Molina: Eligibility Requirements for SEP for Govt. Entity-Declared Disaster/Emergency

REMINDER: Eligibility Requirements for SEP for Government Entity-Declared Disaster or Other Emergency

Medicare guidelines: Individuals affected by an emergency or major disaster declared by a federal, state, or local government entity are eligible for a SEP to make a MA enrollment or disenrollment election. The SEP starts as of the date the declaration is made, the incident start date or, if different, the start date identified in the declaration, whichever is earlier, and ends two full calendar months following the end date identified in the declaration or, if different, the date the end of the incident is announced, whichever is later.

An individual is eligible for this SEP provided the individual meets all three 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 of 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.

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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. We remind plans 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

Please note: For the states that declare a state of emergency for the solar eclipse on April 8, CMS does not anticipate that a solar eclipse and the temporary logistical issues are likely to disrupt a beneficiary’s ability to make a Medicare Advantage/Part D election so significantly that they miss an election period and need to make use of the Disaster/Emergency SEP.

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