How to Help Your Clients Using a Medicare Special Enrollment Period

Here’s what you need to know about SEPs. 
medicare special enrollment period
1 Feb 2020

How to Help Your Clients Using a Medicare Special Enrollment Period

When something comes up during a predesignated enrollment period like OEP or AEP, like a natural disaster or change of residence, how do you help your clients get the coverage they need? In these cases, beneficiaries can use a Medicare Special Enrollment Period (SEP).

Here’s what you need to know about SEPs. 

What’s a SEP?

SEPs are Special Enrollment Periods that are simply a designated amount of time during which beneficiaries can make coverage selections or changes based on certain types of extenuating circumstances. 

The Centers for Medicare and Medicaid Services (CMS) has the power to designate SEPs to ensure every beneficiary has the opportunity to secure the coverage they need.

Who can use a SEP?

There are many reasons a beneficiary may qualify for a SEP. Two of the most common are enduring a natural disaster or moving house.

SEPs for weather or natural disasters come into play when the Federal Emergency Management Agency (FEMA) officially declares an area having been affected by a major disaster. This includes extreme rain and flooding events, hurricanes, tornadoes, wildfires, man-made environmental catastrophe and more.

If a beneficiary has voluntarily changed their residence, they also may need or want to use an SEP. Not every Medicare plan has coverage in every area, so if a client moves out of their plan’s coverage area, they have the right to select a new plan.

In some cases, your clients’ coverage won’t be impacted by a move, because they’re still within the coverage area of their existing plan. But any time a beneficiary moves they should review their coverage options. There’s always a chance they may have moved into a coverage area for an even better Medicare plan than the one they currently have. Altering coverage for this reason is completely acceptable under the SEP.

How long are SEPs? 

SEPs vary based on the circumstances. When beneficiaries move, they have two months to make changes to their coverage. In the case of a FEMA-designated natural disaster, beneficiaries have four months from the first day of the disaster to make changes to their coverage. 

Please note the length of SEPs can be extended if needed. The SEP for Hurricane Katrina, for example, was in place from the day the storm made landfall on August 25, 2005 to December 31, 2006. That particular SEP ended up lasting more than 16 months.

What can be changed during a SEP?

During a SEP, beneficiaries can enroll in, disenroll from or switch Medicare health or prescription drug plan. Essentially, you can add, update, change or drop both medical and prescription drug coverage during the SEP period.

No matter how your clients choose to change (or not change) their coverage, use this time to your advantage and reevaluate their needs. The next enrollment period may be many months away, and the SEP is a great time to reconsider and match them with a plan best suited to their circumstances.

How do I prove my client is eligible?

Fortunately, with a FEMA-designated natural disaster, your client doesn’t need to provide proof of living in an affected area. In some cases, their documents have been lost or destroyed.

If your clients do have proof readily available, they are welcome to supply you with those documents, should the need arise. Providing such documents is completely at the discretion of the beneficiary.

Clients who have moved may need to provide proof they qualify for the SEP, depending on which plan they choose. Prepare them to provide documents like their voter registration card, driver’s license, tax records or recent utility bills, if needed. They may also need to supply documents demonstrating they’ve lived outside the new plan’s service area for more than six months.

SEPs are often granted to beneficiaries during times of transition, whether planned or forced. During these times, your clients are being pulled in many different directions and considering their Medicare coverage options is often the last thing they want to think about. Let them know you’re on their side and you’re here to help.

To truly help your clients, you have to first help yourself. The team at Financial Grade is available to answer your questions, provide tools and help you navigate a SEP. Contact us today!


image credit: shutterstock/Rob Marmion