The Centers for Medicare & Medicaid Services (CMS) are limiting the availability of the Special Election Period (SEP) for Individuals Affected by a Government Entity-Declared Disaster or Other Emergency in response to a number of beneficiaries misusing it to enroll in coverage.
Effective April 1, 2025, beneficiaries wishing to enroll in Medicare coverage using the SEP must follow a new process.
Make sure your clients are aware of this change and know how to proceed moving forward.
What Is the Disaster/Emergency SEP?
The disaster/emergency SEP is an enrollment period designated for beneficiaries who have been affected by a local, state, or federal state of emergency and missed their enrollment period. Beneficiaries who qualify can use this SEP to elect coverage for the first time, disenroll from their plan, or make changes. This SEP is active for the duration of the state of emergency and two months following the disaster or emergency.
To use this SEP, beneficiaries must have resided in the affected area or must rely on someone, for help with health care decisions, who resided in the affected area around the time of the incident. Additionally, the individual must have been eligible for another valid election period, but missed using it, around the time of the incident.
What Is Changing?
As of April 1, 2025, agents and clients can no longer select the disaster/emergency SEP when enrolling or changing coverage online or by paper application.
Instead, clients affected by a state of emergency will need to call 1-800-MEDICARE (TTY: 1-877-486-2048) to make changes, enroll, or disenroll from a plan. A representative will walk them through prompts to verify the SEP qualification and make their enrollment election.
Carriers will no longer accept agent and client applications using the disaster/emergency SEP. If submitted with this SEP selected, the application will be marked as incomplete and denied. Luckily, the SEP will not be listed as an available option when sending in an application after April 1, 2025, and CMS has recommended carriers remove the SEP as an option prior to this date.
Why Is CMS Making This Change?
CMS mentions in their memo that, “This change is in response to concerns that have been raised by plans about the misuse of the Disaster/Emergency SEP to enroll beneficiaries who were not affected by a declared disaster/emergency.” With this transition in enrollment process, CMS aims to verify identity and eligibility for the SEP to enforce compliance.
Note: We were unable to find any data about the estimated number of enrollments processed that did not qualify for the SEP.
Using Other Medicare SEPs to Generate Business
If your clients are eligible for other SEPs, you may continue to assist them with an online or paper application using other SEPs. Check out Medicare.gov to understand significant life changes that could result in an SEP.
We will continue to monitor and report on upcoming changes from CMS. Remember, Ritter is here to answer your questions and provide solutions! Reach out to our sales team for support with questions surrounding this SEP change. If you’re not already, register on RitterIM.com for free today!
Not affiliated with or endorsed by Medicare or any government agency.
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