrollment Period option on the Medicare plan enrollment application that may read something like this:

"I was affected by an emergency or major disaster (as declared by the Federal Emergency Management Agency (FEMA)) or by a Federal, state or local government entity. One of the other statements here applied to me, but I was unable to make my enrollment request because of the disaster."

If this statement is not available on your application, you may wish to telephone the Medicare plan and ask a plan representative to help you complete the application.

Sources include:

CMS May 5, 2020 Memo "Special Enrollment Period (SEP) for Individuals Affected by a FEMA-Declared Weather-Related Emergency or Other Major Disaster: Applicable for COVID-19" -- https://www.cms.gov/files/document/ special- enrollment-period-sep-individuals- affected-fema-declared- weather-related-or-other-major.pdf

"Enrollment Issues for Weather Related Emergencies and Major Disasters, Questions and Answers for Medicare Beneficiaries" -- https://www.cms.gov/ Medicare/Eligibility-and-Enrollment / MedicareMangCareEligEnrol/ Downloads/Disaster_SEP_QAs_for_Beneficiaries.pdf
(and https://www.cms.gov/About-CMS/ Agency-Information/Emergency/ Downloads/ MedicareBeneficiaryDisasterEnrollmentQsandAs.pdf)

https://www.cms.gov/ About-CMS/ Agency-Information/ Emergency/ Downloads/ Disaster-Memo-Medicare-SEP.pdf

https://www.whitehouse.gov/ presidential-actions /proclamation-declaring-national- emergency- concerning- novel-coronavirus- disease-covid-19-outbreak/

https://www.cms.gov/Medicare/Eligibility-and-Enrollment/ MedicarePresDrugEligEnrol/index

CMS Final Regulations published June 2, 2020, "Contract Year 2021 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program", CMS-4190-F

https://www.cms.gov/About-CMS/ Agency-Information/Emergency/ Downloads/ MedicareBeneficiaryDisasterEnrollmentQsandAs.pdf

Medicare Prescription Drug Benefit Manual Chapter 3 - Eligibility, Enrollment and Disenrollment, Updated: August 19, 2011 (Revised: November 16, 2011, August 7, 2012, August 30, 2013, August 30, 2014, July 6, 2015, September 1, 2015, September 14, 2015, December 30, 2015, May 27, 2016, August 25, 2016, June 15, 2017, July 31, 2018 & August 12, 2020)

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