If you live in an area where the Federal Emergency Management Agency (FEMA) declared an emergency or major disaster, and you were not able to take advantage of an enrollment period (such as your Initial Enrollment Period or the annual Open Enrollment Period), you will be granted a Special Enrollment Period (SEP) from the start of the incident and continuing for an additional four (4) full calendar months after the start of the incident.
You can refer to the FEMA website to see the date of when a specific disaster was declared:https://www.fema.gov/disasters
For example, if the FEMA Incident Period began on August 1, and you were not able to change to another Medicare plan during the annual Fall Open Enrollment Period that ended December 7th, you would have a SEP until December 31st to choose a Medicare plan for the following year. If you used the SEP, your coverage would then begin January 1st.
During the "FEMA-Declared Weather Related Emergency or Major Disaster" SEP, Medicare beneficiaries will have the opportunity to enroll in, disenroll from, or change their Medicare Part D or Medicare Advantage plan coverage.
Any enrollment decisions will become effective the first day of the month after the Medicare plan receives the enrollment decision.
For example, if you missed the annual Fall Open Enrollment Period (AEP) that ended December 7th, but were able to use this SEP before December 31st, your Medicare Part D or Medicare Advantage plan coverage would begin January 1st.
I lost most of my personal possessions during the disaster, how do I prove that I am eligible for this SEP?
If you do not have any formal identification (such as a driver's license, passport, utility bill), you can attest that you were living in the impacted area during the FEMA disaster. As noted by Medicare: "If the plan asks you for proof that you reside in an affected area (e.g., driver’s license, utility bills, etc.) and you have it, you should provide it to the plan. However, if your documents were destroyed or you don’t have access to them, you can attest to residing in one of the affected areas, as defined by the Federal Emergency Management Agency (FEMA)."
To learn more about this SEP, please call a Medicare representative at: 1-800-633-4227 (TTY 1-877-486-2048).Where can I find the source of this SEP?
The Centers for Medicare and Medicaid Services (CMS) first established this exceptional SEP in the July 2018 updates to the Medicare Advantage and Medicare Part D plan Enrollment Manuals and the actual SEP guidance states:"SEP for Individuals Affected by a FEMA-Declared Weather Related Emergency or Major Disaster
42 CFR 422.62(b)(4), (Rev. 1, Issued: July 31, 2018; Effective/Implementation: 07-30-2018)
A [Special Enrollment Period] exists for individuals affected by a weather-related emergency or major disaster who were unable to, and did not make an election during another valid election period. This includes both enrollment and disenrollment elections.
Individuals will be considered “affected” and eligible for this SEP if they:
- Reside, or resided at the start of the incident period, in an area for which FEMA has declared an emergency or a major disaster and has designated affected counties as being eligible to apply for individual or public level assistance;
- Had another valid election period at the time of incident period; and
- Did not make an election during that other valid election 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. The SEP is available from the start of the incident period and for four full calendar months thereafter."
Medicare Managed Care Manual, Chapter 2 - Medicare Advantage Enrollment and Disenrollment, Updated: August 19, 2011 (Revised: November 16, 2011, August 7, 2012, August 30, 2013, August 14, 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), Section 30.4.4 (p.50) SEPs for Exceptional Circumstances
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), Section 30.3.8 (p.42) SEPs for Exceptional Circumstances