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 (IEP) or the annual Open Enrollment Period (AEP) or a Special 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 declared start of the natural disaster or incident.
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
Any enrollment decisions will become effective the first day of the
month after the Medicare plan receives the enrollment decision.
You can refer to the FEMA website to see the date of when a specific disaster was declared:https://www.fema.gov/disastersUsing the Natural Disaster SEP if you missed the annual Medicare Open Enrollment Period
If you are involved with a FEMA Incident Period beginning on or after August 1, and you were not able to change to another Medicare plan during the annual Medicare Open Enrollment Period that ended December 7th, you would have a SEP until December 31st to choose a Medicare plan for the following year.
As noted by Medicare:
"If you made your enrollment request after December 7 but no later than December 31 and you are eligible for the plan, your coverage will start January 1. If you haven’t received your membership ID card as of your enrollment effective date, contact the plan and ask about how you can access your medical or prescription drug benefits before you receive your ID card.
Remember, you can only use this [Special Enrollment Period] after December 7 to make a choice for the Fall Open Enrollment Period if the incident period started between August 1 and December 7."
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 2019 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
." [emphasis added]
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
For additional information, please see: "Medicare rules in a disaster or emergency area"