Clarification on SEP Notice for Individuals Affected by Severe Storms

Clarification on SEP Notice for Individuals Affected by Severe Storms, Flooding, Straight-line Winds, Landslides, Mudslides, and Tornadoes.


The SEP is available to those who resided in the affected areas or who rely on help making healthcare decisions from someone who lived in the affected area and had another election period available during the incident period.

Attention: Medicare Agents Licensed in Washington, Mississippi, California, Alabama, Nebraska, & Iowa

CMS will provide a Special Enrollment Period (SEP) for individuals affected by severe storms, flooding, straight-line winds, and tornadoes who need to enroll in, disenroll from or switch Medicare health or prescription drug plans and have missed another enrollment period (i.e., either aging in or a SEP) due to the weather event.  This opportunity will be available in areas for which the Federal Emergency Management Agency (FEMA) has declared an emergency or major disaster, and FEMA has determined they are eligible for Public or Individual assistance.  For those beneficiaries who qualify, the SEP began on the first day of the incident period and runs for four (4) full months from the beginning of the incident period.

Who qualifies for this special enrollment period?
This applies to individuals who:

  • 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; and
  • Had another valid election period at any time during the incident period; and
  • Did not make an election during that other valid election period.

In addition, the SEP is available to those individuals who don’t live in the affected areas but rely on help making healthcare decisions from friends or family members who live in the affected areas. Please note:  Affected counties can change on a regular basis.  Below is the list of eligible counties as of the date of this communication.

Washington – Incident Period Began on December 10, 2018, and ended on December 24, 2018 (SEP End Date – April 30, 2019) 
Clallam, Grays Harbor, Island, Jefferson, Mason, Pacific, Snohomish, Whatcom

Mississippi – Incident Period Began on December 27, 2018, and ended on December 28, 2018 (SEP End Date – April 30, 2019)
Clarke, Covington, Forrest, Greene, Jasper, Jones, Marion, Newton, Noxubee, Perry, Wayne

California – Incident Period Began on February 14, 2019, and ended on February 15, 2019 (SEP End Date – June 30, 2019)
La Jolla Indian Reservation

California – Incident Period Began and ended on February 14, 2019 (SEP End Date – June 30, 2019)
Cahuilla Indian Reservation

Alabama – Incident Period Began and ended on March 3, 2019 (SEP End Date – July 31, 2019)
Lee

Nebraska – Incident Period Began on March 9, 2019, with no end date as of 4/8/2019 (SEP End Date – July 31, 2019) Check FEMA Link below for an update on the end date
Adams, Antelope, Blaine, Boone, Box Butte, Boyd, Brown, Buffalo, Burt, Butler, Cass, Cedar, Cherry, Colfax, Cuming, Custer, Dakota, Dixon, Dodge, Douglas, Fillmore, Frontier, Furnas, Gage, Garfield, Gosper, Greeley, Hall, Harlan, Holt, Howard, Jefferson, Johnson, Keya Paha, Knox, Lancaster, Lincoln, Logan, Loup, Madison, Merrick, Morrill, Nance, Nemaha, Nuckolls, Omaha Indian Reservation, Otoe, Pawnee, Pierce, Platte, Ponca (TDSA), Richardson, Rock, Sac and Fox Indian Reservation (Also KS), Saline, Santee Indian Reservation, Sarpy, Saunders, Scotts Bluff, Seward, Sherman, Stanton, Thayer, Thurston, Valley, Washington, Wayne, Wheeler, Winnebago Indian Reservation, York

Iowa – Incident Period Began and ended on March 12, 2019 (SEP End Date – July 31, 2019)
Adair, Allamakee, Audubon, Boone, Bremer, Buena Vista, Butler, Calhoun, Carroll, Cass, Cherokee, Clay, Crawford, Dallas, Decatur, Dickinson, Emmet, Fayette, Franklin, Fremont, Greene, Guthrie, Hamilton, Hancock, Hardin, Harrison, Howard, Humboldt, Ida, Iowa, Jasper, Kossuth, Lyon, Madison, Mahaska, Marshall, Mills, Monona, Montgomery, O’Brien, Osceola, Page, Plymouth, Pocahontas, Polk, Pottawattamie, Sac, Shelby, Sioux, Tama, Union, Webster, Winnebago, Winneshiek, Woodbury, Wright

What Does This Mean to Agents

If an individual wants to enroll and believes they may qualify for this SEP, agents should:

  • Ask the beneficiary if they can show proof that they lived/live in an impacted area at the start of the incident period.
  • If they do not have proof, ask them to verbally attest.
  • Confirm that they had another election period available during the time of the incident period.
  • Confirm that the beneficiary lived in a county that has been declared an emergency or major disaster and FEMA has determined is eligible for Public or Individual assistance. Once eligibility has been verified, proceed with the application.
  • On applications, use election code SEP DST.

Enrollments made pursuant to this SEP are effective the first of the month following the receipt of the enrollment request. For enrollment requests where more than one enrollment effective date is possible, agents will need to determine the applicant’s desired effective date.

Reminder: These SEPs are only available to beneficiaries who were affected during the incident period and should not be used as a tool to generate new enrollments.

For any updates to eligible counties please refer to the FEMA website at: https://www.fema.gov/disasters


Questions? Call us at (855) 888-8326.

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