Anthem | NY State December SEP
Your Clients May Be Entitled to a Special Election Period
The Centers for Medicare & Medicaid Services (CMS) provides for a Special Election Period (SEP) for beneficiaries impacted by a Federal Emergency Management Agency (FEMA) Emergency or Major Disaster Declaration. This SEP is for Medicare beneficiaries who were prevented from submitting a Medicare Advantage (MA/MAPD) or Prescription Drug (PDP) plan enrollment request during another valid election period due to a declared disaster. This includes both enrollment and disenrollment elections. This SEP applies to beneficiaries who reside in the following NY counties:Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Ulster, Westchesterwho were impacted by Severe Weather.
In addition, the SEP is available to those individuals who do not live in the affected areas but rely on help from friends or family members when making healthcare decisions and those individuals were impacted by the emergency declaration. The SEP is available from the start of the incident period 09/29/2023 and continues through the end of the eligibility period 12/31/2023.
Only those beneficiaries who did not make an election during another eligible enrollment period are eligible for this SEP. An individual can use this SEP one time for each election period they missed.
When there are questions about eligibility, CMS will make the determination. A beneficiary may contact CMS if they want to know all plans in their area for enrollment assistance, or if they have any questions. They can reach CMS by calling 1-800-MEDICARE (1-800-633-4227) anytime, 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. If the beneficiary knows what plan they want to select, they can call the plan or their broker/agent directly to enroll. To review up-to-date information, you may go to the FEMA Disaster Declarations website. This Information is updated at least weekly.
CMS expanded the eligibility guidelines for SEPs effective for any disaster declaration made 1/1/2021 and after. The declaration can come from any level of government – Federal, state or otherwise. Therefore, in addition to the FEMA website, you should also reference any relevant governor executive order and/or state emergency disaster info page for this detail.
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