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Is there a Special Enrollment Period for Medicare beneficiaries affected by natural disasters like a hurricane, wildfire, flood, earthquake, or COVID-19?


Yes.  If you live in an area where a federal, state, or local government entity (such as 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 date the declaration is made, the incident start date or, if different, the start date identified in the declaration, whichever is earlier. "

The Special Enrollment Period "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."

During the "Government Entity-Declared Disaster or Other Emergency" SEP (previously known as 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.

Please refer to your local or state government website regarding declared disasters or you can refer to the:
  • Centers for Medicare and Medicaid Services (CMS) "Current non-Covid emergencies" (https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/current-non-covid-emergencies) or
  • CMS "Current emergencies" (https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page) or
  • CMS "Ongoing emergencies & disasters" (https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Ongoing-emergencies) or
  • FEMA website to see the date of when a specific disaster was declared: https://www.fema.gov/disasters.
To learn more about using this Special Enrollment Period, please call a Medicare representative at: 1-800-633-4227 (TTY 1-877-486-2048).


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 continued only through June 30, 2020.   However, with the January 1, 2021 changes to the Medicare enrollment guidance, this COVID-19 SEP may extend longer. 

As noted by CMS: "As the Centers for Medicare & Medicaid Services (CMS) is working to identify policies and procedures we can put in place to help partners who are responding to the COVID-19 pandemic, 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 . . .."

You can click here to read more about the COVID-19 SEP:  https://Q1News.com/821.html.


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 a government entity 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 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."


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 natural 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)."


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

You can join a Medicare plan using the 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 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:

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, August 12, 2020), Section 30.3.8 (p.40) 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

https://www.cms.gov/files/document/special-enrollment-period-sep-individuals-affected-fema-declared-weather-related-or-other-major.pdf





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