Disaster/Emergency SEP

[LostDollar]

Caveat, not an agent.
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Bolding is mine-you will have to expand the quote to see all of it:
https://www.cms.gov/About-CMS/Agenc...icareBeneficiaryDisasterEnrollmentQsandAs.pdf

Q. 3. Who qualifies for this special enrollment period?
A. The special opportunity to enroll in, disenroll from or switch Medicare health or
prescription drug plans applies to all individuals who:
• Reside, or resided at the start of the incident period, in an area for which the
Federal Emergency Management Agency (FEMA) has declared an emergency or
a major disaster;
• Had another enrollment period at the time of the incident period (such as the Fall
Open Enrollment Period or other special opportunity); and
• Did not enroll or make a change during that other enrollment period.

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From original post:
Low and behold he calls me last week after some crazy weather ripped through.
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The incident period and the fall open enrollment period do not coincide.

 

[Patrick Flammia]

Caveat, not an agent.
-----------------------------------------------------------------------
Bolding is mine-you will have to expand the quote to see all of it:
https://www.cms.gov/About-CMS/Agenc...icareBeneficiaryDisasterEnrollmentQsandAs.pdf


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From original post:
Low and behold he calls me last week after some crazy weather ripped through.
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The incident period and the fall open enrollment period do not coincide.

Thank you! So this SEP does not apply to him because OEP is only for individuals to switch an MA plan. So since he isn't currently on an MA plan OEP isn't a valid election period for him therefore he can't use the disaster SEP. If this disaster SEP would have been during AEP time though, and he didn't make a change, then it would be valid?

 

[LostDollar]

Reread my next question, what would be the reason for a disaster SEP between OEP and AEP? Or is there no such thing. Obviously this isn't that time, but again hypothetically speaking.

My non-agent comment would be:

CMS and Insurance Carriers do not control the weather.

Medicare Beneficiaries as a group have a kaleidoscope of enrollment periods beyond AEP.

A FEMA declared weather disaster provides a POSSIBILITY for SOME Medicare Beneficiaries to use a SEP to change coverage.

 

[Patrick Flammia]

My non-agent comment would be:

CMS and Insurance Carriers do not control the weather.

Medicare Beneficiaries as a group have a kaleidoscope of enrollment periods beyond AEP.

A FEMA declared weather disaster provides a POSSIBILITY for SOME Medicare Beneficiaries to use a SEP to change coverage.

I appreciate your input

 

[TwoCents]

Thank you! So this SEP does not apply to him because OEP is only for individuals to switch an MA plan. So since he isn't currently on an MA plan OEP isn't a valid election period for him therefore he can't use the disaster SEP. If this disaster SEP would have been during AEP time though, and he didn't make a change, then it would be valid?

I mean if the disaster actually prevented him from switching plans during AEP, then sure. So let's say Franklin County Wherever was listed as being in the disaster area. Client lives in Whoville which really didn't see much of anything. If the client only "missed" AEP because he didn't consider changing plans, then I wouldn't feel comfortable using the disaster SEP, but your moral mileage may vary.

And yes, what you wrote about the MA-OEP election is true. Client doesn't qualify for MA-OEP (which this is the last day of as I write this on 3/31/22 so not sure how he "missed" it anyway) so can't ever use the disaster SEP to begin with.

 

[vic120]

I mean if the disaster actually prevented him from switching plans during AEP, then sure. So let's say Franklin County Wherever was listed as being in the disaster area. Client lives in Whoville which really didn't see much of anything. If the client only "missed" AEP because he didn't consider changing plans, then I wouldn't feel comfortable using the disaster SEP, but your moral mileage may vary.

And yes, what you wrote about the MA-OEP election is true. Client doesn't qualify for MA-OEP (which this is the last day of as I write this on 3/31/22 so not sure how he "missed" it anyway) so can't ever use the disaster SEP to begin with.

I don't believe the disaster actually prevented anyone from switching plans during any enrolment period so I don't think that is the issue

The thing is when does the SEP apply

So whenever it applies to OEP only or both AEP and OEP is what matters, Not just for OP but for any who needs a SEP who wants to know

I could be wrong but I believe its OEP only and not all carriers will apply

 

[somarco]

Last Dollar for the win?

 

[vic120]

Last Dollar for the win?

Yes

 

[LostDollar]

TwoCents for the win for identifying and succinctly stating the core issue.

 

[DonP]

The code works . Saw a woman 2 weeks ago with Medicare only . I told her i couldn’t help her until aep . Then I saw this code and went back out there yesterday.A phone rep had already called her and signed her up . She had her card . He put her in crummy plan . We cancelled the app and I rewrote her . All these disaster sep’s are bs . It’s like mapd is a yr round enrollment now . Because Of the incredible money for CO’s there spending crazy money on marketing $’s to agents and Fmo’s .