Important: Disaster/Emergency SEP Changes Withdrawal

Important: Disaster/Emergency SEP Changes Withdrawal

As of March 20, 2025, CMS announced a withdrawal of the December 3, 2024, HPMS memo entitled "Change to Beneficiary Use of the SEP for Individuals Affected by a Government Entity-Declared Disaster or other emergency." That memo announced a change to how beneficiaries can make an election using the Special Election Period for Individuals Affected by a Government Entity-Declared Disaster or Other Emergency (Disaster/Emergency SEP) by requiring that they contact 1-800-MEDICARE to access the disaster/emergency SEP effective April 1, 2025.

With this withdrawal, the proposed change in process will no longer go into effect on April 1, 2025. Plans should continue to accept applications using the Disaster/Emergency SEP and may continue to use enrollment forms and plan materials that include the Disaster/Emergency SEP.

What you need to know:

• Carriers can still use Emergency Disaster SEPs and do not need to send to CMS.
• CMS is rolling back direction to send all Emergency SEPs to them for processing.
• CMS may send more guidance in the future to fine-tune the process for Emergency SEPs.
• If you have questions, please reach out to your Broker Channel Manager for assistance.

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REMINDER:

An individual is eligible for this SEP provided the individual meets ALL 3 of the following:

1. Resides, at the start of the SEP eligibility period, in an area for which a government entity has declared an emergency or major disaster, or relies on help making healthcare decisions from an individual who resides in an affected area

2. Was eligible for another election period at the time of the SEP eligibility period, and

3. Did not make an election during that other election period due to the emergency or major disaster.

A declaration of a disaster at the county, state, or federal level does not, by itself, allow an individual to make use of this Special Election Period. Molina would like to remind you that to be eligible for this SEP, the individual must have been eligible for another election period during the disaster/emergency AND have missed that election period because of the effects of the disaster/emergency.

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