New Medicare FEMA SEP Rules
Ed Crowe
By Ed CroweÂ
In some cases, Medicare beneficiaries miss an enrollment period due to a FEMA emergency. When this happens, beneficiaries may be eligible for a DST SEP. It is imperative that agents are aware of the New Medicare FEMA SEP rules to assist clients. The DST SEP is available to qualified individuals who miss an opportunity to enroll in a Medicare plan.
Medicare FEMA SEPÂ Â
The DST SEP is an enrollment opportunity CMS offers to Medicare beneficiaries affected by either weather-related emergencies or major disasters. The FEMA SEP lets those who miss a valid election period to either enroll in or disenroll from a Medicare plan. The enrollment takes effect the first day of the month after application is submitted.
This is only available in areas where FEMA, state or other local government officials declare an emergency or disaster. FEMA emergencies start when the incident occurs and lasts for two months up to one year after the start or the extension period begins.
Important changes the the FEMA SEPÂ
On December 3, 2024, CMS released a memo that announced changes to the DST election. These changes go into effect as of April 1, 2025.
If a beneficiary needs to submit an application using the DST election period either on or after April 1, 2025, the application must be submitted directly through CMS. Beneficiaries can call 1-800-MEDICARE or TTY 1-877-486-2048 to submit an application.
In other words, CMS will not accept applications that use the DST election even if they are broker assisted.
Any enrollment application that uses this election will be labeled as using an invalid election period. The plan will then attempt to contact the enrollee and obtain a valid election period. If the plan cannot verify a valid election period, the application will be denied.
Important: missing or invalid elections do not trigger the (RFI) Request for Information process. Therefore, beneficiaries do not have additional time to respond to the inquiry or correct their election.
Please note; applications and disenrollment forms will be updated to remove the DST election.
Reasons to use this SEP
There are varied opportunities to use the SEP. This ensures individuals have the coverage they need.
If the beneficiary resides where a natural disaster (earthquake, flood, wildfire, hurricane, tornado or other specific incident) resulting in a missed valid enrollment period. Sometimes disasters cause beneficiaries to have to leave their home. This may result in them missing their enrollment period and enable the use the FEMA SEP.
The SEP is sometimes available when a beneficiary relies on a family member or other caregiver who is impacted by a disaster and they are unable to assist them during their enrollment period.
Other instances that allow for SEP use include; inability to access Medicare plan information or submit a timely enrollment due to a FEMA declared disaster. Enrollees may also use the SEP when the beneficiary’s healthcare provider of facilities are impacted by the disaster. This can result in the inability to receive necessary information to make an informed decision.Â
Rules for Eligibility for Medicare Disaster SEPÂ Â
In order to use the SEP, the beneficiary must live in the are where the disaster occurred. They must have missed a valid enrollment period (AEP, IEP, OEP) during the time of the incident as long as they did not already make a change during the enrollment period. It is also acceptable for those who need assistance from another person to complete the enrollment or make healthcare decisions.Â
Who cannot use this SEP
Anyone who has already changed their plan during a valid election period can’t use the FEMA election to change it again. Beneficiaries must call 1-800-MEDICARE or TTY 1-877-486-2048 to submit an application in a timely manner to avoid missing their window to enroll.
President at Crowe & Associates
