Additional SEP Opportunity for Those Affected by Natural Disasters

Extended SEP Deadlines

The Centers for Medicare & Medicaid Services (CMS) is providing additional opportunities to join, drop or switch Medicare plans for people affected by the hurricanes in Puerto Rico, U.S. Virgin Islands, and the wildfires in California.

Beneficiaries affected by the hurricanes in Puerto Rico and the U.S. Virgin Islands are eligible for a special enrollment period (SEP) through March 31, 2018. This SEP is providing individuals with an additional opportunity to add, drop or change their Medicare plans. Individuals will be considered eligible for this SEP if they reside, or resided at the start of the incident period, in Puerto Rico or the U.S. Virgin Islands. This SEP can be used, even if the person made a choice or change during Medicare’s fall open enrollment period.

Also, beneficiaries who change their permanent residence, rather than temporarily relocate, and no longer reside in their Medicare Advantage or prescription drug plan service area are eligible to join a new Medicare Advantage or prescription drug plan offered in their new location. The SEP date begins when the move or the date the individual notifies the plan of the permanent move and last for two months after. Individuals who use either of these SEPs to join a plan in the new area in which they reside, upon their return to Puerto Rico or the U.S. Virgin Islands, would be eligible for this residence change SEP to rejoin their prior Medicare health plan.

CMS is providing beneficiaries affected by the California wildfires an SEP that gives them an additional opportunity through March 31, 2018 to add, drop, or change their plan in the event they were unable to make an election during the fall open enrollment period or another election period they were eligible for. Individuals will be considered “affected” and eligible for this SEP if they reside, or resided at the start of the incident period, in the FEMA declared emergency or major disaster area related to the recent wildfires in California. An individual can use this SEP once for each election period they missed. Thus, individuals who made an election during the annual election period (AEP) cannot use this SEP to make a second AEP election.

Coverage changes using the special enrollment opportunities due to these disasters will be effective the first of the month following the plan’s receipt of the enrollment request. These SEPs are also available to 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. Plan sponsors may ask for proof of residence to determine if an individual resided in an affected area at the start of the incident period, but must accept an attestation if an applicant states that his or her documents were destroyed or are inaccessible.

We note that individuals with End-Stage Renal Disease (ESRD) have additional limitations that do not permit enrollment in another Medicare Advantage organization, even if they are eligible for a SEP. Such individuals should consider their options carefully before using this SEP to leave their current Medicare Advantage plan, as Medicare Fee-for-Service may be their only option. Should a an individual with ESRD leave their current plan then return to Puerto Rico or the U.S. Virgin Islands, he or she would not be eligible to join their prior or another Medicare Advantage plan.

Related links

Medicare Special Enrollment Periods

Missed Open Enrollment? Here’s What You Can Do.

3 Things to Know about Open Enrollment

Up Next...

blog image

Medicare World Blog

CA Residents: Privacy Notice for California Residents |