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Is there a Special Enrollment Period for Medicare beneficiaries affected by a major disaster like a hurricane, wildfire, flood, or earthquake?


Yes.  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 plan coverage.

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/disasters


The Major Disaster SEP and the coronavirus / COVID-19 Pandemic

In 2020, the Centers for Medicare and Medicaid Services (CMS) announced that people who were unable to change their Medicare Part D drug plan or Medicare Advantage plan enrollment due to the COVID-19 pandemic, can use the Major Disaster Special Enrollment Period (SEP) to join or change a 2020 Medicare plan.  The SEP began in March 2020 and continues only through June 30, 2020.   You can click here to read more about the COVID-19 SEP:  https://Q1News.com/821.html.


Using 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."


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. The SEP is available from the start of the incident period and for four full calendar months thereafter." [emphasis added]"


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).


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 agent or by calling the Medicare plan's enrollment number directly.

If you cannot find the 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  or paper application form, you may see an Enrollment Period option on the Medicare plan enrollment application that may read something like this:

"I was affected by a weather-related emergency or major disaster (as declared by the Federal Emergency Management Agency (FEMA).  One of the other statements here applied to me but I was unable to make my enrollment because of the natural 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.


Where can I find an official reference to this Natural Disaster SEP?

As noted by CMS, "the exceptional conditions Special Enrollment Period (SEP) was 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 [Natural Disaster]".

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."


Sources include:

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

https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/8-9-natural-disaster-SEP.pdf

https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/Downloads/Disaster_SEP_QAs_for_Beneficiaries.pdf

For additional information, please see: "Medicare rules in a disaster or emergency area"
https://www.medicare.gov/what-medicare-covers/medicare-rules-in-a-disaster-or-emergency-area





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