The Centers for Medicare & Medicaid Services on Tuesday issued a memorandum that clarifies the exceptional conditions that qualify for a special enrollment period (SEP) for individuals affected by a FEMA declared weather related emergency or major disaster.
The agency said that the SEP is applicable and available for beneficiaries who were eligible for, but unable to make, an election because they were affected by the ongoing public health crisis.
Jerry Mulcahy, director of the Medicare Enrollment and Appeals Group for CMS, sent the memo to all Medicare Advantage Organizations, Part D sponsors, and Medicare-Medicaid Plans. The letter states that the SEP is available nationwide to residents of all states, tribes, territories, and the District of Columbia as of March 1 if they were unable to and did not make an election during another valid election period as a result of the emergency. This includes enrollment and disenrollment elections.
CMS considers individuals as “affected” and eligible for this SEP under FEMA 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.
Mulcahy also said the SEP is available to individuals who do not live in the affected areas but rely on help to make health care 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 after the start of the incident period.
Further, an eligible beneficiary will receive one opportunity to make that missed election because of this SEP. Beneficiaries do not have to provide proof that they were affected by the pandemic-related emergency.
Plans should refer to the following sections in posted manual guidance for details on the SEP:
- Section 126.96.36.199 of Chapter 2 (Medicare Advantage Enrollment and Disenrollment) of the Medicare Managed Care Manual.
- Section 188.8.131.52 of Chapter 3 (Eligibility, Enrollment and Disenrollment) of the Medicare Prescription Drug Benefit Manual.
Beneficiary-directed questions and answers for this SEP are available at the following links on CMS.gov and address issues such as eligibility for the SEP and how to enroll:
- Questions and Answers on the Medicare Managed Care Eligibility and Enrollment webpage
- Questions and Answers on the Medicare Prescription Drug Eligibility and Enrollment webpage