Special Enrollment Period Available to Beneficiaries Affected by the COVID-19 Pandemic

The Centers for Medicare and Medicaid Services (CMS) announced that Medicare beneficiaries affected by the COVID-19 (Coronavirus) Pandemic (which was declared by the President of the United States on March 13th) will be eligible for a Special Enrollment Period (SEP) to switch, disenroll from or enroll in a Medicare Advantage plan or a Medicare Prescription Drug plan. This SEP will run through July 1st, 2020.

Those affected by COVID-19 are:

  • Beneficiary has been diagnosed with COVID-19 or are experiencing symptoms of COVID-19 and are seeking a medical diagnosis
  • A member of beneficiary’s household has been diagnosed with COVID-19
  • Beneficiary is providing care for a family member or a member of their household who has been diagnosed with COVID-19

Who is eligible?

Any beneficiary who resides in, or resided in, the 50 United States or the District of Columbia, where the Federal Emergency Management Agency (FEMA) has declared an emergency or major disaster is eligible for the SEP.

Beneficiaries who were unable to enroll in or dis-enroll from a plan during another qualifying election period OR beneficiaries who receive decision making assistance from someone affected by COVID-19, also qualify for this SEP.

More specifically, beneficiaries are eligible who:

  • Were unable to take advantage of the final month of OEP
  • Aged in and missed their enrollment window
  • Moved from one county or state to another location
  • Had a change in their Medi-Cal or LIS status
  • Lost their employee group coverage
  • Were prevented from enrollments during any other qualifying SEP opportunity
  • Additional scenarios for eligibility could apply

Agent action:

  • If a beneficiary contacts you as a result of this SEP, you may help them enroll in one of our plans and earn a commission. You must:
  • Once you verify eligibility, you can proceed with the application
  • No burden of proof will be placed upon the beneficiary during this SEP
  • Use the SEP election box on the application that includes: “I was affected by a Weather Related Emergency or Major Disaster.”

Reminder:

  • This SEP is only available to beneficiaries and their decision makers who were affected during the incident period and should not be used as a tool to generate new enrollments.
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