The Centers for Medicare & Medicaid Services (CMS) clarified yesterday that the Special Enrollment Period (SEP) 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 due to the COVID-19 pandemic and meet the terms of the SEP listed below.
Who’s eligible for this SEP?
What you need to know
- This SEP is available nationwide to residents of all states, tribes, territories, and the District of Columbia effective March 1, 2020.
- This declaration does not mean that all Medicare beneficiaries get an SEP. To be eligible, beneficiaries must meet criteria outlined below. All other rules apply.
- For those who qualify, the SEP opportunity will run through June 30, 2020.
- Remember, you cannot proactively market this SEP opportunity to beneficiaries. However, we can assist any clients who contact us about this SEP.
Individuals will be considered “affected” by 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 the incident period; and
- Did not make an election during that other valid election period.
In addition, the SEP is available to those individuals who do not live in the affected areas but rely on help making healthcare decisions from friends or family members who live in the affected areas. Beneficiaries will not be expected to provide proof that they were affected by the pandemic-related emergency.
Contact Total Benefit Solutions Inc at (215)355-2121 if you have any additional questions or concerns about this notice.